Citation Nr: 21004780 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 15-18 843 DATE: January 28, 2021 REMANDED Entitlement to service connection for migraine headaches, claimed as a residual of a head injury, and including as secondary to a service-connected psychiatric disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1988 to February 1990. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). A Board hearing was held before the undersigned in July 2018. A transcript of the hearing is of record. This matter was previously before the Board in October 2018, May 2020, and September 2020 when it was remanded for further development. A November 2020 rating decision granted service connection for unspecified anxiety disorder and unspecified bipolar disorder. As the decision constitutes a full grant of the claim seeking service connection for a psychiatric disorder that was previously before the Board, the matter is no longer before the Board and will not be discussed further.  Entitlement to service connection for migraine headaches is remanded. Although the additional delay is regrettable, the Board finds a further remand is required. In the September 2020 remand order, the Board requested a medical opinion regarding whether the Veteran’s migraine headache condition was caused or aggravated by an acquired psychiatric disorder. In providing the requested opinion, the examiner was asked to consider the Veteran’s statement that she experiences headaches whenever she gets anxious or has panic attacks, as noted in a July 2013 treatment record. In an October 2020 VA medical opinion, a VA examiner opined that the Veteran’s migraine headache condition was neither caused nor aggravated by an acquired psychiatric condition. In providing the opinion regarding causation, the examiner indicated that although there may be an increased prevalence of migraines in those with anxiety or bipolar disorder, it appears this is a correlative relationship, not a causative one in the Veteran’s case. As rationale, the examiner indicated that the migraines did not manifest until 2014, approximately 24 years after the service-connected mental health disorders. First, as the examiner indicated the headaches started in 2014, it appears the examiner may not have considered the Veteran’s statement noted in the July 2013 treatment record, which indicates an onset prior to 2014. Further, the Court of Appeals for Veterans Claims ruled in Frost v. Shulkin, 29 Vet. App. 131, 138-39 (2017), that there is no temporal requirement inherent in 38 C.F.R. § 3.310(a) for claims for service connection on a secondary basis, and that the “primary disability need not be service connected, or even diagnosed, at the time the secondary condition is incurred.” The only temporal requirement is that there be a primary service-connected disease for a separate disease to be connected to secondarily. Id. In this case, the examiner does not provide a clear rationale as to why a psychiatric disorder could not cause migraine headaches many years after diagnosis of the psychiatric disorder.   Additionally, the examiner’s opinion as to whether the Veteran’s headaches were aggravated by her service-connected psychiatric disorder is confusing. Although the examiner provides a rationale that relates to post-service treatment, the ultimate conclusion provided was that the Veteran’s medical records support that her migraines were not aggravated beyond natural progression by an acquired psychiatric disorder “during service.” Thus, the examiner’s opinion on whether the Veteran’s headaches are proximately due to or aggravated by her service-connected acquired psychiatric disorder is inadequate, and remand for an addendum opinion is needed. The matters are REMANDED for the following action: 1. Obtain any updated VA treatment records for the period from October 2020 to the present. 2. Return the Veteran’s claims file to the October 2020 VA examiner, or another VA examiner if he or she is unavailable, for an addendum opinion regarding the Veteran’s current migraine headache condition. An examination should only be scheduled if the clinician determines that an examination is necessary in order to provide the requested opinion. The examiner is asked to provide an opinion on the following: (a) Whether it is at least as likely as not (a 50 percent or greater probability) the Veteran’s migraine headache condition was caused by her service-connected unspecified anxiety disorder and unspecified bipolar disorder. (b) Whether it is at least as likely as not (a 50 percent or greater probability) the Veteran’s migraine headache condition was aggravated (i.e., worsened beyond its natural progression) by her service-connected unspecified anxiety disorder and unspecified bipolar disorder. In providing the requested opinions, the examiner should address the Veteran’s statement that she experiences headaches whenever she gets anxious or has panic attacks, as noted in a July 2013 treatment record. The examiner is also advised that there is no temporal requirement for a claim seeking service connection as caused or aggravated by an already service-connected condition, and that if an opinion continues to be based on a finding that migraine headaches were not caused or aggravated by a psychiatric disorder due to them having an onset many years after the diagnosis of the psychiatric disorder, further rationale is required to explain the basis for that conclusion. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be   rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Jiggetts 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.