Citation Nr: 20022078 Decision Date: 03/30/20 Archive Date: 03/30/20 DOCKET NO. 10-11 338 DATE: March 30, 2020 REMANDED Service connection for migraine headache is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1989 to July 1992. This case is before the Board of Veterans’ Appeals (Board) on appeal from July 2008 and November 2008 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In the July 2008 decision, the RO denied claims of service connection for PTSD and residuals of a head injury. The Veteran subsequently requested reconsideration of that decision by the RO. In the November 2008 rating decision, the RO confirmed and continued the previous denials of service connection for PTSD and residuals of a head injury. The Veteran appealed. In July 2013, the Veteran testified at a video conference hearing at the RO before the undersigned Veterans Law Judge. A transcript of his testimony is of record. In May 2018, the Board granted entitlement to service connection for PTSD and remanded the issue of service connection for residuals of a head injury, to include migraine headaches. In February 2020, the RO granted entitlement to service connection for residuals of a head injury (or traumatic brain injury) with an initial 10 percent disability rating. 1. Service connection for migraine headaches is remanded. By way of background, the Veteran filed a compensation application for PTSD and a head injury, which included his migraine headaches. In May 2018, the Board remanded the issue of service connection for residuals of TBI, which included migraine headaches. In a February 2020 rating decision, service connection for residuals of TBI was granted with an evaluation of 10 percent. Therefore, service connection for residuals of TBI was fully granted. With respect to migraine headaches, in a February 2020 supplemental statement of the case (SSOC), the RO denied service connection for migraine headaches based on the lack of a medical opinion linking the Veteran’s migraine headaches to the TBI injury during military service. The medical record reflects conflicting opinions as to whether the Veteran’s migraine headaches are manifestations of his TBI, secondary to his PTSD or neither related to his TBI nor his PTSD. Therefore, to clarify the etiology of the Veteran’s migraine headaches, another remand is necessary. First, the Veteran himself contended that his headaches were related to his TBI. See October 2013 hearing testimony, December 2017 VA treatment record and March 2020 correspondence. Moreover, in the February 2020 TBI assessment, the VA psychologist noted that the Veteran exhibited migraines as one of his subjective symptoms of his TBI. In another VA evaluation for TBI, the VA examiner noted that the Veteran did not have any subjective symptom of headaches. Second, in a November 2008 VA treatment record (received February 2009), VA psychiatrist opined that the Veteran’s headaches were secondary to his PTSD. Finally, in a September 2017 VA examination report, the VA examiner opined that migraine headaches were not related to his TBI; however, the opinion does not contain the underlying reasons for the conclusion reached. Another VA examiner in July 2019 opined that the Veteran’s migraine headache is a neurological diagnosis and not due to his PTSD because they are separate and distinct conditions; the VA examiner also inferred that the migraine headaches were not due to his TBI. To the extent that the opinion addressed aggravation, the Board finds it inadequate, as it provides no rationale. As there are inadequate opinions that conflict regarding the etiology of the Veteran’s migraine headaches, another opinion is needed to assess whether the Veteran’s migraine headache is a manifestation of his service-connected TBI, or secondary to his PTSD or neither related to his TBI nor PTSD. The matters are REMANDED for the following action: 1. Obtain a VA opinion to clarify the etiology of the Veteran’s migraine headaches. The record, to include a copy of this remand, must be made available to and be reviewed by the examiner, and the examination report should note that review. a. Specifically, the examiner should address whether the Veteran’s migraine headaches are manifestations of his service-connected traumatic brain injury (TBI). The Veteran should review the two February 2020 TBI assessments: one VA neurologist noted that the Veteran did not exhibit headaches due to TBI and one psychologist noted that the migraines were subjective symptoms of his TBI. b. If the migraine headaches are not manifestations of his TBI, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the migraine headaches are (i) caused or (ii) aggravated beyond its natural progression by the service-connected PTSD or by the service-connected TBI? Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. The Veteran’s lay contentions must be considered and weighed in making the determination. The clinician is asked to provide the underlying reasons for all opinions expressed, and is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Lee, 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.