Citation Nr: 18153435 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 07-10 697 DATE: November 27, 2018 REMANDED Entitlement to service connection for headaches, to include either as due to an undiagnosed illness or as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The issue of entitlement to a total disability rating due to service-connected disabilities (TDIU) has been raised by the record in a February 2016 application for TDIU and has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over that issue and it is referred to the AOJ for appropriate action. 38 C.F.R. § 19.9(b). Entitlement to service connection for headaches, to include either as due to an undiagnosed illness or as secondary to service-connected disabilities, is remanded. Unfortunately, there has not been substantial compliance with the Board’s previous remand requests regarding the issue of entitlement to service connection for headaches. In August 2016, the Board remanded the claim for service connection for headaches for the scheduling of an additional examination to determine the etiology of that disabilty. The Board specifically requested that the VA examiner who performed the examination provide opinions regarding whether the claimed headaches were permanently aggravated beyond their natural progression by any service-connected disability. In a May 2018 examination report and September 2018 addendum, written in attempted compliance with the Board’s request, the examiner, a nurse practitioner, did not provide the requested aggravation opinions. Furthermore, in explaining the opinion regarding whether Veteran's disabilities were related to either service, an undiagnosed illness, or a service-connected disability, the examiner merely quoted generic literature regarding headaches without making references to the Veteran's own clinical history. As recitations of medical literature without references to the Veteran's specific disability history are not probative evidence, remand is required to schedule further VA examination. Stegall v. West, 11 Vet. App. 268 (1998). The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from September 2018 to the Present. 2. Schedule the Veteran for a VA neurology examination to be performed by a neurologist to determine the etiology of a headache disability. The examiner must review the record and must note that review in the report. The examiner should note and comment on the treatment records and the Veteran's lay statements. The examiner should also note the opinion offered by Dr. Lisa Miller, submitted in June 2018, and should comment on the bases for any agreements or disagreements with that opinion. Any required tests should be conducted. A complete rationale should be given for all opinions and conclusions expressed. After a review of all evidence, the examiner is asked to opine as to the following: (a) Is it at least as likely as not (50 percent probability or greater) that the Veteran's reported headache symptoms, dating back to the June 2006 date of the claim, can be attributed to any known clinical diagnosis or are evidence that the Veteran has a chronic disability due to an undiagnosed illness, or medically unexplained chronic multisymptom illness, secondary to service in Southwest Asia during the Persian Gulf War? (b) If the Veteran's headache symptoms, dating back to the June 2006 date of the claim, can be attributed to a known clinical diagnosis, is it at least as likely as not (50 percent or greater probability) that they are related to service or any incident of service, to include any exposure to toxins during service? (c) If the Veteran's headache symptoms, dating back to the June 2006 date of the claim, can be attributed to a known clinical diagnosis, is it at least as likely as not (50 percent or greater probability) that they have been caused or aggravated (permanently increased in severity beyond the natural progress of the disorder) by a service-connected psychiatric disability, to include any medication taken for that disability? (d) If the Veteran's headache symptoms, dating back to the June 2006 date of the claim, can be attributed to a known clinical diagnosis, is it at least as likely as not (50 percent or greater probability) that they have been caused or aggravated (permanently increased in severity beyond the natural progress of the disorder) by a service-connected skin disability, to include any medication taken for that disability? (e) If the Veteran's headache symptoms, dating back to the June 2006 date of the claim, can be attributed to a known clinical diagnosis, is it at least as likely as not (50 percent or greater probability) that they have been caused or aggravated (permanently increased in severity beyond the natural progress of the disorder) by service-connected immune thrombocytopenic purpura, to include any medication taken for that disability? (f) If the Veteran's headache symptoms, dating back to the June 2006 date of the claim, can be attributed to a known clinical diagnosis, is it at least as likely as not (50 percent or greater probability) that they have been caused or aggravated (permanently increased in severity beyond the natural progress of the disorder) by service-connected numbness and paresthesia of the upper and lower extremities, to include any medication taken for that disability? (g) If the Veteran's headache symptoms, dating back to the June 2006 date of the claim, can be attributed to a known clinical diagnosis, is it at least as likely as not (50 percent or greater probability) that they have been caused or aggravated (permanently increased in severity beyond the natural progress of the disorder) by a service-connected eye disability, to include any medication taken for that disability? Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T.M. Gillett, Counsel