Citation Nr: 20005074 Decision Date: 01/22/20 Archive Date: 01/22/20 DOCKET NO. 16-28 612 DATE: January 22, 2020 REMANDED Service connection for headaches.   REASONS FOR REMAND The Veteran served on active duty from August 1988 to January 1993, August 1999 to September 2000, September 2001 to July 2002, October 2003 to September 2004 and October 2004 to March 2005. She had additional service in the Air Force National Guard. The case is on appeal from an August 2015 rating decision. In the June 2016 substantive appeal, the Veteran requested a Board hearing. A hearing was scheduled for July 2019. However, in July 2019, the Veteran’s representative indicated she withdrew the hearing request. Accordingly, the Board considers the Veteran’s request for a hearing to be withdrawn. See 38 C.F.R. § 20.704(e). Service connection for headaches. The Veteran contends that she has chronic headaches had their onset during service. Alternatively, she asserts that the disorder was caused or aggravated by her service-connected sinusitis. The Veteran’s service treatment records (STRs) show that she reported headache symptoms during service and that her headache symptoms may be associated with her service-connected sinusitis. The Veteran’s May 1988 enlistment examination was silent for headaches. However, a November 1988 STR showed she reported headaches. A June 1989 record indicated occasional headaches. May 1993 and May 1996 records noted frequent headaches, including sinus headaches. A November 2001 record showed headaches. Additionally, shortly after the Veteran’s active service periods, a November 2006 record noted headaches, and December 2006 and January 2007 records indicated frequent severe headaches. Following the Veteran’s June 2015 claim, the Veteran was afforded an August 2015 VA examination in which she was diagnosed with tension headaches, including constant head pain, pulsating or throbbing head pain and pain on both sides of the head. The examiner indicated the Veteran’s headaches are less likely than not incurred in or caused by service. She stated her service treatment records show headaches in 1989 and 1998, post-separation in 2007. She noted there are no other entries found to support chronicity of headaches to service, or that the disorder is otherwise related to service. Thereafter, a January 2016 medical opinion was submitted from Dr. Stuart. She opined after review of the Veteran’s medical records, there is sufficient documentation that the Veteran has chronic headaches dating back to at least 1989, when she was on active duty. Additionally, there is medical evidence of record which tends to associate the Veteran’s headaches with her service-connected sinusitis. June and August 2015 medical records indicated the Veteran suffers from sinus headaches a few times per week. During the August 2015 VA sinus examination, the Veteran reported experiencing “sinus headaches every day since about 1993.” A January 2020 brief in support was also submitted that includes websites that generally support that veterans are more susceptible to migraines and experience greater symptoms from migraines. Therefore, there is medical evidence of record in favor of and against the service connection claim. Due to the conflict in the medical evidence, the Board finds an additional VA examination is warranted to determine the nature and etiology of the Veteran’s headaches. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination by an appropriate medical professional to determine the nature and etiology of her headaches. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s headaches had their onset during, or are otherwise related to, service, to include the Veteran’s in-service reports of headaches. If not directly related to service, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the headaches were caused or aggravated by her service-connected disabilities, to include sinusitis. The term “aggravation” means an increase in severity beyond the natural progress of the disorder. A complete rationale or explanation should be provided for any opinion reached. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Isaacs, Counsel 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.