Citation Nr: 18148284
Decision Date: 11/07/18	Archive Date: 11/07/18

DOCKET NO. 12-15 414
DATE:	November 7, 2018
REMANDED
Entitlement to service connection for headaches, to include as secondary to service-connected deviated nasal septum and residuals of a right clavicle fracture with arthritis, is remanded.
REASONS FOR REMAND
The appellant is a Veteran who served from November 1977 to October 1980.  This case comes to the Board of Veterans’ Appeals (Board) on appeal from a December 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).  The Board remanded this case to the RO in November 2013 and May 2015.  A June 2016 Board decision, in pertinent part, denied service connection for headaches.  The Veteran appealed the Board’s decision as to the denial of service connection for headaches to the United States Court of Appeals for Veterans Claims (CAVC), which in a March 2018 Memorandum Decision vacated the Board’s decision as to the headache disability claim and remanded the case to the Board for action consistent with the Memorandum Decision.  
The Veteran has also appealed the issues of entitlement to service connection for tinnitus and a total disability rating based on unemployability due to service-connected disability.  In February 2018, the Board remanded the case to the RO for additional development of these matters, and as such development and readjudication of the issues by the RO are still pending, they are not properly before the Board for review.     
Entitlement to service connection for headaches is remanded.
In its Memorandum Decision of March 2018, the CAVC determined that it had discretion to consider an argument not raised before the Board, namely, that the Veteran’s headaches are secondary to his service-connected right shoulder disability.  It was noted on a July 2015 Social Security Administration (SSA) evaluation, the examiner found that it was “possible” that the Veteran’s chronic use of pain relievers – the records indicate use of tramadol and naproxen for his right shoulder disability and other musculoskeletal conditions – “may have resulted in daily headaches.”  The CAVC also determined that the issue of headaches, as secondary to pain medication taken for treatment of the service-connected right clavicle injury, was reasonably raised by the record and that the Board erred by not addressing it.  
The Board cannot make a fully-informed decision on the issue of service connection for headaches until the Veteran undergoes a VA examination to determine the probability of his headaches being secondary to his chronic pain medications for his right shoulder disability.  
The matter is REMANDED for the following action:
Arrange for the Veteran to be examined by an appropriate clinician to determine the nature and etiology of his headaches.  His claims folder must be reviewed by the examiner in conjunction with the examination.  Specifically, the examiner is asked to opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s headaches are proximately due to or aggravated (a permanent increase in severity beyond natural progress) by his service-connected right shoulder disability and the pain medication taken to treat it.  
The examiner must explain the rationale for all opinions, citing to relevant evidence, supporting factual data, medical literature, and prior medical opinions, as deemed appropriate.  The examiner is asked to specifically comment on the July 2015 SSA examiner’s statement regarding a possible relationship between the Veteran’s chronic use of pain relievers (tramadol and naproxen) for his right shoulder disability and his headache disability.  
 
George R. Senyk
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Debbie Breitbeil, Counsel