BRAIN DISEASE DUE TO TRAUMA

Summary

The veteran, who served from February 1981 to February 1988, appeals the denial of service connection for status post intracranial subarachnoid bleed, claimed as brain surgery residuals, and as secondary to his service-connected headaches. The veteran's claim stems from a subarachnoid hemorrhage experienced in February 2008, which he believes is related to chronic headaches he experienced during service. The Board reviewed medical records indicating the subarachnoid hemorrhage was likely due to a basilar artery aneurysm, a condition unrelated to his service-connected migraines. Two VA medical opinions from April 2025 concluded that the subarachnoid hemorrhage was less likely than not related to or aggravated by the service-connected headaches, and also not directly related to service. The Board found these opinions highly probative and consistent with the medical evidence, which did not show brain surgery was performed. The Board assigned little weight to the veteran's lay statements regarding the etiology of the hemorrhage, citing lack of medical expertise. The evidence persuasively weighed against service connection, rendering the benefit of the doubt doctrine inapplicable. Consequently, service connection for the subarachnoid bleed was denied.

Rationale

No evidence of brain surgery performed.; Subarachnoid hemorrhage likely due to basilar artery aneurysm.; VA opinions found hemorrhage unrelated to service-connected headaches.; Evidence persuasively weighs against service connection.

Full Decision Text

Citation Nr: 25012985
Decision Date: 10/16/25	Archive Date: 10/16/25

DOCKET NO. 17-60 696
DATE: October 16, 2025

ORDER

Service connection for status post intracranial subarachnoid bleed (claimed as brain surgery residuals), to include as secondary to the service-connected headache disability, is denied.

FINDINGS OF FACT

1. The evidence shows a current diagnosis of status post intracranial subarachnoid bleed after a subarachnoid hemorrhage.

2.  The subarachnoid hemorrhage was not incurred in service and is not etiologically related to service.

3.  The subarachnoid hemorrhage was not caused or worsened in severity by the service-connected headaches. 

CONCLUSION OF LAW

The criteria for service connection for status post intracranial subarachnoid bleed (claimed as brain surgery residuals), to include as secondary to the service-connected headaches, are not met.  38 U.S.C. §§ 1131, 5103, 5103A, 5107; 

38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran, who is the appellant in this case, served on active duty from February 1981 to February 1988.  

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), the Agency of Original Jurisdiction (AOJ). 

The Veteran and spouse testified at a Board hearing in April 2022 before the undersigned Acting Veterans Law Judge, and a copy of the hearing transcript has been associated with the record.  In February 2023, after determining that new and material evidence had been received, the Board issued a decision remanding the Veteran's claims for service connection for hearing loss, headaches (which included the issue of service-connection for a brain/neurological disorder other than headaches), and skin rash for additional development.  Specifically, the AOJ was to schedule the Veteran for various VA examinations.  

In May 2023, the Veteran received VA skin rash and headache examinations.  In June 2023, the Veteran received a VA examination for hearing loss.  In June 2023, the AOJ issued a Supplemental Statement of the Case, denying the Veteran's claims for service connection for hearing loss, skin rash, and headaches (also claimed as brain surgery secondary to headaches).  In March 2025, the Board granted service connection for bilateral sensorineural hearing loss and a headache disability, and denied service connection for a skin rash.  The Board also remanded the claim for service connection for brain surgery residuals, as secondary to the service-connected headache disability, for a VA examination and/or opinion.  Two VA medical opinions were issued in April 2025.  In May 2025, VA issued a Supplemental Statement of the Case denying service connection for brain surgery residuals, as secondary to the service-connected headache disability.  As the development directed in the Board's March 2025 Remand was adequately completed, the Board finds the instant matter ripe for adjudication.  See Stegall v. West, 11 Vet. App. 268, 271 (1998).

Service connection for status post intracranial subarachnoid bleed (claimed as brain surgery residuals), to include as secondary to the service-connected headache disability, is denied.

The Veteran appeals for service connection for brain surgery residuals, as secondary to the service-connected headaches.  He contends that he had brain surgery because of the chronic headaches that existed during active duty.  See September 2009 VA 21-4138 Statement in Support of Claim.  

The record reflects that in February 2008, the Veteran had a subarachnoid hemorrhage, after which he experienced symptoms of headaches, nausea, and dizziness.  See February 2008 Follow-Up Medical Record.  The Veteran submitted medical records related to this event, which were received by VA in December 2009.  The Veteran has been diagnosed with status post intracranial subarachnoid bleed.  See May 2023 VA Examination.  

Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service.  38 U.S.C. § 1131; 38 C.F.R. 

§ 3.303(a).  Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3
 February 2008 Follow-Up Medical Record.  The Veteran submitted medical records related to this event, which were received by VA in December 2009.  The Veteran has been diagnosed with status post intracranial subarachnoid bleed.  See May 2023 VA Examination.  

Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service.  38 U.S.C. § 1131; 38 C.F.R. 

§ 3.303(a).  Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).  As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service.

Service connection may also be granted for disability that is proximately due to or the result of a service-connected disability.  An increase in severity of a non-service-connected disorder that is proximately due to or the result of a service- connected disability, and not due to the natural progress of the non-service-connected condition, will be service connected.  Aggravation will be established by determining the baseline level of severity of the non-service-connected condition and deducting that baseline level, as well as any increase due to the natural progress of the disease, from the current level.  See 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995).

When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether the persuasive weight of the evidence is against a claim, in which case, the claim is denied.  See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

The Board has thoroughly reviewed all the evidence in the claims file and adequately addresses the relevant evidence in the instant decision.  Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, every piece of evidence of record.  See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence).

Based on a review of the lay and medical evidence, the Board finds that the evidence persuasively weighs against the claim that the Veteran's status post intracranial subarachnoid bleed was caused or aggravated by the service-connected headaches, or is otherwise directly related to service.  

At the outset, the Board notes that the evidence in the claims file does not reflect that the Veteran had brain surgery.  Private medical records reflect that the Veteran had a subarachnoid hemorrhage in February 2008.  He picked up an 80-pound bag and had sudden onset of severe head and neck pain, which rapidly progressed into nausea and vomiting.  Emergency responders took the Veteran to Baptist Medical Center where he was admitted.  Initial findings included a subarachnoid hemorrhage at the base of the brain.  The examiner at the time thought it may represent a basilar tip aneurysm.  The Veteran was then transferred to Shands Hospital Jacksonville for a cerebral angiogram.  While there, he received a diagnostic cerebral angiogram with conscious sedation.  The right common femoral artery was anesthetized and the right common carotid artery, the right internal carotid artery, the right external carotid artery, and the right vertebral artery were all catheterized.  Angiograms were performed for the bilateral cervical carotid, the bilateral cerebral carotid, the right vertebral and left vertebral, and the bilateral external carotid.  The concluding impression was that there was no evidence of aneurysm.  The Veteran reported that after a day of observation he was prescribed medication and discharged.  

The Veteran continued to experience severe headaches and nausea and returned to Baptist Hospital's Emergency Department a few days later.  Repeated imaging reflected subarachnoid hemorrhage in the pre-pontine cistern.  The Veteran was again transferred to
 right internal carotid artery, the right external carotid artery, and the right vertebral artery were all catheterized.  Angiograms were performed for the bilateral cervical carotid, the bilateral cerebral carotid, the right vertebral and left vertebral, and the bilateral external carotid.  The concluding impression was that there was no evidence of aneurysm.  The Veteran reported that after a day of observation he was prescribed medication and discharged.  

The Veteran continued to experience severe headaches and nausea and returned to Baptist Hospital's Emergency Department a few days later.  Repeated imaging reflected subarachnoid hemorrhage in the pre-pontine cistern.  The Veteran was again transferred to Shands Hospital, where he reported no further nausea, weakness, sensory changes, bowel or bladder changes, or any other neurosurgical or neurologic complaints.  The assessment was that the Veteran presented neurologically intact with severe headache and meningismus.  The treatment plan included transfer to the Intermediate Care Unit (ICU) and the Veteran was given several medications prior to a further CT angiogram of the head and neck.  The impression from February 10, 2008 was that there was a collection of subarachnoid blood adjacent to focal dilatation of the distal basilar artery and short segment distal basilar artery narrowing.  The report stated, "this is concerning for a basilar artery aneurysm rupture and vasospasm."  The neck CTA was negative for acute or significant abnormalities.  

In March 2008, a private medical doctor from Shands Hospital advised that the imaging and clinical course were consistent with a benign angiogram negative subarachnoid hemorrhage.  The Veteran was further advised to receive regular CT angiograms and that he could return to work.  

In March 2025, the Board bifurcated the issue of service connection for headaches from the included issue of service-connection for a brain/neurological disorder other than headaches, and found that remand for an addendum secondary service connection VA medical opinion was necessary.  Two VA opinions were issued in April 2025 in response to the Board's March 2025 remand.  

One VA opinion, dated April 8, 2025, determined that the subarachnoid hemorrhage was less likely than not proximately due to or the result of the service-connected headaches.  The VA examiner first noted, after review of the claims file, that the Veteran was diagnosed with migraine headaches, which have been directly related to service.  The service treatment records showed headaches during service and service connection has been established for these headaches that began during service.  In February 2008, the Veteran was evaluated for a headache with other concerning symptoms such as nausea, vomiting, neck pain, and paresthesias.  Imaging showed a subarachnoid hemorrhage with high concern for a rupturing focal basilar artery aneurysm.  The Veteran was followed by neurosurgery for the subarachnoid hemorrhage and ultimately the hemorrhage resolved.  There was no evidence that brain surgery was conducted for the condition.  The VA examiner opined, "there is no evidence that the subarachnoid hemorrhage that occurred in 2008 was caused by or related to the Veteran's chronic migraine disorder, as these are two separate and unrelated medical conditions."  The VA examiner stated that multiple medical conditions can cause headaches.  The Veteran developed an acute headache associated with the subarachnoid hemorrhage in 2008, but this headache was distinct from the service-connected migraines with differing etiologies.  The VA examiner reasoned that subarachnoid hemorrhages are most commonly caused by head trauma, but can also commonly occur (approximately 85 percent of non-traumatic cases) due to an aneurysm of a blood vessel within the brain.  There is no evidence that migraine headaches or migraine disorders cause subarachnoid hemorrhages.  Furthermore, the imaging from February 2008 that diagnosed the Veteran's subarachnoid hemorrhage showed a likely rupture of a basilar artery aneurysm; thus, the aneurysm was the most likely cause of the subarachnoid hemorrhage.  

The April 8, 2025 VA medical opinion further determined that the subarachnoid hemorrhage was not aggravated by the service-connected headaches, because these are separate and unrelated medical conditions.  The VA medical examiner reasoned there is no evidence within the medical literature that the chronic headache disorder caused or aggravated the subarachnoid hemorrhage.  The VA examiner noted again that the claims file reflects that the subarachnoid hemorrhage occurred due to a rupturing basilar vessel aneurysm, which is a common cause of sub
age showed a likely rupture of a basilar artery aneurysm; thus, the aneurysm was the most likely cause of the subarachnoid hemorrhage.  

The April 8, 2025 VA medical opinion further determined that the subarachnoid hemorrhage was not aggravated by the service-connected headaches, because these are separate and unrelated medical conditions.  The VA medical examiner reasoned there is no evidence within the medical literature that the chronic headache disorder caused or aggravated the subarachnoid hemorrhage.  The VA examiner noted again that the claims file reflects that the subarachnoid hemorrhage occurred due to a rupturing basilar vessel aneurysm, which is a common cause of subarachnoid hemorrhages.  There is no relationship between the two conditions to support any effect on the hemorrhage.   

A second VA medical opinion was issued on April 22, 2025.  The VA medical examiner explored whether direct service connection for the subarachnoid hemorrhage could be established.  The VA examiner noted the hemorrhage condition onset in 2008, outside of active duty.  Moreover, subarachnoid hemorrhage is an acute condition, separate from the service-connected migraine headaches.  Therefore, the VA medical examiner determined the subarachnoid hemorrhage was less likely than not incurred in or caused by an in-service injury, event, or illness.  The Board notes that the record also does not reflect, nor does the Veteran contend, that any event, illness, or injury during service caused the basilar vessel aneurysm, which occurred many years after discharge from service, further supporting the lack of a direct nexus to service.    

The Board finds the two VA medical opinions highly probative.  They are based on a review of the claims file, medical expertise, and adequately address the relevant evidence in the record.  Per the VA medical opinions, the subarachnoid hemorrhage was most likely due to an acute basilar vessel aneurysm (as reflected in the private medical records), unrelated to the service-connected migraine headaches.  Significantly, there is no competent opinion evidence in the record that contradicts the VA examiners' conclusions.  

The Board acknowledges the Veteran's lay statements and belief that the subarachnoid hemorrhage was related to the service-connected migraine headache disability.  While the Veteran is competent to report symptoms that he is able to perceive through his senses, the Veteran is not competent to provide an etiology on the subarachnoid hemorrhage and any residuals thereof.  Layno v. Brown, 6 Vet. App. 465, 469 (1994) (personal knowledge is that which comes to the witness through the use of his senses -that which is heard, felt, seen, smelled, or tasted).  Such an etiology opinion requires medical training, expertise, and credentials.  As such, the Board assigns little probative value to the Veteran's statements regarding the cause of the subarachnoid hemorrhage and residuals.  King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2009) (holding that it was not erroneous for the Board to find that a lay veteran claiming service connection for a back disorder and his wife lacked the "requisite medical training, expertise, or credentials needed to render a diagnosis" and that their testimony "could not establish medical causation nor was it a competent opinion as to medical causation").

For the foregoing reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection for status post intracranial subarachnoid bleed (claimed as brain surgery residuals) is warranted either on a direct or secondary basis.  Rather, the evidence persuasively weighs against service connection for status post intracranial subarachnoid bleed (claimed as brain surgery residuals) as a secondary condition and as directly incurred in service.  The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is, therefore, not for application as to this claim.  Lynch v. McDonough, 21 F.4th at 781-82 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).  Therefore, the appeal must be denied.                   

 

 

E. Blowers

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Prairie, N. R.

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. § 20.130