Citation Nr: 18159911 Decision Date: 12/21/18 Archive Date: 12/20/18 DOCKET NO. 17-02 222 DATE: December 21, 2018 REMANDED Entitlement to a compensable evaluation for migraines is remanded. REASONS FOR REMAND 1. Entitlement to a compensable evaluation for migraines is remanded. The Veteran was afforded a VA examination in August 2015 to assess the nature and severity of his migraine disability. The examiner noted the Veteran’s medical history as chronic headaches that start from the neck and progress to the entire head, productive of a pounding sensation and a sensation of his head feeling “squished,” along with hazy vision and poor appetite. The Veteran reported episodes occurring two to three times a week, lasting up to four hours. However, the examiner opined that the Veteran does not have characteristic prostrating attacks. No explanation was given. Nevertheless, the examiner remarked that the Veteran’s migraines affect his ability to work. Specifically, the examiner noted that they interfere with focusing ability and executive function. Also associated with the record is a November 2015 private primary care provider letter, which reflects that the Veteran was seeking treatment for recurring migraines occurring two to three times a month. In addition to the private provider’s letter, the Veteran has also submitted several lay statements for consideration. Specifically, the Veteran’s November 2015 notice of disagreement indicates that when he gets migraine attacks, which occur weekly, he is unable to work. Additionally, a statement received in January 2017 reflects that the Veteran again reported migraine attacks occurring two to three times a month. He described extreme difficulty to do any task, inability to watch television or listen to the radio, and that he has to go to a dark room to lie down. In essence, the Veteran describes his migraine attacks as completely debilitating. The Veteran’s lay statements are corroborated by his children’s statements. The Board finds that the Veteran’s reports are credible. The Veteran’s description of symptoms is corroborated, not only by his children’s statements, but also by the VA examination of record as well as the November 2015 primary care note. However, there is a discrepancy between the Veteran’s description of migraine attacks and the VA examiner’s opinion that his migraines are not prostrating. Further, the evidence of record indicates that his migraines may have worsened since his last VA examination. The Board finds that he should be afforded new examination in order to determine the current nature and severity of his service-connected migraines. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Furthermore, the Board finds that updated medical records should be associated with the claims file. The Veteran has indicated that he has sought regular treatment for migraines at M.F.S.F.H. and Associates, a private medical facility. Thus, on remand, any such records should be obtained and associated with the claims file. The matter is REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records, to include records from M.F.S.F.H. and Associates. For outstanding private treatment records, request that the Veteran submit or authorize for release such private treatment records. After obtaining authorization from the Veteran, request copies of any outstanding treatment records from any treatment provider identified by the Veteran. If VA is unable to obtain such records, the Veteran should be afforded the opportunity to furnish such records directly to VA. All records received should be associated with the electronic claims file. 2. Schedule the Veteran for VA examination to determine the nature and severity of his service-connected migraines. The claims folder and this remand must be made available to the examiner for review, and the examination report must reflect that such a review was undertaken. The examiner must obtain a detailed clinical history from the Veteran and must note all pertinent pathology found on examination in the report of the evaluation. Any testing deemed necessary should be performed. The examiner must provide a full description of each disability and report all signs and symptoms necessary for evaluating the Veteran’s disabilities under the rating criteria. The examiner must comment on the functional effects of each disability evaluated. The examiner is asked to reconcile the conflicting evidence of record, and provide an assessment on the nature and severity of the Veteran’s migraines, including whether any of the Veteran’s migraines are prostrating in nature, for the entire period on appeal. The examiner must also specifically address how often the Veteran has migraines, how often they are prostrating, how long they last, and whether they result in economic inadaptability. In so doing, the examiner must address the private treatment note of record indicating the frequency of the Veteran’s migraine attacks, and the Veteran’s testimony descriptive of debilitating symptoms. The rationale for any opinion rendered must be provided. If the examiner is unable to offer any opinion without speculation, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G.C., Associate Counsel