Citation Nr: 20021776 Decision Date: 03/27/20 Archive Date: 03/27/20 DOCKET NO. 19-25 573 DATE: March 27, 2020 REMANDED Entitlement to a compensable initial rating for tension headaches is remanded. Entitlement to service connection for costochondritis is remanded. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1998 to August 2018. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). REASONS FOR REMAND 1. Entitlement to a compensable rating for tension headaches is remanded The Veteran was most recently afforded a VA examination as to his tension headaches in April 2018. In his June 2019 notice of disagreement (NOD), the Veteran through his representative asserted that his condition has worsened. Specifically, the representative contends that the Veteran has debilitating episodes of tension headaches at least once to twice weekly. He further asserts that the Veteran has headaches on a daily basis. As this suggest a possible worsening of headaches since the April 2018 VA exam, a remand is warranted to determine the current severity of the condition. Prior to arranging for the Veteran to undergo further VA examination, to ensure that all due process requirements are met, and that the record is complete, the AOJ should undertake appropriate action to obtain all pertinent, outstanding records. 2. Entitlement to service connection for costochondritis is remanded The Veteran through his representative contends that he had costochondritis in service and still suffers from it to this date. See the Veteran’s NOD dated June 2019. In this regard, the Veteran, through his representative, has suggested that the Veteran’s chest pain is related to his service-connected lumbosacral spine disability. Id. In this regard, the Veteran contended that a treatment provider at Eglin Air Force Base, Dr. R.M., informed him that his “spine is out of alignment and when the discs move out of place in the spine, that also moves the ribs, which is why his medical records has over 20 different documentations of dull to sharp rib pain”. Id. He asserts that his ribs connect to this sternum and that is what causes the costochondritis. Id. Given the Veteran’s competent contentions of continuing chest pain, as well as his assertions of secondary service connection, the Board finds that, upon remand, he should be afforded a new VA examination. The Board notes that in the June 2019 NOD, the Veteran’s attorney indicated that the Veteran has obtained private medical treatment for his claimed costochondritis. Accordingly, upon remand, the Veteran should again be asked to identify all pertinent outstanding private treatment records, so that said records may be obtained and associated with his claims file. REASONS FOR REMAND The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his costochondritis and tension headaches. After securing any necessary releases, request any relevant records identified, obtain all outstanding treatment records. If any requested records are unavailable, the Veteran and his representative should be notified of such. 2. Obtain all outstanding records of VA evaluation and/or treatment of the Veteran. Follow the procedures set forth in 38 C.F.R. § 3.159(c) with respect to requesting records from Federal facilities. All records/responses received should be associated with the claims file. 3. Schedule the Veteran for an examination by an appropriately qualified medical professional to determine the nature and etiology of any current costochondritis disability. The examiner is requested to review the claims file in its entirety including all service treatment records, VA, and private treatment records. (a). The examiner should identify any current costochondritis disability. (b). The examiner should then provide an opinion as to whether it is at least as likely as not that any diagnosed costochondritis disability, began during active service or is related to an in-service injury, event, or disease. (c). Whether it is at least as likely as not that said disability is (1) proximately due to a service-connected disability to include lumbosacral strain, or is (2) aggravated beyond its natural progression by a service-connected disability to include lumbosacral strain. In answering these questions, the examiner should address the Veteran’s assertions of continuity of symptomatology dating from his military service. The medical reasons for accepting or rejecting the Veteran’s statements regarding continuity since service should be set forth in detail. If the examiner determines that he/she cannot provide an opinion without resorting to speculation, the examiner should explain the inability to provide an opinion, identifying precisely what facts could not be determined. In particular, he/she should comment on whether an opinion could not be provided because the limits of medical knowledge have been exhausted or whether additional testing or information could be obtained that would lead to a conclusive opinion. 4. Schedule the Veteran for a VA examination to address the current severity of his service-connected tension headaches. The electronic claims file must be reviewed by the examiner. Any indicated tests and studies must be accomplished and the results reported. The examination should be performed in accordance with the current disability benefits questionnaires. The examiner should determine all manifestations and residuals associated with his service-connected tension headaches, and the severity of any such manifestations and residuals. Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Asare, Associate 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.