Citation Nr: 18142672 Decision Date: 10/16/18 Archive Date: 10/16/18 DOCKET NO. 16-29 700 DATE: October 16, 2018 REMANDED Entitlement to service connection for a left hip disability, to include as secondary to her service-connected disabilities, is remanded. Entitlement to service connection for migraines, to include as due to her service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran had active service in the United States Army from July 1997 to July 2004. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for a left hip disability, to include as secondary to her service-connected disabilities, is remanded. The Veteran asserts service connection for a left hip disability. The Board notes that the Veteran has left extremity radiculopathy as well as a documented left hip labral tear. The Veteran underwent a VA examination in January 2015. Although it was noted that the Veteran had a labral tear in her left hip, the examiner only provided that there was an “other” diagnosis for her left hip. Abnormal range of motion and painful motion was recorded on examination. The examiner determined that there was no relationship between the Veteran’s current symptoms and her service-connected back disability. An additional VA examination was performed in February 2015. The Veteran was diagnosed with radiculopathy. Concerning the Veteran’s left hip labral tear, the examiner found that it was a separate and mutually exclusive disorder from her service-connected disabilities. The examiner noted that labral tears can be due to repetitive micro-traumatic injuries due to overuse. The Board finds these examinations to have limited probative value. The examiner did not account for the Veteran’s assertions regarding overcompensating because of pain from her service-connected disabilities. Moreover, an opinion was not given regarding the Veteran’s radiculopathy. Additionally, the Veteran has presented competent evidence that provides a nexus between her disability and her service-connected disability. The Veteran is a registered nurse who is competent to provide a medical opinion. See Jones v. West, 12 Vet. App. 460, 465 (1999). She asserts that her left hip labral tear is due to instability in her gait because of her service-connected disabilities. While the Veteran is competent to testify as to the etiology of her left hip labral tear, the Board finds that a new VA examination is needed to further clarify any current left leg disabilities as well as their etiology. 2. Entitlement to service connection for migraines, to include as due to her service-connected disabilities, is remanded. The Veteran asserts service connection for a migraine disability. The Board notes that the Veteran has a diagnosis of migraines. The Veteran underwent a VA examination in January 2015. The examiner determined that the Veteran’s migraines were not related to her service-connected disabilities as a migraine with aura is a separate mutually exclusive disorder when compared to a cervicogenic headaches (one that is caused by cervical disorders). The Board finds this examination to have limited probative value as well. The examiner overly relied on the Veteran’s migraines solely being aura migraines. However, medical records show that it has not been determined that the Veteran has only aura migraines. The Veteran has since presented testimony that provides a nexus between her disability and her service-connected disability. The Veteran is a registered nurse who is competent to provide a medical opinion. See Jones v. West, 12 Vet. App. 460, 465 (1999). She asserts that her migraines are secondary to her service-connected disabilities because her service-connected disabilities have increased in pain which in turn cause her migraines to be more frequent and debilitating. While the Veteran is competent to provide evidence regarding her migraines and relationship with her service-connected disabilities, the Board finds that a new VA examination is needed to determine whether the Veteran has migraines that are separate from aura migraines and whether they are secondary to her service-connected disabilities. The matters are REMANDED for the following actions: 1. Obtain any outstanding VA treatment records. All requests and responses for the records must be documented. If any identified records cannot be obtained, notify the Veteran of the missing records, the efforts taken, and any further efforts that will be made by VA to obtain such evidence, and allow her an opportunity to provide the missing records. 2. After associating any treatment records with the claims file, then schedule the Veteran for an appropriate VA examination (with a different VA examiner than the January and February 2015 VA examinations) to determine the nature and etiology of the Veteran’s left leg disability. The claims file, including this remand, must be reviewed by the examiner and such review should be noted in the examination report. Please note that the Veteran has diagnoses of a left hip labral tear as well as radiculopathy. Any other left leg disability should be noted, and an opinion provided as discussed below. 3. After reviewing the record and examining the Veteran, the examiner is to respond to the following: (a.) Is it at least as likely as not (50 percent or greater) that any left leg disability was caused by a disease or injury in service? (b.) If no, is it at least as likely as not (50 percent or greater) that any left leg disability was either 1) proximately due to or 2) aggravated by any service-connected disability? ** Please acknowledge and account for the Veteran’s statements, to include on her VA Form 9, regarding the etiology of any left leg disability. ** 4. After completion of the above, schedule the Veteran for a VA examination (separate VA examiner than the January 2015 VA examination) to determine the etiology of her migraine headaches. (a.) Is it at least as likely as not (50 percent or greater) that any migraine disability was caused by a disease or injury in service? (b.) If no, is it at least as likely as not (50 percent or greater) that any migraine disability was either 1) proximately due to or 2) aggravated by any service-connected disability? ** Please acknowledge and account for the Veteran’s statements to include on her VA Form 9, regarding the etiology of any migraine disability. ** The term “aggravated” refers to a worsening of the underlying condition beyond the natural progression of the disease, as opposed to temporary or intermittent flare-ups or symptoms that resolve with return to the baseline level of disability. If aggravation is found, please state, to the extent possible, the baseline level of disability prior to aggravation. (Continued on the next page)   A comprehensive rationale for all opinions must be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be provided without resorting to speculation, the examiner must explain why this is so and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Morales, Associate Counsel