Citation Nr: 0005057 Decision Date: 02/28/00 Archive Date: 03/07/00 DOCKET NO. 95-14 780 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUE Entitlement to service connection for headaches as secondary to a service-connected fracture of the left mandible. REPRESENTATION Appellant represented by: Military Order of the Purple Heart WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD B. N. Booher, Associate Counsel INTRODUCTION The veteran had active service from December 1945 through October 1947 and from September 1950 through June 1952. This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from a January 1995 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) located in Detroit, Michigan which denied the benefit sought on appeal. In November 1996 and in March 1998 the Board REMANDED this case to the RO for additional development. The case is now ready for appellate review. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The veteran's headaches have not been shown to be causally or etiologically related to the service-connected fracture of his left mandible. CONCLUSION OF LAW Headaches are not proximately due to or the result of a service-connected disease or injury. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. §§ 3.102, 3.303, 3.310 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran contends that he is entitled to service connection for headaches as secondary to a service-connected fracture of the left mandible. A veteran is entitled to service connection for disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a) (1999). The Board must first determine, however, whether the veteran has presented evidence sufficient to justify a belief by a fair and impartial individual that his claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). If a claim involves a question of medical causation, i.e., whether one medical condition is related to another medical condition, competent medical evidence is required to establish a causal nexus. Absent such evidence, the claim must be denied as not well grounded, and VA need not fulfill its duty to assist the veteran in developing the facts pertinent to his claim. Epps v. Gober, 126 F.3d 1464, 1468 (Fed. Cir. 1997); Lathan v. Brown, 7 Vet. App. 359, 365 (1995); Caluza v. Brown, 7 Vet. App. 498, 506 (1995); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Initially, the Board finds the veteran's claim for secondary service connection for headaches "well grounded" within the meaning of 38 U.S.C.A. § 5107, Epps v. Gover, 126 F. 3d 1464, 1468 (1997); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990); Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). That is, the Board finds that the veteran has presented a claim that is plausible when his contentions and the evidence of record are viewed in a light most favorable to the claim. The Board is also satisfied that all relevant facts have been properly and sufficiently developed to the extent possible. The veteran is currently service connected for a fracture of the left mandible as a result of an injury he sustained during service. In support of his claim for secondary service connection, the veteran has submitted treatment records from C.H. Ewing, M.D. dated July 1956 through November 1968. These records reflect that the veteran reported experiencing frontal headaches in the morning for approximately two years. Dr. Ewing did not discuss the etiology of the veteran's headaches. The record also shows that the veteran was hospitalized at the Woman's Hospital in Detroit, Michigan from October 1963 through November 1963 for treatment of a sub endocardial posterior myocardial infarction. During this hospitalization, the veteran gave a history of experiencing occasional frontal headaches of a pounding character. Additional evidence submitted by the veteran in support of his claim includes a December 1994 statement from Kenneth J. Dziuba, M.D. Dr. Dziuba indicated that the veteran had experienced intermittent left-sided headaches since sustaining a jaw fracture in 1946. He went on to state that the veteran had also experienced episodes of sinusitis, but headaches had been present despite treatment for sinusitis. Dr. Dziuba opined that the veteran's headaches may have a remote relationship to the jaw fracture sustained in service. VA outpatient treatment records and records from the Dental Clinic dated September 1988 through June 1995 reveal that the veteran complained of severe headaches in January 1995. The veteran was diagnosed with sinusitis of the left maxillary and hypertension. During a July 1995 hearing held before the RO in Detroit, Michigan, the veteran testified that he believes that his headaches are caused by nerve damage associated with his previous jaw fracture. He indicated that his headaches typically started in his left eye, and were associated with radiating pain into the left side of his face and into his neck. The veteran stated that he has had headaches since being hospitalized in the 1960's for a heart attack. The veteran testified that he had been advised by his dentist that his headaches could be the result of grinding his teeth at night and that his dentist gave him a mouthpiece to wear during his sleep. The veteran was afforded a VA examination in August 1995. At that time, the veteran reported experiencing headaches since 1950 to 1960, with more frequent headaches during the previous four years. The veteran indicated that his headaches persist for several hours and are characterized by intense pain in his left eye. The veteran reported that his private physician had recently prescribed Xanax, which had helped with the frequency and intensity of his headaches. The veteran also indicated that he occasionally had pain in his teeth and had attacks of sinusitis. Physical examination revealed no abnormality. X-rays revealed evidence of sinusitis either acute or chronic in the left maxillary sinus. The veteran was diagnosed with left maxillary sinusitis, probably chronic, hypertension and possible Horton's headaches. The examiner opined that it was not likely that the veteran's headaches were related to sinusitis or to his jaw fracture. Specifically, the examiner indicated that sinusitis would cause facial pain, but not eye pain. It was the examiner's opinion that the veteran's headaches were most likely Horton's headaches and unrelated to either sinusitis or his previous jaw fracture. The veteran underwent a second VA examination April 1997. At that time, the veteran reported experiencing vascular, throbbing and severe headaches approximate two to three times per week. He also indicated that he had a family history of recurrent headaches. Physical examination was entirely normal. A CT scan of the brain and orbits was obtained and was normal. Based on the physical examination and a review of the CT scan, the examiner opined that the veteran's headaches were of a migraine variant and unrelated to and not aggravated by his previous jaw fracture. The examiner also indicated that the veteran's headaches were a familial, genetic trait and not an acquired disability. Treatment records from Dr. Dziuba dated April 1998 through June 1998 show that the veteran reported experiencing headaches and pain in the left eye area. However, the treatment records from Dr. Dziuba do not contain any discussion regarding the possible etiology of the veteran's headaches. In a May 1998 statement from Andrew I. Dzul, M.D. with Lakeshore Ear, Nose, Throat Center, P.C., Dr. Dzul indicated that the veteran had complaints of daily positional vertigo, headaches upon awakening in the morning and nasal congestion. Dr. Dzul diagnosed the veteran with chronic positional vertigo, but did not address the cause of the veteran's headaches. In June 1998, Dr. Dzul confirmed his diagnosis of chronic positional vertigo based on the results of a slightly abnormal neuro-otologic evaluation. An October 1998 treatment record from Eastside Eye Physicians shows that the veteran presented with complaints of seeing floaters and blurry vision. The veteran was diagnosed with floaters, but his headaches were not discussed. The governing law provides that when there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of a claim, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. However, in this case, the record contains one medical opinion indicating a tentative nexus between the veteran's current headaches and his service-connected fracture of the left mandible, and two more thorough opinions indicating that the veteran's headaches are not causally related to his fracture of the left mandible. Thus, the Board finds that the provisions of 38 U.S.C.A. § 5107 are not applicable under the present facts. In this regard, in December 1994, Dr. Dziuba opined that the veteran's headaches "may" have a remote relationship to the jaw fracture sustained in service. Such an opinion is speculative. See Tirpak v. Derwinski, 2 Vet. App. 609 (1992). This opinion also does not contain any additional analysis or discussion of the reasons and bases of Dr. Dziuba's opinion. In August 1995 and April 1997, the veteran was afforded two thorough VA examinations. In August 1995, after taking a history from the veteran, performing a physical examination and reviewing x-ray reports, a VA examiner opined that the veteran's headaches were most likely Horton's headaches and unrelated to either sinusitis or his previous jaw fracture. Likewise, in April 1997, after noting that the veteran has a family history of recurring headaches, performing a physical examination and reviewing a CT scan, a VA examiner opined that the veteran's headaches were of a migraine variant and unrelated to and not aggravated by his previous jaw fracture. The examiner also indicated that the veteran's headaches were a familial, genetic trait and not an acquired disability. The Board finds the August 1995 and April 1997 VA medical opinions more persuasive than Dr. Dziuba's December 1994 opinion, in that the opinions provide a thorough discussion of the veteran's family, and medical history as they relate to the veteran's current headaches and his previous jaw fracture. As such, the Board concludes that the preponderance of the evidence is against the veteran's claim for entitlement to service connection for headaches, to include as secondary to a service-connected fracture of the left mandible, and the appeal is denied. ORDER Service connection for headaches as secondary to a service- connected fracture of the left mandible is denied. RAYMOND F. FERNER Acting Member, Board of Veterans' Appeals