MIGRAINE

JOHN J. CROWLEY · 2026 · Case ID: A26029244

DENIED

Summary

The veteran, who served in the U.S. Navy from September 1987 to July 1995, appeals the denial of service connection for migraine headaches, traumatic brain injury (TBI), gastroesophageal reflux disease (GERD), and erectile dysfunction (ED). The Board found that the veteran's claims stemmed from a July 1993 motor vehicle accident during service, which was determined by the service department to be willful misconduct and not in the line of duty. The Board agreed with the service department's findings, citing the veteran's intoxication, driving on the wrong side of the highway, and combative behavior with police as proximate causes of his injuries. Consequently, the claims for migraine headaches and TBI, stemming from this accident, were denied. For the other claimed conditions (GERD and ED), the Board found no evidence of diagnosis, treatment, or complaint during service or within one year of separation. The service treatment records were noted as silent regarding these conditions, and post-service medical evidence indicated onset significantly later than service. The Board also reviewed the veteran's contentions regarding TERA exposure for GERD and headaches, finding the VA examiner's opinions more probative than the veteran's lay statements and the February 2022 VA opinion, ultimately denying service connection for these conditions due to lack of association with TERA or service. The Board also considered the veteran's assertion that his headaches were secondary to hypertension, but found the medical opinion stating no established link between hypertension and chronic headaches to be more probative, denying this claim as well.

Rationale

No evidence of migraine headaches during service or within one year of separation.; Service treatment records silent regarding complaints, treatment, or diagnoses.; Post-service onset in 2020, 25 years after service.; VA opinion found less likely than not related to hypertension.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250219-519765

Full Decision Text

Citation Nr: A26029244
Decision Date: 03/31/26 Archive Date: 03/31/26

DOCKET NO. 250219-519765
DATE: March 31, 2026

ORDER

Entitlement to service connection for migraine headaches is denied.

Entitlement to service connection for traumatic brain injury (TBI) is denied.

Entitlement to service connection for gastroesophageal reflux disease (GERD) is denied.

Entitlement to service connection for erectile dysfunction (ED) is denied.

FINDINGS OF FACT

1. While on active duty, the Veteran was involved in a motor vehicle accident in July 1993; the accident was due to the Veteran's misconduct and not in line of duty.

2. The Veteran's erectile dysfunction (ED), migraine headaches (HA's), gastroesophageal reflux disease (GERD) and traumatic brain injury (TBI) were not caused or aggravated by his service, to include by participation in a toxic exposure risk activity (TERA).

CONCLUSION OF LAW

The criteria for service connection for erectile dysfunction (ED), migraine headaches (HA's), gastroesophageal reflux disease (GERD) and traumatic brain injury (TBI) are not met. 38?U.S.C. §§?1110, 1117, 1131, 5107(b); 38?C.F.R. §§?3.102, 3.301, 3.303, 3.307, 3.309, 3.317, 3.320.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran served on active duty in the United States Navy from September 1987 to July 1995.

This matter is before the Board of Veterans' Appeals (Board) on appeal from October 2024 and November 2024 Appeals Modernization Act (AMA) rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO).

In the appellant's February 2025 AMA Notice of Disagreement (NOD), he elected the Direct Review option; therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decisions on appeal, which are the October 2024 (TBI) and November 2024 (HA, GERD, ED) rating decisions. 38 C.F.R. § 20.301.

Notably, any evidence submitted after the AOJ decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was added to the claims file 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[s], 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 also highlights that the Veteran has other appeals as to issues which are not before the Board in the present appeal. This is so because the Veteran submitted multiple VA Form 10182 (AMA NOD) and under the AMA framework, the Board may not merge AMA appeals stemming from different AMA Notices of Disagreement. See 84 Fed. Reg. 138 (Jan. 18, 2019). Accordingly, the Veteran's other AMA appeals will be the subject of separate Board decisions, despite the fact the appeals may involve similar issues.

The Board apologizes for any confusion this may cause the Veteran.

SERVICE CONNECTION CLAIMS

The Veteran contends he is entitled service connection for his claims.

Direct service connection may be granted only when a disability or cause of death was incurred or aggravated in line of duty, and not the result of the veteran's own willful misconduct or, for claims filed after October 31, 1990, the result of his or her abuse of alcohol or drugs. 38 U.S.C. § 105(a); 38 C.F.R. § 3.301(a).

In this regard, for VA purposes, for a veteran to be entitled to VA disability compensation, the injury or disease from which the veteran's disability results must have been incurred during active military service "in line of duty" and not the result of the veteran's own misconduct. 38 U.S.C. § 105(a); 38 C.F.R. §§ 3.1(k), 3.1(m), 3.1(n), 3.301(a).

Put simply, federal law provides that no VA
, 1990, the result of his or her abuse of alcohol or drugs. 38 U.S.C. § 105(a); 38 C.F.R. § 3.301(a).

Put simply, federal law provides that no VA disability compensation shall be paid for a disability that is the result of the Veteran's own willful misconduct. 38 U.S.C. § 1110.

As such, the line of duty requirement acts as a pre-requisite to VA disability benefits.

Willful misconduct means an act involving conscious wrongdoing or known prohibited action. 38 C.F.R. § 3.1(n). Said another way, willful misconduct involves deliberate or intentional wrongdoing with knowledge of or wanton and reckless disregard of its probable consequences. 38 C.F.R. § 3.1(n)(1).

In any event, willful misconduct will not be determinative unless it is the proximate cause of injury, disease or death. 38 C.F.R. § 3.1(n)(3); see also Carter v. McDonough, 46 F.4th 1356 (Fed. Cir. August 29, 2022) (the statutory bar for service connection due to a Veteran's own willful misconduct requires that the misconduct be the "proximate cause" of the injury, disease, or death - direct causation is not required).

Importantly, the veteran does not bear the burden of proving that his injury was not the result of willful misconduct; rather, VA bears the burden of proving that it was. See Holton v. Shinseki, 557 F.3d 1362, 1366-69 (Fed. Cir. 2009). VA must establish by a preponderance of the evidence that the injury was proximately caused by an act of willful misconduct by the veteran. See Thomas v. Nicholson, 423 F.3d 1279, 1285 (Fed. Cir. 2005); Myore v. Brown, 9 Vet. App. 498, 503 (1996).

Additionally, the Board highlights that a service department finding that the injury, disease, or death occurred in line of duty and was not due to misconduct will be binding on VA unless it is patently inconsistent with the requirements of laws administered by VA. 38 C.F.R. §§ 3.1 (m), (n).

Notably, when the evidence of record includes service department findings, it is error for the Board to make its own findings of fact of line of duty and willful misconduct without addressing the service department findings before it. See Crediford v. Shulkin, 877 F.3d 1040, 1046-47 (Fed. Cir. 2017). "The regulations recognize that the Service Department is in the best position to assess willful misconduct and line of duty actions of its Service." Id. (citing United States v. Yellow Cab Co., 338 U.S. 338, 341 (1949)).

Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) a current disability, (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury, and (3) medical evidence or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

To establish service connection on a secondary basis, the evidence must show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)(b) (2016); Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); see also Ward v. Wilkie, 31 Vet. App. 233 (2019) (the Court redefined the definition of aggravation in the context of secondary service connection claims to include temporary flare
Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

In general, the absence of any one element will result in denial of service connection. Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006).

Moreover, service connection may be granted based on a post-service initial diagnosis of a disease if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38?C.F.R. §?3.303(d).

Certain chronic diseases, including migraine headaches as an organic disease of the nervous system, may be presumed to have been incurred during service if they become manifested to a compensable degree within one year of separation from active duty. 38?U.S.C. §§?1101, 1112, 1113, 1137; 38?C.F.R. §§?3.307, 3.309.

If a condition noted during service is not shown to be chronic, then a showing of continuity of symptomatology after service is generally required for service connection, but only if the disability is one that is listed in 38?C.F.R. §?3.309(a). 38?C.F.R. §?3.303(b); see also Walker v. Shinseki, 708 F.3d 1331, 1335 (Fed. Cir. 2013).

Furthermore, the Board notes that the Court in Joyner v. McDonald, 766 F.3d 1393, 1395 (Fed. Cir. 2014) held, in part, that the Board needs to always consider 38 U.S.C. § 1117 in cases where the Veteran has served in the Persian Gulf, since August 2, 1990.

For claims arising under 38 C.F.R. § 3.317 and § 3.320, qualifying service generally includes service in the Persian Gulf and Southwest Asia theater of operations during the Persian Gulf War as well as service in various other locations designated by the Secretary on or after September 19, 2001.

Under 38 U.S.C. § 101(33) and 38 C.F.R. § 3.2(i), the Persian Gulf War is defined as August 2, 1990, through date to be prescribed by Presidential proclamation or law.

The term Persian Gulf veteran means a veteran who served on active service in the Southwest Asia theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(e)(1).

Service connection and the laws and regulations surrounding presumptive service connection for Southwest Asia service and Persian Gulf War claims have become increasingly complex.

Initially, the Board notes service connection may be established on a presumptive basis for a Veteran with qualifying service who exhibits objective indications of a qualifying chronic disability provided that it became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2026, and which by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38?U.S.C. §?1117; 38?C.F.R. §?3.317(a)(1).

To fulfill the requirement of chronicity for the presumption of service connection the illness must have persisted for a period of six months. 38?C.F.R. §?3.317(a)(4).

A qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following): an undiagnosed illness, a medically unexplained chronic multi symptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms, or any diagnosed illness that the Secretary determines warrants a presumption of service-connection. 38?U.S.C. §?1117; 38?C.F.R. §?3.317.

"Objective indications" include both "signs," in the medical sense of objective evidence perceptible to
of six months. 38?C.F.R. §?3.317(a)(4).

"Objective indications" include both "signs," in the medical sense of objective evidence perceptible to a physician, and other, non-medical indicators that are capable of independent verification. 38?C.F.R. §?3.317(a)(3).

Signs or symptoms that may be a manifestation of an undiagnosed illness or a chronic multi symptom illness include the following: fatigue, unexplained rashes or other dermatological signs or symptoms, headache, muscle pain, joint pain, neurological signs and symptoms, neuropsychological signs or symptoms, signs or symptoms involving the upper or lower respiratory system, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, menstrual disorders. See 38?U.S.C. §?1117; 38?C.F.R. §?3.317(b).

The term medically unexplained chronic multi symptom illness means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. 38?C.F.R. §?3.317(a)(2)(ii).

The Board notes that, effective July 13, 2010, VA amended its adjudication regulations governing presumptions for Persian Gulf War veterans under 38 C.F.R. § 3.317(a)(2)(i)(B) to clarify that chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome are examples of medically unexplained chronic multi symptom illnesses and are not an exclusive list of such illnesses. See 75 Fed. Reg. 61997 (Oct 7, 2010).

Another type of presumption is also available for Veterans with qualifying service under 38 C.F.R. § 3.320, from August 5, 2021, when VA regulations were amended to establish presumptive service connection for three chronic respiratory health conditions, i.e., asthma, rhinitis, and sinusitis, to include rhinosinusitis, in association with presumed exposures to fine, particulate matter. See 75 Fed. Reg. 42724 (Aug. 5, 2021).

The listed diseases shall be service connected if manifested to any degree within 10 years from the date of separation from military service. 38 C.F.R. § 3.320(a)(1) (2021). However, on September 1, 2023, VA issued a final rule revising 38 C.F.R. § 3.320, with an effective date of October 31, 2023, and among other things, removed the 10-year manifestation requirements for asthma, rhinitis, and sinusitis (to include rhinosinusitis). See 88 Fed. Reg. 169, 60336 (Sep. 1, 2023).

Also of note, effective April 26, 2022, VA issued a final rule revising 38 C.F.R. § 3.320 to also establish presumptive service connection for nine rare respiratory cancers in association with presumed exposure to fine particulate matter. See 87 Fed. Reg. 24421 (Apr. 26, 2022). These cancers are presumed as due to exposure to fine particulate matter if manifested to any degree at any time following separation from a qualifying period of military service: squamous cell carcinoma of the larynx, squamous cell carcinoma of the trachea, adenocarcinoma of the trachea, salivary gland-type tumors of the trachea, adenosquamous carcinoma of the lung, large cell carcinoma of the lung, salivary gland-type tumors of the lung, sarcomatoid carcinoma of the lung, typical and atypical carcinoid of the lung. 38 C.F.R. § 3.320(a)(3).

The PACT Act also establishes additional presumptions of in-service exposure to burn pit and other environmental hazards for qualifying service in the Persian Gulf and Southwest Asia. See Pub. L. 117-168.

Under the PACT Act, the VA shall presume that any covered
squamous cell carcinoma of the trachea, adenocarcinoma of the trachea, salivary gland-type tumors of the trachea, adenosquamous carcinoma of the lung, large cell carcinoma of the lung, salivary gland-type tumors of the lung, sarcomatoid carcinoma of the lung, typical and atypical carcinoid of the lung. 38 C.F.R. § 3.320(a)(3).

Under the PACT Act, the VA shall presume that any covered veteran was exposed to the substances, chemicals, and airborne hazards identified by the Secretary during the service of the covered veteran unless there is affirmative evidence to establish that the covered veteran was not exposed to any such substances, chemicals, or hazards in connection with such service. 38 U.S.C. § 1119.

Relevant to Southwest Asia claims, the PACT Act, among other things, added more than 20 burn pit and other toxic exposure presumptive conditions for covered Veterans (within the meaning of 38 U.S.C. § 1119(c)) including: (1) asthma that was diagnosed after service; (2) the following types of cancer: (A) Head cancer of any type, (B) Neck cancer of any type, (C) Respiratory cancer of any type, (D) Gastrointestinal cancer of any type, (E) Reproductive cancer of any type, (F) Lymphoma cancer of any type, (G) Kidney cancer, (H) Brain cancer, (I) Melanoma, (J) Pancreatic cancer; as well as (3) Chronic bronchitis, (4) Chronic obstructive pulmonary disease, (5) Constrictive bronchiolitis or obliterative bronchiolitis, (6) Emphysema, (7) Granulomatous disease, (8) Interstitial lung disease, (9) Pleuritis, (10) Pulmonary fibrosis, (11) Sarcoidosis, (12) Chronic sinusitis, (13) Chronic rhinitis, (14) Glioblastoma. 38 U.S.C. § 1120(b).

Under 38 U.S.C. § 1120(a), a disease specified in subsection (b), above, becoming manifest in a covered veteran shall be considered to have been incurred in or aggravated during active service, notwithstanding that there is no record of evidence of such disease during the period of such service.

Moreover, under the PACT Act, VA must provide the Veteran with a medical examination that considers service connection for a claimed disability as due to a toxic exposure in situations where there is (a) evidence of a disability, (b) evidence of participation in a toxic exposure risk activity (TERA), and (c) not enough evidence to establish service connection for the disability. 38 U.S.C. § 1168(a).

However, no examination is required if the Secretary has determined there is no indication of an association between the claimed disability and a TERA. 38 U.S.C. § 1168(b).

In this regard, a TERA examination is required unless the claimed disability (1) is based on physical trauma, (2) is a mental disorder, (3) did not manifest during service, or (4) has an etiology not associated with toxic exposure. See VBA Letter 20-22-10, pp. 10-12 (Dec. 22, 2022). Accordingly, a TERA examination is not warranted in either of these cases under the PACT Act.

While the PACT Act amendment is not effective until October 1, 2026, in an Executive Decision Memorandum (EDM) dated September 20, 2022, VA adopted the Office of General Counsel's interpretation of the PACT Act and VA has, in substance, added the above conditions to the list of presumptive disorders due to burn pit and other toxic exposure without waiting for the 2026 phase-in date.

In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (200
above conditions to the list of presumptive disorders due to burn pit and other toxic exposure without waiting for the 2026 phase-in date.

In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995).

Importantly, the Veteran bears the burden of presenting and supporting his claim for benefits. See 38 U.S.C. § 5107(a). In its evaluation, the Board considers all information and lay and medical evidence of record. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board gives the benefit of the doubt to the claimant. Id; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

1. Entitlement to service connection for migraine headaches

2. Entitlement to service connection for traumatic brain injury (TBI)

3. Entitlement to service connection for gastroesophageal reflux disease (GERD)

4. Entitlement to service connection for erectile dysfunction (ED)

As an initial matter, the service records indicate the Veteran is a Persian Gulf veteran pursuant to 38 U.S.C. § 1117(f).

In this case, the Veteran is a qualifying "Persian Gulf veteran" as defined by law. 38 U.S.C. § 1117(f); 38 C.F.R. §§ 3.317(e)(2), 3.320(a)(5).

Therefore, the Board finds that it is required to consider 38 U.S.C. § 1117, 38 C.F.R. § 3.317 and § 3.320 in this claim.

The appellant first contends that he meets the basic eligibility for VA benefits for his claimed migraine headache (HA) and TBI disabilities due to trauma sustained in a July 1993 motor vehicle accident (MVA) during service. See December 2021 Lay Statement; September 2022 Correspondence.

Based on the competent, credible and probative evidence cited below, the Board finds that any injuries stemming from the July 1993 MVA were the result of the appellant's willful misconduct and therefore not in line of duty. See 38 U.S.C. §§ 105(a), 1110.

The service records confirm the appellant was in a MVA in July 1993. The MVA was caused when the appellant hit another car while driving under the influence and crashing into a third vehicle.

Notably, he was traveling eastbound in the westbound lane of a major interstate highway at the time. See First Endorsement for Investigation of Line of Duty, opinions by J.H.Y., September 1993.

He was ultimately medically discharged for his injuries stemming from the accident.

In this case, the Board finds the preponderance of the evidence shows that the injuries were proximately caused by an act of willful misconduct by the veteran.

In this regard, the investigative reports and service department line of duty findings all unanimously show the appellant's reckless driving on the wrong side of the highway, his intoxication at the time of the accident and his failure to obey police orders to stop prior to the accident, were the direct and proximate cause of the injuries. The evidence in this case is highly probative against the Veteran's claim.

Specifically, the investigation reports in service show the appellant's blood alcohol content at the time of the accident was 0.19 (e.g., per the reports, over the legal limit), he exhibited "aberrant behavior" as seen by accessing a "major interstate highway" driving "eastbound in the westbound lane" (e.g., in the wrong direction); he showed complete non-responsiveness to police-attempts to attract his attention to the fact he was traveling on the wrong side of the highway (e.g., reportedly, with flashing lights as they tried to wave him down); he
were the direct and proximate cause of the injuries. The evidence in this case is highly probative against the Veteran's claim.

Specifically, the investigation reports in service show the appellant's blood alcohol content at the time of the accident was 0.19 (e.g., per the reports, over the legal limit), he exhibited "aberrant behavior" as seen by accessing a "major interstate highway" driving "eastbound in the westbound lane" (e.g., in the wrong direction); he showed complete non-responsiveness to police-attempts to attract his attention to the fact he was traveling on the wrong side of the highway (e.g., reportedly, with flashing lights as they tried to wave him down); he crashed into other cars while driving on the wrong side of the highway; and his combative behavior with police subsequent to the accident, provide the Board with sufficient evidence to warrant a finding of willful misconduct in causing the July 1993 MVA and thus, by proximity, the injuries stemming from that accident. See First Endorsement for Investigation of Line of Duty, opinions by J.H.Y., September 1993.

The appellant's injuries stemming from the July 1993 accident were found not incurred in the line of duty by the service department. Furthermore, the injuries that he sustained in the July 1993 MVA were found to be due to his own misconduct by the service department as well. See Third Endorsement for Investigation of Line of Duty, November 1993.

In this regard, the Board agrees with the service department findings.

Namely, the Veteran's misconduct of driving down the wrong side of the highway, while his blood alcohol content was above the legal limit and the resulting MVA that caused injuries to himself and others, was shown to be willful and the injuries deriving from that misconduct cannot therefore now be said to have been incurred in the line of duty. See 38 C.F.R. § 3.301.

While the Board acknowledges the Veteran's assertions in this claim, there is nothing in the record to discount the highly probative value of the service department findings and the Board finds the three separate military commander endorsements made by the line of duty investigators during service to be highly probative evidence against his current assertion that his injuries, to include headache and TBI, stemming from the July 1993 MVA, were in the line of duty.

Given all the above, the Board finds that his claim for injuries sustained in the July 1993 MVA, to include migraine headaches and TBI, cannot be said to have been incurred in line of duty and therefore, service connection on this basis, must be denied. 38 C.F.R. § 3.301.

Alternatively, the Veteran contends that his migraine headaches, TBI, GERD and ED conditions are otherwise due to service.

Turning to the evidence, the record shows the Veteran has a current diagnosis of erectile dysfunction (ED), migraine headaches (HA's), gastroesophageal reflux disease (GERD) and a history of traumatic brain injury (TBI).

Notwithstanding the singular notation of a complaint of a headache during service, related to an upper respiratory infection (assessed as "URI"), the Board finds the service treatment records are silent as to complaints, treatment or diagnoses of ED, HA's, GERD and TBI.

Accordingly, the service treatment records lack the combination of manifestations sufficient to identify a chronic disability as distinguished from merely isolated findings.

The Board has reviewed the service treatment records very closely. It is important for the Veteran to understand that these records provide particularly negative evidence against his claims, clearly indicating he had treatment for many other problems during service, to include hospitalizations, but did not cite to having any problems with HA's, TBI, GERD, and ED.

Furthermore, there is no evidence of any complaint, treatment or diagnosis of migraine headaches, TBI, GERD, and ED in the first year after leaving service.

As such, service connection cannot be established for migraine headaches, TBI, GERD, and ED disabilities on a presumptive basis for chronic conditions. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309.

Following service, the medical and lay evidence shows that the Veteran's migraine headaches were not reported to have started until 2020. See January 2022 VA Examination for Headache Conditions. The appellant reported he had migraine headaches "on and off due to hypertension since 2020."

The medical evidence supports his claim that he began having migraine headaches in 2020, but not before. See CAPRI Records, Received by VA, October 3, 2024. Notably, throughout his treatment at VA, to include a number of clinical visits and multiple hospitalizations for seizures, the Veteran denied having headaches in the large majority (if not all) of his clinical visits prior to 2020. Tellingly, while investigating the etiology and status of his seizures due to TBI in 2015 and 2017, the Veteran often and repeatedly denied having headaches as a symptom, between 2015 and 2020. Id.

Given the above, the Board finds his current migraine headache condition began in 2020. Therefore, onset for his claimed headache condition is shown by the best available evidence to be 25 years after leaving service.

Post service VA treatment records in September 2015 also indicate the Veteran suffered a TBI with subarachnoid hemorrhage after "falling on some stairs approximately 3 years ago" (e.g., 2012). In 2015, the Veteran began suffering from seizures that were at least in part due to his TBI from 2012. He was diagnosed with a seizure disorder in part due to the 2012 TBI.

The Board notes the onset of his current TBI is shown by the best available evidence to be 2012 and therefore 17 years after leaving service due to a post-service accident (fall).

His ED reportedly began in 2014, as reported by the Veteran. See October 2024 VA Examination for Male Reproductive Organ Conditions. This is nearly two decades after the Veteran left service.

Furthermore, nearly thirty years after service, the Veteran asserted that his GERD began in 1995. See October 2024 VA Examination for Esophageal Conditions. However, it went undiagnosed. He reported that he took TUMS to self-treat the condition but in 2000 he began having worsening symptoms and sought treatment at VA. Id.

In this regard, the Board finds that while the Veteran is competent to report symptoms, he is not competent to diagnose the medical condition of GERD in 1995 or render an etiology of his current GERD condition because of the medically complex nature of such a diagnosis or opinion. Layno v. Brown, 6?Vet. App.?465 (1994); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); see Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis); Kahana v. Shinseki, 24?Vet. App.?428, 435 (2011).

However, nonetheless, the VA treatment records show that the Veteran began seeking treatment for GERD in 2004. See CAPRI Records, Received by VA, October 3, 2024.

Accordingly, the Board notes the onset of his current GERD is 2004 and therefore nearly a decade after leaving service.

To the extent the Veteran implicitly requests a VA examination for his HA's, GERD, TBI and ED by virtue of his application for benefits, the United States Court of Appeals for Veterans Claims (Court) has found there are four elements to review to determine if a medical examination is necessary: (1) competent evidence of a current disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. 38?U.S.C. §?5103A(d)(2); 38?C.F.R. §?3.159(c)(4)(i); see also McLendon v. Nicholson, 20?Vet. App.?79 (2006).

Here, the Board notes that there is no competent evidence of an event, injury, or disease occurring in
or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. 38?U.S.C. §?5103A(d)(2); 38?C.F.R. §?3.159(c)(4)(i); see also McLendon v. Nicholson, 20?Vet. App.?79 (2006).

Here, the Board notes that there is no competent evidence of an event, injury, or disease occurring in service for HA's, GERD, TBI and ED, for the reasons explained above. As such, remand for VA medical opinions is not warranted.

The Board is also mindful that the AOJ made a favorable finding based on the evidence that the Veteran has TERA participation.

The Veteran underwent an examination for his GERD and migraine headache conditions with a medical opinion based on toxic exposure risk activity (TERA) in October 2024.

The examiner found that although the evidence of record shows participation in a TERA, the evidence does not show an association between the claimed GERD and headache disability and any in-service TERA.

The Board finds the VA examiner's opinions to be highly probative. The opinions were based on a thorough review of the claims file, including the service treatment records and examination of the Veteran, as well as his lay statements and the opinions are consistent with other evidence of record. Moreover, the examiners provided adequate rationales for their opinions.

Put simply, there is no medical or lay evidence of a migraine headache condition or a GERD condition diagnosed during service.

Accordingly, the Board finds his migraine headache and GERD condition are not shown to be due to an in-service TERA. Notably, TBI is based on physical trauma and ED is not associated with toxic exposure and therefore TERA examinations are not required for these disabilities.

Moreover, the Board acknowledges the record contains a favorable February 2022 VA medical opinion as to his assertion of the claim for headaches. However, while the February 2022 medical opinion, to include several addendum opinions, have been considered, the Board finds that they are not more probative than the October 2024 VA opinion. In this regard, the February 2022 VA examiner reported the Veteran's service records show a single complaint of a headache in 1990 and opines that his headache "symptoms have been present continuously since that point". However, as noted above, the great weight of the clinical evidence of record, known at the time of the examination, included service and post-service medical and lay evidence that clearly shows the Veteran expressly denied having headaches during service and for more than twenty years after leaving service.

Put simply, the Board finds the February 2022 VA opinion lacks probative value because it is not supported by any clinical data, and actually contradicts the clinical data, especially given this record in particular. See Black v. Brown, 5?Vet. App.?177, 180 (1995) (holding that a medical opinion is inadequate when it is unsupported by clinical evidence).

As such, the Board finds the October 2024 VA opinion on his headache condition being due to TERA and/or service is not adequate and in any event, not more probative than the October 2024 VA examination and the many years of VA treatment records to the contrary.

Finally, the Veteran also asserts that his headaches are due to his service connected hypertension and they began in 2020. See December 2021 VA Examination for Headaches.

Here, while the Veteran is competent to report observable symptomatology, he is not competent render an etiology of his current migraine headache condition, as this requires special testing, to include studies, and specialist knowledge to make such a finding. Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007).

The Veteran underwent a VA medical examination for his headaches in February 2022. The examiner, Dr. M.P., opined that the migraine headache condition is less likely than not due to or the result of the Veteran's service connected hypertension condition. In support, as annotated by Dr. M.P., hypertension is not an established primary etiology of chronic headaches in the medical literature. It was also noted that chronic headaches represent an exceedingly common condition which often occur without any pre-existing etiology whatsoever.

In this regard, the Board finds the opinions of Dr. M.P. more probative than the appellant's lay statements to the contrary. See Sickels v. Shinseki, 643 F.3
2007).

In this regard, the Board finds the opinions of Dr. M.P. more probative than the appellant's lay statements to the contrary. See Sickels v. Shinseki, 643 F.3d 1362, 1366 (Fed. Cir. 2011) (noting that, in the absence of clear evidence to the contrary, VA medical examiners are presumed competent); see also AMERICAN MEDICAL ASSOCIATION CODE OF MEDICAL ETHICS, Principle of Medical Ethics V ("A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education....").

Given all the above, the Board finds the VA opinion on secondary service connection to be highly probative since Dr. M.P. stated plainly that medical literature does not support the Veteran's lay hypothesis that his headaches are due to hypertension. See Guerrieri v. Brown, 4 Vet. App. 467, 473 (1993) ("...the probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches.... As is true with any piece of evidence, the credibility and weight to be attached to these opinions [are] within the province of the [Board as] adjudicators). Therefore, the Board finds that the medical opinion is highly probative evidence against the claim.

Significantly, there is no competent medical opinion of record providing for the possibility that the current migraine disability is related to a hypertension disability nor is there competent evidence linking the Veteran's complaints of a migraine condition to his hypertension in the record. See Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990) (where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence to the effect that the claim is "plausible" or "possible" is required).

Therefore, in the absence of an in-service incurrence for any of the claimed disabilities on appeal, or any nexus to service, to include consideration of chronic conditions with continuity of symptoms, or with participation in TERA, or under line of duty determination, the claims for service connection must be denied. See Coburn, supra.

In reaching the above conclusions the Board has considered the applicability of the benefit of the doubt doctrine. However, as there is not an approximate balance of positive and negative evidence regarding the claim that doctrine is not applicable in this case. See 38?U.S.C. §?5107(b); 38?C.F.R. §?3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

John J. Crowley

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Davidson, Christopher M.

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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