MIGRAINE

BETHANY L. BUCK · 2024 · Case ID: A24077556

DENIED

Summary

The veteran, who served honorably in the U.S. Air Force from March 1978 to August 1990, appeals the denial of service connection for headaches. The veteran contended that his headaches were caused by or aggravated by medication taken for his service-connected insomnia disorder, major depressive disorder, and sleep disturbances. The Board reviewed the evidence, including the veteran's service treatment records (STRs), VA examinations, and treatment notes. The veteran's STRs showed some headache complaints during service, often linked to acute illnesses like sinusitis or eye strain, and a 28-year gap in headache complaints after service until late 2018. The veteran specifically attributed his headaches to Trazodone, a medication for his psychiatric conditions. The Board found the veteran's lay statements regarding medication side effects were not competent to establish medical nexus. The Board reviewed multiple VA medical opinions. The September 2021 opinion was deemed inadequate due to speculative language and failure to address the medication theory. The November 2021 opinion was found to be based on an inaccurate premise regarding the psychiatrist's response to the medication side effect claim. The July 2022 opinion, however, was found probative, concluding that headaches are not a common side effect of Mirtazapine or Trazodone and that objective medical evidence of headache diagnosis or treatment was lacking. This opinion also noted the absence of headache complaints during the January 2020 VA psychiatric examination for the service-connected disorder. The Board found the July 2022 opinion adequate and more probative, concluding the evidence weighed against the claim. Service connection for headaches was denied.

Rationale

Veteran's claim based on medication side effect theory.; STRs show some headache complaints during service, but not continuous.; Veteran's lay opinion on medication side effects not competent.; July 2022 VA opinion found headaches not common side effect of Mirtazapine/Trazodone.; July 2022 VA opinion noted lack of objective headache diagnosis/treatment.; Evidence weighed against claim, denying service connection.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

220808-265711

Full Decision Text

Citation Nr: A24077556
Decision Date: 11/22/24 Archive Date: 11/22/24

DOCKET NO. 220808-265711
DATE: November 22, 2024

ORDER

Entitlement to service connection for headaches due to service-connected insomnia disorder with major depressive disorder and sleep disturbances, including medication treatment, is denied.

FINDING OF FACT

The Veteran's tension headache disability first manifested many years after service and has not been medically related to his service, to include medication for his service connected insomnia disorder with major depressive disorder and sleep disturbances.

CONCLUSION OF LAW

The criteria for entitlement to service connection for headaches due to his service connected insomnia disorder with major depressive disorder and sleep disturbances, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served honorably on active duty in the United States Air Force from March 1978 to August 1990. This matter comes to the Board of Veterans' Appeals (Board) from a July 2022 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

Although the Veteran initially requested Higher-Level Review when submitting the April 2022 VA Form 20-0996, Decision Review Request: Higher-Level Review, the Higher-Level Reviewer determined that there had been a duty to assist error and transferred the claim to the Supplemental Claim decision review option for additional development.

In the August 2022 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the July 2022 agency of original jurisdiction (AOJ) supplemental claim decision on appeal. 38?C.F.R. § 20.301. If evidence was submitted after the AOJ issued the supplemental claim decision on appeal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300,?20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Generally, service connection requires evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 C.F.R. §3.303(a). Shedden v. Principi, 381 F.3d 1163, 1166 - 67 (Fed. Cir. 2004).

Secondary service connection is available if a condition is proximately due to or worsened beyond its natural progression (aggravated) by a service-connected disability. See 38 C.F.R. § 3.310; see also Allen v. Brown, 7 Vet. App. 439 (1995). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310 (b).

Entitlement to service connection for headaches, to include as due to his service connected insomnia disorder with major depressive disorder and sleep disturbances, is denied.

The Veteran expressly contends that his current headache disability is due to medication for his service connected insomnia disorder with major depressive disorder and sleep disturbances (acquired psychiatric disorder). See VBMS document titled, "VA 21-526EZ, Fully Developed Claim (Compensation)," receipt date 08/19/2021. See VBMS document titled, "Correspondence," receipt date 09/28/2021.

The question for the Board is whether the Veteran's current tension headache disability is proximately due to or the result of or is aggravated beyond its natural progress by his service-connected acquired psychiatric disorder or medication treatment thereof.

Evidence

The Veteran was afforded a VA examination in September 2021. The VA examiner diagnosed the Veteran with tension headaches with an onset the date of the examination, September 28, 2021. The examination was in-person and the examiner noted that she reviewed the Veteran's VA e-folder. The examiner noted that on his report of medical history at his entrance examination the Veteran indicated "yes" to history of frequent or severe headaches. The examiner also included 5 entries in the Veteran's service treatment records (STRs) between 1980 and 1990; three instances of headaches, a follow-up visit for eye strain, and a 1984 CT scan of the Veteran's brain which yielded normal results. However, the Veteran told the examiner that his current headaches began when he started taking Trazodone for his service-connected acquired psychiatric disorder in February 2021. The September 2021 examination report also includes the Veteran's statement that he had communicated with his VA treatment provider about the headaches and restated that the headaches are a Trazodone side effect. The September 2021 examination report does not include any statement or indication that the Veteran believes or contends that his current headaches are related to the headaches documented in his STRs or any other service connected disability. See VBMS document titled, "C&P Exam," receipt date 09/28/2021 (DBQ).

The September 2021 VA examiner provided opinions for direct and secondary service connection but not for aggravation. The September 2021 VA examiner opined that the Veteran's tension headache disability is less likely than not due to or the result of the Veteran's acquired psychiatric disorder. Although the examiner listed the relevant evidence from the Veteran's file, the rationale did not include any explanation of the examination findings or the Veteran's medical history relevant to his headaches and his service connected acquired psychiatric disorder. The rationale only refenced general medical literature. See VBMS document titled, "C&P Exam," receipt date 09/28/2021 (opinion).

In November 2021, VA obtained an addendum opinion from a different VA examiner on the theory of aggravation of a preexisting condition. The November 2021 VA examiner conducted a records review and did not otherwise examine the Veteran. The November 2021 VA examiner opined the Veteran's current headache disability is less likely than aggravated by the Veteran's acquired psychiatric disorder and that the Veteran's headache condition "clearly and unmistakably preexisted service," and "was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness," including the Veteran's service connected acquired psychiatric disorder. The rationale is that after reviewing the Veteran's e-file, the examiner concluded that "the Veteran had headaches prior to service." The examiner only referenced the Veteran's report of medical history for entry into service as evidence of pre-service headaches. In addition, the examiner found that "while in service there are few mentions of headaches and those listed are due to eye strain and no mention of insomnia or depression." The examiner only briefly addressed the Veteran's specific contention that the medications used to treat his acquired psychiatric disorder caused the headaches; opining that "there is objective documentation from the physician stating they are not side effects of those meds and based on how long he had been on them it is less likely than not that they were the etiology." The examiner concluded that "based on the lack of objective data it is less likely than not that the Veterans headaches were aggravated by service." See VBMS document titled, "C&P Exam," receipt date 11/22/2021.

Following the May 2022 HLR decision, VA obtained an addendum opinion in July 2022. The July 2022 VA examiner addressed aggravation of a non-service connected condition by a service connected condition. The July 2022 VA examiner opined that the Veteran's current headache disability is less likely than not aggravated by the Veteran's service-connected acquired psychiatric disorder and less likely than not aggravated by the medication of the service-connected acquired psychiatric disorder. The rationale is that, after reviewing the Veteran's medical records, "it appears that the Veteran's headaches preexisted service. He acknowledged a history of frequent or severe headache during his Enlistment Examination performed at the AFEES Charlotte on 1/6/78." The examiner also recalled the Veteran's STRs showing "a complaint of headache during service on 7/14/
. The July 2022 VA examiner addressed aggravation of a non-service connected condition by a service connected condition. The July 2022 VA examiner opined that the Veteran's current headache disability is less likely than not aggravated by the Veteran's service-connected acquired psychiatric disorder and less likely than not aggravated by the medication of the service-connected acquired psychiatric disorder. The rationale is that, after reviewing the Veteran's medical records, "it appears that the Veteran's headaches preexisted service. He acknowledged a history of frequent or severe headache during his Enlistment Examination performed at the AFEES Charlotte on 1/6/78." The examiner also recalled the Veteran's STRs showing "a complaint of headache during service on 7/14/82 in conjunction with possible sinusitis," as well as several entries in the Veteran's VA treatment record where he denied headaches between September 2018 and October 2019. The July 2022 VA examiner further noted that although the September 2021 VA examiner rendered a diagnosis of tension headaches, "no diagnosis of tension headaches was ever seen during a clinical encounter," and "no medication was indicated for the condition." The July 2022 VA examiner then explained that if the Veteran's headaches were "aggravated beyond natural progression, it would be anticipated that some of the aforementioned parameters would be remarkable." The examiner then pointed to the Veteran's VA treatment records where the Veteran "thought he was having headaches secondary to mirtazapine and then to trazodone," but that the VA physician disagreed that the headaches were a side effect of mirtazapine. The July 2022 VA examiner explained that pursuant to her research, "headaches are not a common side effect of mirtazapine or trazodone," and that the "Sections III and V were silent for headaches attributable to his mental health diagnoses per the Veteran's [January 2020 VA examination for] Mental Disorders (other than PTSD and Eating Disorders)." See VBMS document titled, "C&P Exam," receipt date 07/07/2022 (opinion).

The Veteran is service connected for insomnia disorder with major depressive disorder and sleep disturbances. In January 2020 the Veteran was afforded a VA examination for his acquired psychiatric disorder. The January 2020 VA examiner diagnosed the Veteran with insomnia with onset prior to 2016 and with major depressive disorder with onset two to three years after the insomnia. The January 2020 medical nexus opinion concluded that the Veteran's insomnia disorder is due to his service connected tinnitus and that his major depressive disorder is due to his insomnia disorder. The January 2020 VA examination report is totally silent for any mention, complaints, or reports of headaches, to include as a symptom or due to insomnia disorder or major depressive disorder. See VBMS document titled, "C&P Exam," receipt date 01/10/2020.

The Veteran is also service connected for eye conditions including chronic dry eyes syndrome and bilateral cataracts with vitreous floaters and photophobia. The Veteran was afforded VA examinations for his service connected eye conditions in April 2020, March 2021, October 2021, December 2021, and March 2022. All corresponding examination reports are totally silent for mention, complaints, or reports of headaches, to include as a symptom or due to chronic dry eyes, bilateral cataracts, or photophobia. See VBMS documents titled, "C&P Exams," receipt dates 04/02/2020, 03/10/2020, 10/01/2021, 12/07/2021, and 03/05/2022.

The Veteran's VA treatment records reveal that he began receiving VA treatment in October 2016. VA treatment records are totally silent for any headache diagnosis, to include tension headaches, and there were no complaints of headaches until a November 2018 follow-up examination for hypertension, GERD, and back pain when the Veteran endorsed occasional headaches without any other description or relation to medications or other disabilities. The Veteran expressly denied headaches in June 2019, July 2019, and four times in August 2019 treatment notes. The next record of headache was in September 2019 when the Veteran reported nausea and headache due to tinnitus, the Veteran stated that "it wasn't the first time that this has happening or this length of time (sic)," and that "I'm noticing that it's worse when I'm really stressed." The Veteran endorsed headaches due to lightheadedness during an October 2019 audiology consultation. The Veteran did not complain of headaches again until a September 2020 direct message to his VA psychiatrist. The Veteran stated that "I'm having headaches more often than I used to," and wondered whether his Mirtazapine medication is causing headaches. His VA psychiatrist replied that because the Veteran has been taking
2019 treatment notes. The next record of headache was in September 2019 when the Veteran reported nausea and headache due to tinnitus, the Veteran stated that "it wasn't the first time that this has happening or this length of time (sic)," and that "I'm noticing that it's worse when I'm really stressed." The Veteran endorsed headaches due to lightheadedness during an October 2019 audiology consultation. The Veteran did not complain of headaches again until a September 2020 direct message to his VA psychiatrist. The Veteran stated that "I'm having headaches more often than I used to," and wondered whether his Mirtazapine medication is causing headaches. His VA psychiatrist replied that because the Veteran has been taking Mirtazapine for six months and because he is taking a number of other medications, it makes it "difficult to know what medication, if at all, is the cause" of the Veteran's headaches. The psychiatrist added that "it is also possible that the headaches may not be related to a medication." The psychiatrist "did not find [headaches] as side effect of Mirtazapine," reiterated that he had previously offered alternate medications to Mirtazapine but that the Veteran elected to continue the medication. The VA psychiatrist also referred the Veteran to his primary care provider if he continued to have headaches. The Veteran's VA treatment records do not include any complaints or reports of headaches to the Veteran's primary care provider following the September 2020 psychiatrist's message. See VBMS document titled, "CAPRI," receipt date 03/26/2021, pages 287, 288, 422, 448, 463, 467, 471, 475, 479, 488, 514, 611 of 616.

VA treatment records show that the Veteran began taking Trazodone in January 2021. Then in a February 2021 direct message to his psychiatrist, the Veteran reported that he had recently notice "louder" ringing in his ears and headaches "since I started taking Trazodone," but added that he did not want to switch medications because he believed that the Trazodone helped him sleep. The psychiatrist replied and offered to schedule therapy sessions to assist the Veteran with his symptoms of depression but did not respond to the Veteran's opinion that the Trazodone is causing his headaches. Id. at 10 of 616.

The Veteran's STRs include his entrance examination with corresponding report of pre-service medical history and three in-service reports of headaches. On the January 1978 report of medical history for entry into service, the Veteran indicated "yes" to history of frequent or severe headaches but did not include any explanation. The Board notes that the Veteran had first indicated "no" but scratched it out and indicated "yes" and added his initials next to his correction. However, the entrance examination is silent for diagnosis or other notation of headaches. The entrance examiner notes bilateral pes planus under summary of defects and diagnoses on the examination report but nothing else. See VBMS document titled, "STR-Medical," receipt date 07/25/2017, pages 2, 4, 6, 39 of 104; see also VBMS document titled, "STR-Medical," receipt date 07/25/2017, page18 of 84.

The STRs also include a July 1982 report of headache, chills, and stomach pains under a provisional diagnosis of sinusitis; a February 1990 report of headache, body aches, and fever under a diagnosis of "viral syndrome;" and a June 1990 complaint of headache in relation to photophobia. The STRs are silent for tension headaches, prostrating headaches, or any other complaints of headaches. Id.

The Veteran's record also includes lay statements. The Veteran filed his initial claim for entitlement to service connection for headaches in August 2021 and included a description stating, "the medication trazodone, used to treat my service connected insomnia disorder and major depressive disorder with sleep disturbances causes me to have headaches." See VBMS document titled, "VA 21-526EZ, Fully Developed Claim (Compensation)," receipt date 08/19/2021. Then, in a September 2021 lay statement from the Veteran, he wrote, "Correspondence between my provider [ redacted ] and myself concerning headaches caused by the medication used to treat my service connected Insomnia Disorder And Major Depressive Disorder With Sleep Disturbances can be found in a secure message dated 02/14/2021." See VBMS document titled, "Correspondence," receipt date 09/28/2021.

Analysis

The Board concludes that, while the Veteran has a current headache disability, the evidence of record persuasively weighs against finding that the Veteran's
document titled, "VA 21-526EZ, Fully Developed Claim (Compensation)," receipt date 08/19/2021. Then, in a September 2021 lay statement from the Veteran, he wrote, "Correspondence between my provider [ redacted ] and myself concerning headaches caused by the medication used to treat my service connected Insomnia Disorder And Major Depressive Disorder With Sleep Disturbances can be found in a secure message dated 02/14/2021." See VBMS document titled, "Correspondence," receipt date 09/28/2021.

Analysis

The Board concludes that, while the Veteran has a current headache disability, the evidence of record persuasively weighs against finding that the Veteran's tension headache disability is proximately due to or the result of or aggravated beyond its natural progression by the Veteran's service-connected acquired psychiatric disorder to include medication treatment. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a).

In the July 2022 rating decision on appeal, the AOJ made favorable findings including in-service complaints of headaches in July 1982 and February 1990; a current diagnosis of tension headaches; and that the claimed primary disability of insomnia disorder with major depressive disorder and sleep disturbances (acquired psychiatric disorder) is service connected. The Board is bound by these favorable findings. 38 C.F.R. § 3.104(c).

The Board finds that the Veteran has not asserted any claim for entitlement to service connection for headaches on a direct basis and has specifically said he is not seeking direct service connection. The Veteran has expressly asserted only one theory of entitlement, that his current headache disability is due to medication treatment for his service connected acquired psychiatric disorder. In addition, the Board has thoroughly reviewed the record and although the Veteran's STRs include three complaints of headaches between 1978 and 1990, the July 1982 and February 1990 complaints were in relation to acute illnesses (sinusitis and viral syndrome) and the June 1990 complaint was in relation to photophobia, for which the Board acknowledges that the Veteran is service connected. The STRs are silent for tension headaches, no examiner had opined that his current tension headache disability is related to headaches experienced during service, and there is no evidence otherwise linking the Veteran's current headache disability to his headaches experienced during service.

The Veteran has not asserted that his in-service headaches continued after service and there is no indication in the evidence of record that the Veteran experienced any continuous headache disability from the date of separation in August 1990 until the November 2018 VA treatment report of occasional headaches, to include as due to photophobia or any other service connected disability. This constitutes a 28 year gap in the Veteran's complaints or reports of experiencing headaches. Thus the Board finds that there is no continuity of symptomatology of a chronic disability.

The Veteran believes the claimed headache disability is proximately due to or the result of or aggravated beyond its natural progression by Trazodone mediation treatment for his service-connected acquired psychiatric disorder. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between pharmaceuticals and multiple organ systems in the body. Therefore, it is outside the competence of the Veteran in this case because the record does not show that the Veteran has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).

The Board finds that the September 2021 VA opinion is inadequate as to secondary service connection because it does not include facts specific to the Veteran's conditions and uses speculative language such as "may be more likely." See Stefl v. Nicholson, 21 Vet.App. 120, 124-25 (2007) (the Board may reject a medical opinion that is conclusory and lacks supporting analysis). See also McLendon v. Nicholson, 20 Vet.App. 79, 85 (2006) (stating that speculative medical opinion as to causation cannot establish medical nexus to service). In addition, the opinion does not address the Veteran's specific contention that his headaches are due to his medication treatment for his service connected acquired psychiatric disorder. Because the September 2021 opinion uses speculative language, fails to apply facts specific to the Veteran's claim, and fails to address the Veteran's specific theory of service connection, the Board assigns it low probative weight.

The Board also finds that the November 2021 VA opinion is inadequate because although
7) (the Board may reject a medical opinion that is conclusory and lacks supporting analysis). See also McLendon v. Nicholson, 20 Vet.App. 79, 85 (2006) (stating that speculative medical opinion as to causation cannot establish medical nexus to service). In addition, the opinion does not address the Veteran's specific contention that his headaches are due to his medication treatment for his service connected acquired psychiatric disorder. Because the September 2021 opinion uses speculative language, fails to apply facts specific to the Veteran's claim, and fails to address the Veteran's specific theory of service connection, the Board assigns it low probative weight.

The Board also finds that the November 2021 VA opinion is inadequate because although it briefly addresses the claimed causation between the Veteran's medication and headaches, the Board finds that it is based on an inaccurate factual premise. Specifically, the opinion states that the Veteran's VA psychiatrist found that headaches are not a side of effect of either Mirtazapine or Trazodone. However, the VA treatment records show that the Veteran's psychiatrist never responded to the Veteran's assertion that his headaches are due to or aggravated by Trazodone medication treatment. The November 2021 VA examiner did not indicate that they conducted any research into the side effects of either medication or had any medical knowledge of the side effects of either medication which leads the Board to conclude that the opinion is based solely off the inaccurate restatement of the VA treatment records. Therefore, the Board finds that the November 2021 VA opinion is based on an inaccurate factual premise and assigns no probative weight. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (A medical opinion based on an inaccurate factual premise has no probative value.); Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) ("If the opinion is based on an inaccurate factual premise, then it is correct to discount it entirely") (citing Reonal).

The Board notes that the November 2021 opinion is specifically an opinion on "aggravation of a condition that existed prior to service," and the examiner makes findings that the Veteran's headaches "clearly and unmistakably existed prior to service," based solely off of the Veteran's January 1978 report of medical history at entry to service where he indicated "yes" next to "history of frequent or severe headaches." There is no explanation, and the examining physician did not make any notation regarding any history of headaches prior to service. The only noted condition noted on the Veteran's January 1978 entrance examination is pes planus. There is no other clinical or objective evidence of record that the Veteran experienced headaches prior to entry into service. Importantly, a "[h]istory of preservice existence of conditions recorded at the time of examination does not constitute a notation of such conditions." 38 C.F.R. § 3.304(b)(1). There must be actual diagnosis on the entrance exam to be considered noted at entry. Accordingly, the presumption of soundness attaches, and the January 1978 entrance examination is not clear unmistakable evidence required to rebut the presumption. Therefore, the Board will not consider the November 2021 VA opinion as to aggravation of a condition that existed prior to service. See 38 U.S.C. § 1132; 38 C.F.R. § 3.304(b); Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991); Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004).

The Board finds that the July 2022 VA opinion is probative as to the issue of whether the Veteran's headache disability is due to or aggravated by his medication treatment for his service connected acquired psychiatric disorder. The July 2022 VA examiner applied their own medical knowledge, research, and expertise to the evidence of record in that the examiner specifically found that headaches are not a common side effect of either Mirtazapine or Trazodone and that if the Veteran's headaches were aggravated by his service connected acquired psychiatric disorder or medications, they would expect to see objective medical evidence of a headache diagnosis "during a clinical encounter" or records of treatment for headaches. In addition, the July 2022 VA examiner included discussion of the Veteran's January 2020 VA examination for his acquired psychiatric disorder and noted that the Veteran did not complain of headaches and there were no findings that the Veteran's headaches were due to, or symptoms of his service connected acquired psychiatric disorder. Therefore, the Board finds that the July 2022 VA opinion is adequate as to the issue of whether the Veteran's headache disability is due to or aggravated by his medication treatment for his service connected acquired psychiatric disorder because it considers the evidence of
the Veteran's headaches were aggravated by his service connected acquired psychiatric disorder or medications, they would expect to see objective medical evidence of a headache diagnosis "during a clinical encounter" or records of treatment for headaches. In addition, the July 2022 VA examiner included discussion of the Veteran's January 2020 VA examination for his acquired psychiatric disorder and noted that the Veteran did not complain of headaches and there were no findings that the Veteran's headaches were due to, or symptoms of his service connected acquired psychiatric disorder. Therefore, the Board finds that the July 2022 VA opinion is adequate as to the issue of whether the Veteran's headache disability is due to or aggravated by his medication treatment for his service connected acquired psychiatric disorder because it considers the evidence of record in light of objective medical knowledge, training, and expertise.

The Board finds that the July 2022 VA opinion is supported by the objective evidence of record, namely the Veteran's STRs, MPRs, VA examinations, and VA treatment records. Consequently, the Board gives more probative weight to the July 2022 VA opinion.

Based on the forgoing, the Board finds that the probative evidence is against the Veteran's claim for entitlement to service connection for a headache disability due to his service connection insomnia disorder with major depressive disorder and sleep disturbances, to include medication. All probative evidence of record persuasively indicates that the Veteran's headaches are not due to or aggravated by the Veteran's service connected insomnia disorder with major depressive disorder and sleep disturbances, to include medication. There is no reasonable doubt to be resolved, and the claim of entitlement to service connection for a headache disability must be denied. 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310.

Bethany L. Buck

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Webb, Katherine S.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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