MIGRAINE

Summary

The Veteran, an Army Veteran who served from October 1974 to September 1977, appealed the denial of service connection for headaches with dizzy spells, right shoulder disability, and upper respiratory disability. The Veteran passed away in May 2023, and his surviving spouse was substituted to continue the appeal. The Board granted service connection for headaches with dizzy spells as secondary to service-connected tinnitus, finding an approximate balance of evidence and applying the benefit of the doubt. The Veteran's tinnitus was granted service connection in a prior rating decision. For the right shoulder disability, including glenohumeral degenerative joint disease (DJD), the Board denied service connection. While the Veteran had normal upper extremities at entry and a notation of shoulder pain at separation, the evidence persuasively weighed against a service connection. The separation examination was normal, and treatment records did not reference the right shoulder until 2012. A September 2025 VA medical opinion found the DJD less likely than not related to service due to the long interval since service, lack of in-service injury documentation, and absence of early post-service treatment. For the upper respiratory disability, including chronic sinusitis and allergic rhinitis, the Board denied service connection. The Veteran did not have a current diagnosis of chronic sinusitis. While allergic rhinitis was diagnosed later, a September 2025 VA medical opinion found it less likely than not related to service, citing normal separation examinations and lack of chronic symptoms during service. The opinion also concluded that toxic exposure risk activities (TERA) were not causally related to the allergic rhinitis. The Board gave significant weight to the September 2025 VA medical opinion for both denied claims.

Rationale

Secondary to service-connected tinnitus; Approximate balance of evidence; Benefit of the doubt applied

Full Decision Text

Citation Nr: 26004859
Decision Date: 04/22/26	Archive Date: 04/22/26

DOCKET NO. 17-04 273
DATE: April 22, 2026

ORDER

Entitlement to service connection for headaches with dizzy spells, as secondary to service-connected tinnitus, is granted.

Entitlement to service connection for right shoulder disability, including right glenohumeral degenerative joint disease (DJD), is denied.

Entitlement to service connection for upper respiratory disability, including chronic sinusitis and allergic rhinitis, is denied.

FINDINGS OF FACT

1. The Veteran's headaches with dizzy spells were due to tinnitus.

2. The evidence of record persuasively weighs against finding that right shoulder disability, including glenohumeral DJD, manifested in service or manifested to a compensable degree within the first post-service year; the disability is not otherwise etiologically related to service.

3. The evidence of record persuasively weighs against finding that the Veteran had chronic sinusitis at any time during or approximate to the pendency of the claim, or that allergic rhinitis began during active service or is otherwise related to an in-service injury or disease.  

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for headaches with dizzy spells, as secondary to tinnitus, have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for entitlement to service connection for right shoulder disability, including glenohumeral DJD, have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

3. The criteria for entitlement to service connection for upper respiratory disability, including chronic sinusitis and allergic rhinitis, have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from October 1974 to September 1977.  These matters come before the Board of Veterans' Appeals (Board) on appeal from a February 2015 rating decision of the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ).  The Veteran passed away in May 2023.  The appellant is his surviving spouse and has been substituted for the Veteran to continue the appeal.

These matters were previously remanded by the Board in January 2019, March 2022, and September 2022.  

The AOJ has duties to notify and assist claimants in substantiating a claim for VA benefits.  38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326(a).  These duties have been satisfied in this case.  Appropriate notice was included in the Veteran's October 2014 application form.  

The AOJ associated the Veteran's service records, VA medical center (VAMC) records, and private treatment records (PTRs) with the claims file.  The appellant submitted a May 2025 release authorizing the AOJ to obtain PTRs from 12 providers.  Five providers sent records; seven providers failed to respond to letters (May 2025 and June 2025) as well as calls (July 2025); and one provider (Baptist Neurological Associates) replied that the form sent was insufficient.  In an August 2025 letter, the AOJ informed the appellant that attempts to obtain records from the seven unresponsive providers had been unsuccessful.  The AOJ's failure to obtain records from Baptist Neurological Associates or inform the appellant that they had not been obtained is harmless error, because they were related to post-stroke neurological treatment (see May 2025 VA Form 21-4142a) and thus unrelated to the right shoulder and upper respiratory disabilities being denied service connection in this decision.  No other relevant records have been identified and are outstanding.  

The AOJ provided appropriate VA examinations and opinions as needed.  They are adequate because they evaluated the Veteran, made findings necessary to identify his current disabilities, considered the evidence in the claims file, and applied medical knowledge to his specific facts.  Thus, VA has satisfied its duty to assist with the procurement of relevant records.  38 U.S.C
 to obtain records from Baptist Neurological Associates or inform the appellant that they had not been obtained is harmless error, because they were related to post-stroke neurological treatment (see May 2025 VA Form 21-4142a) and thus unrelated to the right shoulder and upper respiratory disabilities being denied service connection in this decision.  No other relevant records have been identified and are outstanding.  

The AOJ provided appropriate VA examinations and opinions as needed.  They are adequate because they evaluated the Veteran, made findings necessary to identify his current disabilities, considered the evidence in the claims file, and applied medical knowledge to his specific facts.  Thus, VA has satisfied its duty to assist with the procurement of relevant records.  38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c).  Neither the appellant nor her representative has raised any issues with the duties to notify or assist.  See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). 

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service.  See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  "To establish a right to compensation for a present disability, a veteran must show: '(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service' - the so-called 'nexus' requirement."  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

To establish a right to compensation for a present disability secondary to a service-connected disability, a veteran must demonstrate the existence of (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability.  38 C.F.R. § 3.310; Wallin v. West, 11 Vet. App. 509 (1998).  

Headaches with Dizzy Spells

The appellant contends that service connection is warranted for headaches with dizzy spells.  The Board agrees.

A February 2020 VA examination for headaches diagnosed tension headaches and classified them as "secondary to tinnitus."  A July 2022 rating decision granted  service connected for tinnitus, effective October 10, 2013.  

Therefore, the Board finds at least an approximate balance of positive and negative evidence exists regarding a link between the Veteran's service and his headaches with dizzy spells.? Entitlement to service connection is warranted for headaches with dizzy spells as secondary to service-connected tinnitus.  See 38?U.S.C. §?5107(b); see also Gilbert v. Derwinski, 1?Vet. App.?49, 53-54 (1990).

Right Shoulder Disability

The appellant contends that service connection is warranted for right shoulder disability.  Because the evidence fails to demonstrate a nexus to service, the Board disagrees.

Some chronic diseases, including arthritis, may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period.  38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a).  For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013).  For arthritis, the presumptive period is one year following separation from service.

The Board concludes that, although the Veteran has a current diagnosis of right glenohumeral DJD and evidence shows that he had right shoulder pain in service, the evidence of record persuasively weighs against finding that his DJD began during service, manifested within one year of service, or is otherwise related to an in-service injury, event, or disease.

A September 1974 entrance examination evaluated the Veteran's upper extremities as normal.  The only service record to reference his shoulder is an August 1977 report of medical history (RMH) for separation in which the Veteran reported current or past "P
 (Fed. Cir. 2013).  For arthritis, the presumptive period is one year following separation from service.

The Board concludes that, although the Veteran has a current diagnosis of right glenohumeral DJD and evidence shows that he had right shoulder pain in service, the evidence of record persuasively weighs against finding that his DJD began during service, manifested within one year of service, or is otherwise related to an in-service injury, event, or disease.

A September 1974 entrance examination evaluated the Veteran's upper extremities as normal.  The only service record to reference his shoulder is an August 1977 report of medical history (RMH) for separation in which the Veteran reported current or past "Painful or 'trick' shoulder or elbow" and the medical officer noted "c/o [complaint of] Painful R[ight] shoulder."  A contemporaneous August 1977 separation examination evaluated his upper extremities as normal.

Despite receiving treatment as early as 1998 for many conditions - including his left knee, feet, left shoulder, and left calf - the first treatment record to reference the Veteran's right shoulder is a July 2012 private treatment record (PTR).  Even then, the July 2012 record noted his complaint that "R[ight] shoulder hurts when moved" but only discussed and diagnosed left shoulder pain.  An August 2014 PTR noted that he    

started to experience lower back pain since September 2007 shortly after he was started on Lipitor for hyperlipidemia . . . Lipitor has been stopped, but the patient continued to have pain not only in the lower back but in his shoulders, hands, knees, feet, below and above the waist bilaterally in the soft tissues.

 A June 2017 VAMC pain clinic record treating fibromyalgia noted "chronic pain involving the mid back, low back and neck and shoulder blades of myofascial origin."  A June 2018 orthopedic PTR noted complaints of left knee pain and left shoulder pain; on examination, right shoulder "does not show any tenderness, deformity or injury.  Range of motion is unremarkable.  There is no gross instability. Strength and tone are normal."  A September 2018 orthopedic PTR similarly documented treatment for the left shoulder with no right shoulder issues on examination.

A May 2022 VA medical opinion provided an insufficient negative opinion because it relied on a lack of disability without addressing the Veteran's symptoms (stiffness, locking, and popping) reported at a May 2022 VA examination.  He stated at the May 2022 VA examination that his right shoulder disability began in 1976 because "I was moving equipment in the radio shack, it was too heavy and hurt my shoulder."

A September 2025 VA medical opinion listed a diagnosis of right glenohumeral DJD based on 2018 bilateral shoulder radiographs.  The VA medical opinion determined that the disability was less likely than not due to right shoulder pain mentioned in the separation RMH because it was "a single contemporaneous notation" and the separation examination was "normal with no chronic shoulder diagnosis."  Additionally, it emphasized that there was no "documented treatment during service.  There is no contemporaneous objective documentation of an acute structural shoulder injury in service (for example, dislocation, fracture, surgical repair, or persistent post-injury care) - injuries of that type are the ones most commonly linked to accelerated, post-traumatic glenohumeral osteoarthritis."  The VA medical opinion further cited the "long interval between service and the radiographic diagnosis in 2018" as well as "the absence in the record of objective structural shoulder damage or ongoing treatment beginning in service or immediately thereafter."

The Board gives significant weight to the September 2025 VA medical opinion because it was provided by a medical professional who reviewed the complete medical record.

In sum, the evidence is neither evenly nor approximately balanced regarding whether service connection for right glenohumeral DJD is warranted.  Rather, the evidence persuasively weighs against the claim, and the benefit-of-the-doubt doctrine is not for application.  Lynch v. McDonough,?21 F.4th 776, 781-82 (Fed. Cir. 2021) ("[T]he benefit-of-the-doubt rule?does not apply[] when the evidence persuasively favors one side or the other").  Entitlement to service connection for right shoulder disability is denied.

Upper Respiratory Disability, Including Sinusitis and Rhinitis

The appellant contends that service connection is warranted for upper respiratory disability.  Because the evidence fails to show a current disability of chronic sinusitis or a nexus to service for allergic rhinitis, the Board disagrees.

The Board concludes that, although the Veteran
 and the benefit-of-the-doubt doctrine is not for application.  Lynch v. McDonough,?21 F.4th 776, 781-82 (Fed. Cir. 2021) ("[T]he benefit-of-the-doubt rule?does not apply[] when the evidence persuasively favors one side or the other").  Entitlement to service connection for right shoulder disability is denied.

Upper Respiratory Disability, Including Sinusitis and Rhinitis

The appellant contends that service connection is warranted for upper respiratory disability.  Because the evidence fails to show a current disability of chronic sinusitis or a nexus to service for allergic rhinitis, the Board disagrees.

The Board concludes that, although the Veteran has a current diagnosis of allergic rhinitis and evidence shows that he had cold symptoms in service, the evidence of record persuasively weighs against finding that his allergic rhinitis began during service or is otherwise related to an in-service injury, event, or disease.

Initially, the Board notes that the Veteran has not been diagnosed with chronic sinusitis.  A February 2020 VA examination did not diagnose chronic sinusitis, though it noted allergic rhinitis.  A May 2022 VA examination similarly determined that the Veteran did not have chronic sinusitis.  A September 2025 VA medical opinion indicated that he "does not carry a chronic sinusitis diagnosis but more likely has allergic rhinitis as the primary condition" because 

[p]ost-service, there are several documented episodes of acute sinusitis in 2012 and 2013, which are common transient infections and do not establish a chronic sinus disorder. Later ENT [ear, nose, and throat] evaluation in November 2013 noted changes consistent with rhinitis, and a 2020 [VA examination] confirmed allergic rhinitis associated with enlarged tonsils, whereas a 2022 [VA examination] found no active sinus diagnosis.

Thus, the Board finds that the Veteran had a current diagnosis of allergic rhinitis but not chronic sinusitis.

Turning to his service records, the Veteran reported current or past sinusitis in a September 1974 entrance RMH.  The September 1974 entrance examination evaluated his head, nose, and sinuses as normal.  A February 1975 service treatment record noted his complaint of "head cold x 2 wks [weeks]" with "runny nose."  He denied having a sinus condition in a November 1976 dental health questionnaire.  An April 1977 service treatment record noted a complaint of "congestion[,] fever, headache, [and] cough."  He denied current or past sinusitis; ear, nose, or throat trouble; hay fever; and "[c]hronic or frequent colds" in the August 1977 separation RMH.  The August 1977 separation examination evaluated his head, nose, sinuses, mouth, and throat as normal. 

PTRs in 2012 and 2013 assessed sinusitis (July 2012, November 2012, April 2013, May 2013).  A November 2013 PTR noted the Veteran's "[l]eft hemiparesis in a patient who experienced stroke [in July 2013], now with some hearing loss and changes of rhinitis."  An August 2014 PTR initial evaluation indicated that he had "[n]o history of . . . chronic sinusitis."  PTRs in November 2018 and November 2019 listed "[p]erennial allergic rhinitis" as an active problem.

As noted, the February 2020 VA examination noted allergic rhinitis, including symptoms of "fatigue, chills, fever, blow nose frequently and take medicines approximately 3 times a year" when discussing functional impact.  The Veteran stated at the VA examination that his disability began "10/17/1974 . . . with runny nose, sore throat.  I get sinus infections and enlarged tonsils because of the drainage."  At the May 2022 VA examination, the Veteran reported that his disability began in 1976 while stationed in Germany "and the weather was extremely cold."  He indicated that he "developed stuff nose, nasal drainage, headache" but "didn't go to sick call."

The September 2025 VA medical opinion determined that his allergic rhinitis was less likely than not incurred in or caused by service because he was evaluated as normal at the August 1977 separation examination and denied sinusitis or hay fever in the August 1977 separation RMH.  "The acute symptoms documented in service are medically consistent with transient viral infections rather than manifestations of chronic allergic rhinitis or sinusitis.  Thus, the lay report of continuous symptoms since service is not supported by the objective medical record" (September 2025 VA medical opinion).  Moreover
 Germany "and the weather was extremely cold."  He indicated that he "developed stuff nose, nasal drainage, headache" but "didn't go to sick call."

The September 2025 VA medical opinion determined that his allergic rhinitis was less likely than not incurred in or caused by service because he was evaluated as normal at the August 1977 separation examination and denied sinusitis or hay fever in the August 1977 separation RMH.  "The acute symptoms documented in service are medically consistent with transient viral infections rather than manifestations of chronic allergic rhinitis or sinusitis.  Thus, the lay report of continuous symptoms since service is not supported by the objective medical record" (September 2025 VA medical opinion).  Moreover, the VA medical opinion stated that his allergic rhinitis was less likely than not incurred in or caused by in-service symptoms because "[t]he in-service complaints represented acute, self-limited viral infections that resolved without chronic sequelae, and no chronic sinus condition was documented at separation.  Allergic rhinitis was not clinically identified until decades later."   Finally, the VA medical opinion considered whether allergic rhinitis was due to in-service toxic exposure risk activities (TERA) such as exposure to lithium batteries, fuels, fumes, and exhaust, but indicated that "the available medical literature does not support a causal relationship between such exposures and the later development of allergic rhinitis."

As in the previous section, the Board gives significant weight to the September 2025 VA medical opinion because it was provided by a medical professional who reviewed the complete medical record.

Thus, the evidence is neither evenly nor approximately balanced regarding whether service connection for an upper respiratory disability is warranted.  Instead, the evidence persuasively weighs against the claim.  The Veteran did not have a current sinusitis disability and his allergic rhinitis was not due to in-service symptoms or TERA.  The benefit-of-the-doubt doctrine is therefore not for application, Lynch,?21 F.4th at 781-82, and entitlement to service connection for upper respiratory disability is denied.

 

 

WILLIAM H. DONNELLY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	W. Ripplinger, Counsel

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.