Citation Nr: 20057541 Decision Date: 08/31/20 Archive Date: 08/31/20 DOCKET NO. 16-53 470A DATE: August 31, 2020 REMANDED Entitlement to service connection for migraine headaches, to include as secondary to service-connected tinnitus, is remanded. Entitlement to service connection for diabetes mellitus is remanded. REASONS FOR REMAND The Veteran had active service from June 1989 to October 1989, November 1989 to September 1993, March 1995 to June 1996, August 1994 to November 2005, and November 2007 to October 2008. These matters come before the Board of Veterans Appeals (Board) on appeal from an August 2014 rating decision of a Regional Office (RO) for Department of Veterans Affairs (VA). These matters were previously before the Board in December 2018 when they were remanded for further development. Service connection for a psychiatric disorder, which was also remanded in this decision, was granted by an April 2020 rating decision. The Board finds that the prior remand directives have not been substantially complied with, thus the claim must again be remanded for compliance. Stegall v. West, 11 Vet. App. 268, 271 (1998). On April 15, 2020, the Veteran’s representative requested an extension of 90 days in order to submit additional evidence and argument regarding the Veteran’s claims. However, no further argument regarding these claims has been submitted at this time and the Board will proceed to adjudicate the claims as the Veteran is not prejudiced by the actions taken herein as a further opinion is necessary. See generally Hickson v. Shinseki, 23 Vet. App. 394 (2010). The Veteran’s claim for service connection of his migraines condition was previously remanded for an opinion as to whether this condition was caused by or aggravated by his service-connected tinnitus. The Veteran submitted a January 2015 Headaches Disability Benefits Questionnaire and opinion along with his VA Form 9 submission from Dr. H.S. that indicated that the Veteran’s headaches were permanently aggravated by his service-connected tinnitus. However, this opinion did not contain a sufficient rationale to form an opinion and therefore the matter was remanded. On remand the Veteran was provided a July 2019 VA exam. The VA examiner indicated that the Veteran had not been diagnosed with a headache condition. The Veteran denied that his service-connected tinnitus aggravated or caused his headaches and instead indicated that his service-connected sinusitis caused his headaches. The examiner offered an opinion that it was less likely than not that the Veteran’s headaches first manifested within one year of separation, or were caused or aggravated by his service-connected tinnitus. The examiner failed to address the prior diagnosis offered by Dr. H.S. in providing an opinion. In addition, the examiner also applied the incorrect standard regarding aggravation of a service-connected condition as they indicated that there was no permanent aggravation of a headache condition due to tinnitus. The Board notes that aggravation need not be permanent in order for the condition to be service connected. As the Board finds that the opinion is inadequate to form a fully formed decision a remand is necessary. Regarding the Veteran’s claim for service connection of diabetes, A VA exam was conducted in July 2019. The examiner offered an opinion that the Veteran’s elevated blood sugar levels from January 2004 and August 2009 would be mildly abnormal if they were results from fasting prior to testing, but would be in the normal range if they were not fasting, but that it was not clear from the record if the results were from a period of fasting. The examiner indicated that evidence sufficient to diagnose diabetes did not appear in the record until 2014. The examiner failed to offer an opinion as to whether the abnormal blood sugar results were manifestations of disease which ultimately resulted in the Veteran’s diabetes. As the examiner’s opinion is inadequate to make a fully informed decision on the issue of service connection the Board will request and addendum opinion. The matters are REMANDED for the following action: 1. Associate all outstanding VA treatment records with the claims file since July 2020 to present. 2. Obtain an addendum opinion regarding the Veteran’s headache condition from the VA examiner who offered the July 2019 opinion if available, or another qualified examiner if they are not available. The need for a further examination is left to the examiner’s discretion. The examiner should answer the following questions: a) Is it at least as likely as not (i.e., probability of 50 percent or greater) that the migraine headaches had its onset during active service or is otherwise related to any in-service disease, event or injury? b) Is it at least as likely as not (i.e., probability of 50 percent or greater) that the migraine headaches first manifested within one year of separation from service (last date of separation was October 2008)? c) Is it at least as likely as not (i.e., probability of 50 percent or greater) that migraine headaches were caused or aggravated by the Veteran’s service-connected tinnitus during the period on appeal (July 2014 to present)? The examiner is advised that permanent aggravation of the condition need not be shown. In offering this opinion the examiner is specifically asked to address whether the Veteran has had a diagnosis of a migraine condition during the period on appeal (July 2014 to present). The examiner should specifically address the findings of Dr. H.S. if a negative opinion is offered. The examiner is also asked to consider the reports of the Veteran contained in his service treatment records of: His use of aspirin for occasional headaches on a December 1994 report of medical history. Headaches reported during his deployment reported on his September 2005 post deployment health assessment. The examiner should offer a complete rationale consistent with the evidence of record 3. Obtain an addendum opinion regarding the Veteran’s diabetes mellitus from the VA examiner who offered the July 2019 opinion if available, or another qualified examiner if they are not available. a) Is it at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s diabetes had its onset during active service or is otherwise related to any in-service disease, event or injury? Is it at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s diabetes first manifested within one year of separation from service (date of last separation was October 2008) The examiner is asked to specifically discuss the Veteran’s elevated blood sugar levels from January 2004 and August 2009 and discuss whether these were a manifestation of disease that ultimately led to the Veteran’s diabetes. The examiner should offer an opinion as to whether the Veteran’s blood sugar levels were the result of fasting prior to the exams or not. The examiner should offer a complete rationale consistent with the evidence of record. If the examiner is unable to offer an opinion without resorting to speculation, the examiner must set forth a sufficient explanation as to why. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board John M. Middleton 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.