Citation Nr: 20032348 Decision Date: 05/07/20 Archive Date: 05/07/20 DOCKET NO. 08-16 847 DATE: May 7, 2020 REMANDED Service connection for migraine headaches is remanded. REASONS FOR REMAND The Veteran served on active duty from March 2003 to July 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2008 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran offered testimony in support of some of her claims at a personal hearing before the Board in March 2014, and a transcript of the hearing is of record. The Veteran also initially requested a personal hearing for the remaining issues, but, in November 2018, the Veteran’s representative withdrew the Veteran’s request for an additional hearing. Furthermore, the Veterans Law Judge who conducted the March 2014 hearing is no longer at the Board. In March 2020, the Veteran was notified of this fact and was afforded the opportunity to have another Board hearing. He has not responded to schedule another hearing. Thus, the Board concludes that the Veteran does not desire another hearing. The issue of entitlement to service connection for migraines was previously characterized as whether new and material evidence has been received to reopen a previously denied claim of entitlement to service connection for migraines. The RO originally denied the Veteran’s claim for service connection in March 2008. The claims file contains a copy of a letter notifying the Veteran of the denial dated March 20, 2008. After appeal to the United States Court of Appeals for Veterans Claims (Court), which vacated a November 2015 Board decision denying the Veteran’s request to reopen the claim, the Board found in January 2019 that the March 2008 rating decision denying service connection for migraines was never became final; 38 C.F.R. §§ 20.302, 20.1103; and the Board recharacterized the issue accordingly. In September 2017 and January 2019, the Board remanded the matter for further development. The matter has been returned to the Board for further adjudication. 1. Service connection for migraine headaches is remanded. Although the Board regrets the additional delay, a remand is once again required. The Board cannot make a fully-informed decision on the issue of service connection migraine headaches because the August 2019 medical opinion does not provide a rationale regarding whether the Veteran’s migraine is caused or aggravated by another service-connected disability, including depressive disorder, sleep apnea, hernia repair residuals, hysterectomy, and knee disabilities. All the examiner stated was, “[the] veteran’s service connected disabilities of sleep apnea, knee[], hysterectomy, depressive disorder and scar do not cause, nor do they aggravate headaches.” The opinion as to these theories was entirely a conclusion without any explanation. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (a medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions). See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (stating that a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two). An addendum opinion is required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s migraine headaches disorder is at least as likely as not: (a.) proximately due to a service-connected disability; (b.) aggravated beyond its natural progression by a service-connected disability. Although an independent review of the claims file is required, the examiner’s attention is called to the following: (a) February 2017 statement by the Veteran that her migraines got worse after surgery for her uterine condition; and (b) medical articles submitted by the Veteran’s attorney regarding the relationships between migraines and psychiatric disorders and migraines and sleep apnea. The examiner is advised that an opinion and rationale must be provided for both (a) causation and (b) aggravation. The Board emphasizes that it is not determining whether or not the aforesaid evidence is credible at this time, as the additional development set forth in the directives below could impact that determination. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 2. Ensure that the directive specified in this remand has been implemented. If it has not, appropriate corrective action must be undertaken before readjudication. Stegall v. West, 11 Vet. App. 268 (1998). 3. If upon completion of the above action any benefit sought on appeal remains denied, the case should be returned to the Board after compliance with appellate procedure. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Rocktashel, 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.