Citation Nr: 21004051 Decision Date: 01/25/21 Archive Date: 01/25/21 DOCKET NO. 17-15 355 DATE: January 25, 2021 REMANDED Service connection for migraines, claimed as due to environmental hazards while serving in the Persian Gulf War, to include as secondary to the service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND Service Connection for Migraines The Veteran served on active duty from June 1998 to October 1998, and from January 2004 to March 2005. The Veteran contends that her migraines are related to her Gulf War service, to include exposure to environmental hazards. She reports that after returning home from deployment she was treated by her gynecologist for migraines and headaches. The service treatment records indicate that the Veteran was treated for headaches relating to viral symptoms in July 1998 and in December 2004. The Veteran also contends that, as she was stationed in Iraq, the headaches are due to a multi-symptom illness of the Gulf War. The Veteran alternatively contends that the service-connected PTSD contributes to the migraines because the headaches are worse whenever she stops taking PTSD medications, raising a theory of secondary service connection. This matter is on appeal from a December 2014 rating decision from Regional Office (RO) in Cleveland, Ohio. The Veteran filed a notice of disagreement in November 2014 and a statement of the case was issued in February 2017. The Veteran filed a substantive appeal in March 2017. A supplemental statement of the case was issued in April 2017. This matter was previously before the Board in September 2019. The Board reopened the claim for service connection for migraines, claimed as due to environmental hazards while serving in the Persian Gulf War, to include as secondary to PTSD, but denied the claim on the merits. The Veteran appealed December 2019 Board decision to the U.S. Court of Appeals for Veterans Claims (CAVC).    A September 2020 Order by CAVC adopted a Joint Motion for Partial Remand (JMPR) filed by the parties. The parties agreed that a remand is required because the April 2017 VA examination opinion was inadequate for rating purposes because it does not adequately address the issue of aggravation consistent with the Court’s decision in Ward v. Wilkie. 31 Vet. App. 233 (2019). In Ward, the Court held that VA examiners must address the issue of aggravation, to include whether there is any incremental increase in disability in the nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase. Id. at 239. In the April 2017 VA examination, the VA examiner opined that “there is no credible medical evidence to support any aggravation (chronic worsening) of the Veteran’s migraine or tension headaches by the service-connected PTSD.” The parties agreed that the VA examiner’s standard of “chronic worsening” does not comport with the holding in Ward, which found that even an incremental increase in disability above the degree of disability existing before the increase would qualify as aggravation for the purposes of secondary service connection. Based on the agreement of the parties before the Court, the Board finds that a remand is warranted to obtain an addendum opinion. The issue of service connection for migraines is REMANDED for the following action: Send the April 2017 VA examination report to a VA examiner for an addendum opinion. Examination of the Veteran is not required unless the examiner determines that an examination is necessary to provide a reliable opinion. A rationale for all opinions and a discussion of the facts and medical principles involved should be provided. The VA examiner should offer an opinion in answer to the following questions: Is it at least as likely as not that the migraines were aggravated by (i.e., incrementally increased in severity beyond a natural progression by) the service-connected PTSD? J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Costantino, 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.