Citation Nr: 21062694 Decision Date: 10/08/21 Archive Date: 10/08/21 DOCKET NO. 17-39 149 DATE: October 8, 2021 REMANDED Entitlement to service connection for migraine headaches is remanded. Entitlement to service connection for bilateral trigger fingers is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1977 to January 1997. He appeals a May 2014 rating decision by the Agency of Original Jurisdiction (AOJ). In March 2019 the Board remanded the Veteran's claims to the AOJ for further action consistent with the Board's remand directives. The claim is back before the Board for further appellate proceedings. 1. Migraine Headaches The Board remanded the Veteran's claim in March 2019 in order to address the Veteran's assertions that his headaches are due to his exposure to a variety of chemicals during his 20 years of service as a mechanic. See March 2019 Board Remand. Consequently, an October 2019 VA medical opinion was produced. The October 2019 clinician opined that it was less likely than not the Veteran's migraine headaches were due to service. See October 2019 VA medical opinion. The clinician reasoned that a "migraine headache condition is not corroborated as having occurred during service to include the Veteran working with his hands as a mechanic." Id. (emphasis added). She stated that there is no continuity of care or chronic disability for a migraine headache condition until 10 years after service when the Veteran was diagnosed with caffeine withdrawal headaches. The clinician concluded that it is less likely that migraine headaches are related to his active service, to include chemical exposure while working as a mechanic. Id. Notably, the rationale provided by the October 2019 clinician regarding the etiology of the Veteran's migraine headaches included reference to his working with his hands as a mechanic during servicethis is not the contention raised by the Veteran regarding his headaches. The Veteran asserts chemical exposure was the cause of his headaches. The clinician appears to confuse her rationale for the negative opinion regarding headaches with that of her opinion regarding bilateral trigger fingers, discussed in more detail below. Moreover, the clinician did not explain why the Veteran's repeated exposure to chemicals while in service could not cause his migraine headaches. Further, she relied primarily on the absence of contemporaneous medical records to render a negative nexus opinion; such an opinion is inadequate for adjudicative purposes. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (2006). Notably, the Veteran stated that he did not suffer from headaches prior to service but has had problems since retirement. See July 2017 Veteran statement. The Veteran also indicated that his migraines have been "going on for years." See August 2013 Veteran statement. Further, the Veteran indicated that he did not "run to the hospital" every time he had a headache in service because "you were expected to do your job." See September 2020 Veteran statement. VA treatment records also indicate the Veteran has had a "long history of migraine headaches." See February 2008 VA treatment note. Considering these facts, a new VA opinion is needed to properly address the nature and etiology of the Veteran's current migraine headache disability. 2. Bilateral Trigger Fingers The Board remanded the Veteran's claim in March 2019 in order to address the Veteran's contention that his bilateral trigger fingers are due to working with his hands as a mechanic during his 20 years of active service. See March 2019 Board Remand. Consequently, an October 2019 VA opinion was produced. The October 2019 clinician opined that it was less likely than not the Veteran's bilateral trigger fingers were due to service. See October 2019 VA medical opinion. The clinician reasoned that "a bilateral trigger fingers condition is not corroborated as having occurred during service to include the Veteran working with his hands as a mechanic. There is no continuity of care or chronic disability for a trigger fingers bilateral hands condition until 10 years after military discharge in 1997." Id. The clinician did not explain why the Veteran's repetitive work with his hands as an aircraft mechanic in service could not cause his bilateral trigger fingers. Further, she relied primarily on the absence of contemporaneous medical records to render a negative nexus opinion; such an opinion is inadequate for adjudicative purposes. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (2006). Therefore, the Board finds that remand is warranted to afford the Veteran with an adequate opinion. The matters are REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his migraine headaches and bilateral trigger fingers that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified and the record clearly documented. 2. After the development in #1 is complete, obtain an opinion from an appropriately qualified clinician to determine the nature and etiology of the Veteran's migraine headaches. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the reviewing clinician. The opinion must include a notation that this record review took place. It is up to the discretion of the reviewing clinician as to whether an examination is necessary to provide an adequate opinion. After the record review and examination of the Veteran, if deemed necessary by the reviewing clinician, the reviewing clinician is asked to respond to the following: Is it at least as likely as not that the Veteran's migraine headaches were incurred in, or is otherwise related, to his time in service, to include but not limited to exposure to a variety of chemicals during his 20 years of service as a mechanic? In rendering this opinion, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. After the development in #1 is complete, obtain an opinion from an appropriately qualified clinician to determine the nature and etiology of the Veteran's bilateral trigger fingers. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the reviewing clinician. The opinion must include a notation that this record review took place. It is up to the discretion of the reviewing clinician as to whether an examination is necessary to provide an adequate opinion. After the record review and examination of the Veteran, if deemed necessary by the reviewing clinician, the reviewing clinician is asked to respond to the following: Is it at least as likely as not that the Veteran's bilateral trigger fingers were incurred in, or are otherwise related, to his time in service, to include working with his hands as a mechanic during his 20 years of active service? In rendering this opinion, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 4. After the above development has been completed, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Katie Poe, 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.