Citation Nr: 20060340 Decision Date: 09/14/20 Archive Date: 09/14/20 DOCKET NO. 11-12 154 DATE: September 14, 2020 REMANDED Entitlement to service connection for headaches is remanded. REASONS FOR REMAND The Veteran had active service from August 1988 to August 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The Board notes that jurisdiction currently rests with the Salt Lake City, Utah RO. In February 2016, the Veteran provided testimony at a Central Office hearing. A transcript of the hearing is of record. Addressing the relevant procedural history, this claim was most recently previously before the Board in February 2020. At that time, it was remanded for additional development, to specifically include obtaining a VA addendum opinion. The claim has now been returned to the Board for further adjudication. Unfortunately, an additional remand is necessary. While there is a contemporaneous VA examination of record, this examination does not provide a sufficient basis upon which to decide the claim. The VA examiner who provided the addendum opinion in July of 2020 in order to comply with the most recent Board remand concluded that, “the claimant’s current complaint of migraines is less likely than not related to any in service complaints”. As rationale, the examiner stated that, “[a]lthough the claimant was seen in service for complaints of headaches she has multiple other contributing factors for her headaches and I cannot differentiate which symptom belong to which headaches”. However, while stating that there may be multiple factors contributing to the Veteran’s headaches, the examiner did not affirm nor definitively exclude the possibility of the Veteran’s military service being one such contributing factor in regard to her headaches. Evidence that is speculative, general or inconclusive in nature cannot support a claim. See Obert v. Brown, 5 Vet. App. 30 (1993). In addition, even if this examiner is unable to differentiate the respective symptomology attributable to various asserted headache conditions, this does not resolve the heart of the matter currently before the Board which is whether any headache condition the Veteran currently has was caused by or related to her military service. Therefore, the Board cannot make a fully-informed decision on the issue of service connection for the Veteran’s asserted headache condition until an additional addendum opinion is obtained on remand. The matter is REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician. The entire claims file, including a complete copy of this remand, should be made available to and be reviewed by the clinician, and it should be confirmed that such records were available for review. This should be a different clinician than any who has authored any opinion already of record. Following a review of the evidence of record, to include the Veteran’s lay statements, the clinician should answer the following: (a.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s asserted headache condition is related to an in-service injury, event, or disease. In so opining, the clinician is asked to identify and clarify the nature of any current headache conditions. In addition, the clinician is asked to reconcile, to the extent possible: 1) the in-service notations related to headaches including the February 1991 note indicating that she reported for “c/o HA’s x 3 days”, the June 1992 notation where the Veteran reported “for f/u on tonsilitis, headaches, and ear pain for 2 days” and the July 1991 service treatment record that documented the Veteran’s complaints of headaches for two days at which the assessment was tension headaches; 2) the July 1993 VA treatment notation that states the Veteran “[w]as treated here 7-2-93 for tension/vascular headache (given injection and tablets). Admits, lots of tension at work and her involvement in a psychologic triangle with her boss and one other employee”; and 3) the Veteran’s assertions made at her Board hearing that she was prescribed “Midrin” after her migraines began in 1990 that she continued to take throughout her active duty service. A complete rationale must be provided for any opinion given. If it is not possible to provide a specific opinion, the clinician must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the clinician (does not have the knowledge or training). 2. Thereafter, readjudicate the claim. If the benefits sought on appeal remain denied, issue a supplemental statement of the case to the Veteran and her representative. Then return the appeal to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Smith, 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.