BRAIN DISEASE DUE TO TRAUMA

Summary

The Veteran, who served from September 1980 to May 1982, appeals the denial of service connection for residuals of traumatic brain injury (TBI), including memory loss, and for migraine headaches, cyclic vomiting syndrome, and anxiety disorder as secondary to TBI residuals. The Veteran claims a TBI occurred in July 1981 when struck by a baseball, leading to daily headaches and later vomiting. However, the Board found significant discrepancies in the Veteran's reporting. Service treatment records indicated no loss of consciousness from the in-service injury, contradicting the Veteran's claim. Furthermore, military personnel records showed multiple disciplinary actions prior to and around the time of the alleged injury, and the Veteran's commanding officer noted no awards or decorations when requesting discharge for misconduct, contrary to the Veteran's representative's assertions. The Board gave significant weight to a May 2017 VA examination, which concluded the Veteran did not have a current TBI residuals diagnosis, finding the reported symptoms more likely related to a psychological diagnosis and noting normal results on a mini-mental status examination. A subsequent July 2018 VA consultation also indicated a mild head injury, with cyclical vomiting and headaches not being typical TBI symptoms. A June 2024 nexus letter from a VA primary care provider linking the symptoms to the in-service event was given less weight due to inconsistencies with other medical records. The Board denied service connection for TBI residuals, finding the weight of the evidence against the claim. Consequently, the secondary claims for migraine headaches, cyclic vomiting syndrome, and anxiety disorder were also denied as a matter of law. The Veteran's claims were denied due to lack of current diagnosis and insufficient evidence of a service connection.

Rationale

No current diagnosis of TBI residuals; Discrepancies in Veteran's reporting of injury and symptoms; Medical evidence suggests symptoms more likely psychological or mild head injury

Full Decision Text

Citation Nr: A26026265
Decision Date: 03/24/26	Archive Date: 03/24/26

DOCKET NO. 200626-97218
DATE:       March 24, 2026

ORDER

Entitlement to service connection for residuals of traumatic brain injury, to include memory loss, is denied.

Entitlement to service connection for migraine headaches as secondary to traumatic brain injury residuals is denied.

Entitlement to service connection for cyclic vomiting syndrome as secondary to traumatic brain injury residuals is denied.

Entitlement to service connection for an anxiety disorder as secondary to traumatic brain injury residuals is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that the Veteran has had residuals of traumatic brain injury, including memory loss, at any time during or approximate to the pendency of the claim. 

2. The Veteran's migraine headaches, cyclic vomiting syndrome, and anxiety disorder are not related to a service-connected disability. 

CONCLUSIONS OF LAW

1. The criteria for service connection for residuals of traumatic brain injury are not met. 38 U.S.C. § 1131; 38 C.F.R. § 3.303.

2. The criteria for service connection for migraine headaches, cyclic vomiting syndrome, and anxiety disorder, as secondary to residuals of traumatic brain injury, are not met. 38 U.S.C. § 1131; 38 C.F.R. § 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran has active-duty service from September 1980 to May 1982, including creditable excess leave from September 1981 to May 1982. See DD214.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2019 rating decision (RD) issued by the Department of Veterans Affairs (VA) Regional Office (RO).

In the June 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held before the undersigned on May 2, 2024, and a transcript associated with the claims file.

Therefore, the Board may only consider the evidence of record at the time of the November 2019 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

The Board thoroughly reviewed all evidence in the Veteran's file. In every decision, the Board must provide a statement of the reasons and bases for its determination, adequate to enable an appellant to understand the precise basis for the Board's decision, as well as to facilitate review by the Court. 38?U.S.C. §?7104(d)(1). Although the entire record must be reviewed by the Board, the Court has repeatedly found that the Board is not required to discuss, in detail, every piece of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Dela Cruz v. Principi, 15?Vet. App.?143, 149 (2001) (rejecting the notion that the Veterans Claims Act mandates the Board discuss all evidence). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the appellant. See Timberlake v. Gober, 14?Vet. App.?122 (2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The appellant must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake, supra.

1. Entitlement to service connection for residuals of traumatic brain injury, to include memory loss, is denied.

The Veteran contends entitlement to service
 App.?143, 149 (2001) (rejecting the notion that the Veterans Claims Act mandates the Board discuss all evidence). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the appellant. See Timberlake v. Gober, 14?Vet. App.?122 (2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The appellant must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake, supra.

1. Entitlement to service connection for residuals of traumatic brain injury, to include memory loss, is denied.

The Veteran contends entitlement to service connection for traumatic brain injury from being struck in the head by a baseball in July 1981. See VBMS entry document type "VA 21-4138 Statement in Support of Claim," receipt date 08/15/2016. She contends that she began having severe headaches almost daily from that time forward and began vomiting with the headaches in 1991. Id.; May 2017 VA examination. The Veteran via her representative contends that she received awards and decorations for being an outstanding motor transport operator and began having disciplinary issues following the July 1981 injury. See May 2024 Hearing transcript, pg. 2, 3.

Credibility

As an initial matter, the Veteran's claims for service connection are subject to a level of subjectivity, dependent on accurate reporting of facts and relevant symptomology. To that end, it is important that the lay statements are accurate and credible. However, the record reflects significant discrepancies in the Veteran's reporting of events over time that relate directly to the within matters and undercut the validity of her assertions. Notably, the evidence demonstrates discrepancies in the Veteran's reporting of the in-service injury and her military service over time and evidence of record is contrary to the assertions of the Veteran's representative.  

In an August 2016 statement in support of claim, the Veteran reported that she was knocked unconscious after being struck in the head by a baseball on July 15, 1981, and began having severe headaches at that time. However, service treatment records show the Veteran denied loss of consciousness during treatment for the reported July 15, 1981, injury. See VBMS entry document type "Medical Treatment Record-Government Facility," receipt date 04/18/2019.

Further, the Veteran contends via her representative that she began to experience disciplinary issues after the July 1981 injury. However, military personnel records show the Veteran was subject to multiple disciplinary actions prior to July 15, 1981, including an Article 15 punishment in October 1980 for failure to obey a lawful order; four counseling sessions in June 1981 for failure to appear for formation or physical training, being out of uniform, and refusing to join detail; and four disciplinary incidents in July 1981 prior to the injury, the last culminating in an Article 15 punishment for being absent from her place of duty from 08:00a.m. to 11:00a.m. and from 1:00p.m. to 4:00p.m. on July 15, 1981. See VBMS entry document type "Military Personnel Record," receipt date 10/25/2016, pgs. 25-30, 41, 50.

Contrary to the assertions of the Veteran's representative, the Veteran's commanding officer noted in April 1982 that the Veteran had received no awards or decorations when he requested her discharge for misconduct-frequent incidents of a discreditable nature. Id. at 14.

The above findings relate directly to the Veteran's claims for service connection. Inadvertent or otherwise, the Board notes such evidence to show that the Veteran and her representative's statements have not always accurately represented essential facts and, therefore, supporting evidence of lay statements is of particular importance in this case. 

Service connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that the Veteran
1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that the Veteran does not have a current diagnosis of residuals of traumatic brain injury (TBI) and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

In a May 2017 VA examination for residuals of traumatic brain injury, the examiner indicated that the Veteran had a diagnosis of TBI. However, importantly, the May 2017 VA examiner determined that, while the Veteran experienced subjective symptoms of memory loss, severe headaches with sinus symptoms, and anxiety, the Veteran did not have a current diagnosis of TBI residuals. (Emphasis added.) The examiner noted there were no records of chronic headaches after the day of injury. Considering the Veteran's report to the examiner of loss of consciousness at the time of injury, additional testing was performed in the form of a mini-mental status examination (MMSE) to develop objective evidence of memory loss secondary to TBI. However, the Veteran demonstrated no deficit on the MMSE with a score of 30 out of 30. The Veteran's history of abnormal social behavior, and her reported history of vomiting beginning in 1990 were also noted. Ultimately, the May 2017 VA examiner opined that the Veteran's reported symptoms were more likely related to her psychological diagnosis and there was no support for a residual of TBI diagnosis. 

The May 2017 examiner possessed the necessary education, training, and expertise to provide the requested opinions. See Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In addition, the examiner provided a detailed rationale for the opinions, which was based on thorough review of the service treatment records, post-service treatment records, and lay statements of the Veteran. The May 2017 VA examiner's opinions considered an accurate history, were definitive, and supported by a detailed rationale that considered the lay and medical evidence. Nieves-Rodrigues v. Peake, 22 Vet. App. 295 (2008). Thus, the Board affords the May 2017 VA examination significant probative weight.

In July 2018, the Veteran was referred by her VA primary care provider, Dr. G.M.G., to VA physical medicine for a TBI consultation. The Veteran reported that she did not have any immediate medical attention following the July 1981 injury and was first evaluated for reported headaches in 1982 or 1983. See VBMS entry document type "Medical Treatment Record-Government Facility," receipt date 06/27/2024, pg. 60. This is inconsistent with the evidence showing treatment in July 1981. See VBMS entry document type "Medical Treatment Record-Government Facility," receipt date 04/18/2019. The Veteran related that the episodes of vomiting and headaches caused her to lose custody of her child. However, the provider noted the Veteran had previously reported a history of alcohol abuse from 1981 until about 17 years ago. The provider noted that, based on the Veteran's report of the injury, it was difficult to fully ascertain the true severity level of the injury and concluded it was more of a mild head injury. The Veteran's reported diagnosis of cyclical vomiting in the 1990s was noted. The provider indicated this was not a typical symptom to follow a head injury and that cyclical vomiting was not a known symptom of TBI. See VBMS entry document type "Medical Treatment Record-Government Facility," receipt date 06/27/2024, pgs. 60-66.

The Veteran was also evaluated by VA neurology in August and October 2018 for evaluation of migraines and cyclical vomiting syndrome. She reported a history of cocaine and crystal-meth use while married years ago. She currently smoked cannabis and had done so for greater than 30 years. The provider noted that the long history and improvement in frequency from weekly to now once a month, as well as no motor, visual, or
s was noted. The provider indicated this was not a typical symptom to follow a head injury and that cyclical vomiting was not a known symptom of TBI. See VBMS entry document type "Medical Treatment Record-Government Facility," receipt date 06/27/2024, pgs. 60-66.

The Veteran was also evaluated by VA neurology in August and October 2018 for evaluation of migraines and cyclical vomiting syndrome. She reported a history of cocaine and crystal-meth use while married years ago. She currently smoked cannabis and had done so for greater than 30 years. The provider noted that the long history and improvement in frequency from weekly to now once a month, as well as no motor, visual, or sensory symptoms spoke against diagnosis of neuromuscular disorders, multiple sclerosis, or a space occupying lesion, but the daily cannabis use and relief with frequent showering were consistent with cannabinoid hyperemesis. Id. at 52-56. The Veteran demonstrated in August 2018 a neurological examination within normal limits except for somewhat tangential speech that was easily redirected. In October 2018, she demonstrated a normal neurological examination with clear and fluent speech without paraphasic errors. Id. 45-48, 54-55. 

In September 2018, Dr. G.M.G. noted that the Veteran had been seen by a TBI clinic and neurology and was told there was no connection between her headaches post in-service injury and her cyclical vomiting syndrome and the Veteran "wondered how that could be." Id. at 48. 

The Veteran submitted a June 2024 positive nexus letter from Dr. G.M.G., VA primary care provider, linking the Veteran's episodic headaches and cyclical vomiting to the in-service event where she was struck in the head with a baseball. However, the statement appears to be based on the Veteran's self-reported medical history and conclusion, which are inconsistent with the Veteran's military personnel records, service treatment records, and VA neurology and physical medicine specialty treatment records that show diagnosis of migraines and cyclical vomiting syndrome more likely attributable to causes other than TBI. Consequently, the Board gives more probative weight to findings by the May 2017 VA examiner and VA specialists in neurology and physical medicine.

While the Veteran believes there is a current diagnosis of TBI residuals, the Veteran is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education and knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Evidence on appeal does not show the Veteran possesses education or training to provide a diagnosis. Consequently, the Board gives more probative weight to the competent medical evidence that considered an accurate history consistent with the records in evidence.

For all the reasons discussed above, the weight of the probative evidence is against the claim for service connection. Accordingly, the benefit of the doubt doctrine is not for application, and the Veteran's claim for service connection is denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

2. Entitlement to service connection for migraine headaches, cyclic vomiting syndrome, and anxiety disorder, as secondary to residuals of traumatic brain injury, is denied.

The Veteran contends entitlement to service connection for migraine headaches, cyclic vomiting syndrome, and anxiety disorder, secondarily to residuals of traumatic brain injury. However, in light of the decision above that denied entitlement to service connection for residuals of traumatic brain injury, the claim of secondary service connection for migraine headaches, cyclic vomiting syndrome, and anxiety disorder must be denied. Where the underlying disability is not service connected, the claim of secondary service connection has no foundation and must be denied as a matter of law. 38 C.F.R. § 3.310; see Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (where the law and not the evidence is dispositive, the Board should deny the claim on the ground of lack of legal merit).

The Veteran's service treatment records show the Veteran complained of headache on the day of injury in July 1981. However, there are no further complaints of headaches throughout the remainder of her service. The Veteran has not asserted, and the evidence does not show complaints or diagnosis of cyclic vomiting syndrome or anxiety disorder during service.

Post-service, the Veteran reports vomiting associated with headaches began in 1990 and she was diagnosed with migraines and cyclical vomiting syndrome thereafter. The Veteran was first noted to have anxiety in July 2018. See VBMS entry document type "Medical Treatment Record-Government Facility," receipt date 06/27/2024, pg. 66.

A review
 deny the claim on the ground of lack of legal merit).

The Veteran's service treatment records show the Veteran complained of headache on the day of injury in July 1981. However, there are no further complaints of headaches throughout the remainder of her service. The Veteran has not asserted, and the evidence does not show complaints or diagnosis of cyclic vomiting syndrome or anxiety disorder during service.

Post-service, the Veteran reports vomiting associated with headaches began in 1990 and she was diagnosed with migraines and cyclical vomiting syndrome thereafter. The Veteran was first noted to have anxiety in July 2018. See VBMS entry document type "Medical Treatment Record-Government Facility," receipt date 06/27/2024, pg. 66.

A review of the records in evidence does not indicate, and the Veteran does not contend, that her migraine headaches, cyclic vomiting syndrome, and anxiety disorder, are directly related to service. Instead, the Veteran only contends these conditions are related to her non-service-connected residuals of TBI. Thus, the Board finds that the Veteran's migraine headaches, cyclic vomiting syndrome, and anxiety disorder, are denied as a matter of law.  

 

L.M. YASUI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Spears, J.E.

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.