Citation Nr: 21000155 Decision Date: 01/04/21 Archive Date: 01/04/21 DOCKET NO. 14-02 315 DATE: January 4, 2021 REMANDED Entitlement to service connection for migraine headaches is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1981 to December 1984. These matters are before the Board of Veterans’ Appeals (Board) following a March 2020 Board remand. This matter was originally on appeal of a November 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office in Waco, Texas (RO). The Veteran was afforded a hearing before the undersigned Veterans Law Judge in November 2019. A transcript of the hearing has been associated with the Veteran’s claim file. The Board notes that a claim for service connection for corneal laceration was previously on appeal. However, in a September 2020 rating decision, the RO granted service connection for corneal laceration of the eye resulting in reduced depth perception (eye condition) with an evaluation of 0 percent, effective December 29, 2009. Accordingly, this issue is no longer on appeal before the Board. In addition, in October 2020, the Veteran submitted a VA Form 20-0996 Request for Higher-Level Review. On October 13, 2020, the AOJ sent the Veteran a letter informing the Veteran that the VA was unable to process his form because it was incomplete. The Veteran was instructed to resubmit the form, but to date, the Veteran has not resubmitted VA Form 20-0996. As such, the Veteran’s claim will be evaluated under the legacy system. 1. Entitlement to service connection for migraine headaches is remanded. The Veteran contends he suffers from migraine headaches as a result of his time in service. The Veteran’s service treatment records (STRs) contain complaints of back pain and an eye injury but do not reflect complaints of migraines/headaches. A May 1984 treatment note reported no neurological symptoms. The Veteran declined a separation examination, and it was determined that a medical examination was not required. See October 1984 Statement of Option. In an October 2020 VA Form 20-0996 Request for Higher Level Review, the Veteran indicated that the VA did not consider whether his migraines were made worse by the physical, mental, and economic injuries he sustained in service. The Veteran is currently service connected for a thoracolumbar strain and eye condition. He is not service connected for a psychiatric condition. In addition, the Veteran indicated that he submitted a letter from a physician containing a nexus opinion. The letter from Dr. L.M. does not offer a nexus opinion for the Veteran’s migraines claim but discusses his posttraumatic stress disorder. The Veteran was originally afforded a VA examination in March 2014. The examiner noted the Veteran reported his migraines started six months after his eye injury in 1985. The examiner opined that the Veteran’s migraines are less likely as not related to the military and or aggravated by back, or eye strain, corneal abrasion of the eye or any other condition. His migraines are less likely as not related to the military. The examiner stated there is nothing in medical studies or literature which states that an old foreign body with a scratch/eyestrain causes migraines or aggravates migraines. There was nothing found in the STRs about migraines. At a November 2019 Board hearing, the Veteran testified that his migraine headaches began during active duty service due to stress and that he has been receiving treatment for migraines since discharge from the military. The Veteran also testified that he has been receiving treatment for vision problems since discharge. The Veteran testified that he is currently receiving treatment at a VA facility. A December 2019 treatment note indicates the Veteran has a diagnosis of hyper-anxiety with migraines. Following the March 2020 Board remand, the Veteran was afforded a new VA examination in September 2020. The examiner noted the Veteran reported that when he was in Germany, he started to get sharp pounding headaches on both sides of the head, mainly the right side, associated with flashes of light and light sensitivity. He sought medical attention and was prescribed over the counter headache relievers with temporary relief. Additionally, the Veteran reported while in Germany he was under tremendous amounts of stress for multiple reasons leading to the development of headaches. The examiner opined the Veteran’s migraine headaches are less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated there are no service treatment records showing migraine headaches while in service. There is no separation exam available for review. There is no mention of migraine headaches in his records until several years after service. A nexus cannot be established. The September 2020 opinion regarding migraine headaches is incomplete because the March 2020 Board remand directed the VA examiner to address the Veteran's lay testimony that his migraines began in service due to stress. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The examiner did not provide a sufficient rationale in support of his etiology opinion. The Court has held that a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez, 22 Vet. App. 295; 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"). For these reasons, the Board requires further medical guidance from a VA professional regarding the etiology of the existing migraine headaches. On remand, a thorough medical opinion must be obtained that contains a complete rationale including consideration of the lay evidence. Such opinion should also address the Veteran’s newly raised theory that his headaches are secondary to his back condition. The matters are REMANDED for the following action: 1. Contact the Veteran and request that he identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who treated him from discharge until the present for his migraine headaches. With any necessary authorization from the Veteran, the RO should attempt to obtain copies of pertinent treatment records identified by the Veteran which have not previously been secured. 2. Obtain an addendum opinion to the September 2020 VA opinion regarding the etiology of the Veteran’s migraine headaches. The examiner should address whether the Veteran’s migraine headaches are at least as likely as not (50 percent probability or greater) causally or etiologically due to service. In so opining, in light of the Veteran’s description of symptoms reported at the September 2020 VA examination and the Veteran’s contention that his migraine headaches began in service due to stress, the examiner must explain (i) whether there is any medical reason to accept or reject the proposition that the Veteran’s current migraines had their onset in service and continued ever since service, (ii) whether the Veteran's assertions are generally consistent with medical knowledge or plausible, and (iii) whether the Veteran's reports about his symptoms align with how the disease is known to develop. In addition, the examiner should address whether the Veteran’s migraine headaches are at least as likely as not (50 percent probability or greater) caused OR aggravated by his service-connected back condition. In October 2020, the Veteran indicated that the VA did not consider whether his migraines were made worse by the physical injuries he sustained in service. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Daley, 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.