Citation Nr: 20046065 Decision Date: 07/09/20 Archive Date: 07/09/20 DOCKET NO. 15-15 607 DATE: July 9, 2020 REMANDED Entitlement to service connection for migraine headaches is remanded. Entitlement to service connection for hypertension, to include as due to exposure to herbicide agents, or secondary to diabetes mellitus, is remanded REASONS FOR REMAND The Veteran served on active duty from October 1964 to September 1966. These matters come to the Board of Veteran’s Appeals (Board) on appeal of a November 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge in a June 2018 Board hearing. A transcript of that hearing has been associated with the claims folder. The Board remanded this claim to obtain VA examinations for the disabilities on appeal in March 2019. The Veteran was afforded VA examinations for these disabilities in October 2019. The Board finds that prior to adjudication, addendum opinions from the VA examiner must be obtained to clarify the October 2019 VA medical opinions regarding the etiology of the claimed disabilities.   1. Entitlement to service connection for hypertension The Veteran claims that preexisting hypertension was aggravated during service. The Veteran’s service treatment records reflect that he experienced high blood pressure prior to service. The March 2019 Board remand directed that the VA examiner opine if the hypertension clearly and unmistakably preexisted the Veteran’s service, and if not, directed the examiner to opine whether it is at least as likely as not related to an in-service injury, event, or disease. The VA examiner failed to offer an explicit opinion as to whether the Veteran’s hypertension preexisted the Veteran’s service. The United States Court of Appeals for Veterans Claims has held that a remand confers on the veteran, as a matter of law, the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268 (1998). Furthermore, in lieu of offering a rationale for if the hypertension was at least as likely as not related to service, the VA examiner opined that because hypertension is not considered a presumptive disability for Agent Orange exposure, such causation is speculative. This opinion is inadequate for several reasons. First, the VA examiner’s opinion appears to be relying on VA’s presumptive list, rather than medical knowledge and research, remand is required for an adequate opinion. See Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other non-presumptive conditions based on exposure to Agent Orange). Further, the opinion is conclusory. The examiner opines that the Veteran’s hyptension is unrelated to service and provides no rationale to support this conclusion. Given these deficiencies, the Board finds an additional addendum opinion discussing any potential etiological relationship between the Veteran’s hypertension and his active duty service must be obtained. 2. Entitlement to service connection for migraine headaches The Veteran contends that his migraine headaches are related to service. He reports current symptoms of migraine headaches. The Veteran’s service treatment records also include notations of headaches during service, including a diagnosis in June 1966. The Veteran also reports he continues to suffer from symptoms related to migraine headaches, such as nausea and vomiting. In October 2019, the Veteran was afforded a VA examination for his headache disability. The VA examiner diagnosed the Veteran with migraine headaches. The Veteran reported he was evaluated in 1969-1870 at VA and was given pills. The Veteran reported his migraine headache condition “never stopped.” The examiner opined that the Veteran was treated for two headache conditions in service in December 1965 and June 1966. The examiner opined there was no continuity or particular pattern to these two “poorly defined” events and noted no headache disability was indicated during the September 1966 separation examination. The examiner opined there was no “logical way to link” these headache episodes in service during the 1960s and the current disability. No further elaboration was provided. This opinion is inadequate in that it states that there was no continuity of symptomatology but contains no discussion regarding the Veteran’s lay statements of experiencing migraine headaches since service and such statements should be addressed. Accordingly, an addendum opinion addressing the Veteran’s lay statements and to provide a rationale regarding the etiology of the migraine headache disorder must be obtained. The matters are REMANDED for the following action: 1. After completing any additional development deemed necessary, obtain addendum opinions from appropriate VA clinician(s). The need for a VA examination of the Veteran is left to the discretion of the VA examiner. The examiner must opine whether it is at least as likely as not that any diagnosed hypertension is related to an in-service injury, event, or disease. The examiner should address each of the Veteran’s theories of service connection, including exposure to Agent Orange and aggravation of a preexisting disability. The examiner should consider whether the Veteran’s hypertension clearly and unmistakably (undebatable) preexisted the Veteran’s service. Service treatment records reflecting elevated blood pressure before and during service should be addressed. If the examiner finds it did clearly and unmistakably preexist service, the examiner must opine whether it was clearly and unmistakably not aggravated by service. If the examiner finds that it either did not clearly and unmistakably preexist service, or was not clearly and unmistakably aggravated by service, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, to include herbicide exposure therein. With respect to the herbicide exposure, the examiner must not rely solely on whether the disability is listed among the presumptive conditions by VA, but must provide a rationale based on medical evidence and principles involved. A complete rationale for all opinions should be provided. The Veteran’s lay contentions should be addressed. 2. The examiner must opine whether it is at least as likely as not that any migraine headache condition is related to an in-service injury, event, or disease. A complete rationale for any opinion should be provided. The Veteran’s lay statements, including regarding continuity of symptomatology since service, should be addressed. 3. After the above development has been completed, readjudicate the issues on appeal. If any benefit sought is not granted, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Keogh, 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.