Citation Nr: 21063125 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 14-37 155 DATE: October 13, 2021 REMANDED Service connection for headaches. REASONS FOR REMAND The Veteran served on active duty from April 2003 to April 2010. The case is on appeal from a July 2013 rating decision. In May 2018, the Veteran testified at a Board hearing. In a July 2018 decision, the Board granted service connection for sleep apnea. At that time, the Board also remanded the claim of service connection for headaches for additional development. The Board again remanded the claim for additional development in January 2020, December 2020, and April 2021. Service connection for headaches. The Veteran is seeking service connection for a headache condition. He contends migraine headaches he experienced prior to service increased in severity and frequency during service. Hr'g. Tr. at 6-7. Alternatively, the Veteran testified that he experiences tension headaches that are distinct from his migraine headaches. Hr'g. Tr. at 7-8. The Veteran also contends that his tension headaches and migraine headaches are secondary to his service-connected post-traumatic stress disorder (PTSD). In addition, the Board found that the question of whether the Veteran's headaches are secondary to his service-connected sleep apnea was raised by the record. The Board previously remanded the case in April 2021. Pursuant to the Board's remand, an examination and opinions were obtained in May 2021. In this regard, the examiner determined that it is less likely than not that the Veteran's migraine headaches are aggravated by his service-connected PTSD. She explained that despite experiencing traumatic events in service, his headaches did not worsen. In addition, she explained that the Veteran's PTSD is well managed, and he has been on the same medication for treatment of his headaches with no evidence of worsening of symptoms. The examiner also determined that it is less likely than not that the Veteran's migraines are not aggravated by his service-connected sleep apnea. She stated that the Veteran's migraines did not worsen post service. However, the Board finds that these opinions are not entirely sufficient to decide the claim. In this regard, and pertaining to both theories of entitlement, the Veteran reported to the examiner at the time of the May 2021 VA examination the only trigger he identified concerning his migraine headaches is when he does not sleep well. The examiner did not appear to consider this statement as it relates to the question of whether the Veteran's migraines are aggravated by his service-connected PTSD. In this regard, sleep impairment may be a symptom of the Veteran's PTSD as an August 2020 VA treatment record reflects that although the Veteran thinks his PTSD is managed, he has been experiencing insomnia lately. In addition, the examiner also did not address the Veteran's statement regarding lack of sleep as a trigger as it concerns the question of whether the Veteran's migraines are aggravated by his service-connected sleep apnea. In this regard, at the May 2018 Board hearing, the Veteran stated that since using a CPAP machine to treat his sleep apnea, his headache condition improved. In addition, a July 2016 VA treatment record similarly reflects that the Veteran reported less headaches upon using his new CPAP machine. Moreover, the examiner stated that there was no evidence to suggest worsening of the Veteran's headache condition after service. However, the Veteran reported that he did not experience headaches during his final two years of service, but VA treatment records reflect that he reported a recurrence of headaches in 2011, suggesting a worsening after service. Accordingly, a new VA opinion is warranted on remand. In light of the remand, updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain VA treatment records since March 2021. 2. Schedule the Veteran for a VA examination (or telehealth interview, record review, etc., if an in-person examination is not feasible) by a qualified medical professional for an opinion to determine the nature and etiology of any headache condition. The examiner should specifically address: Whether it is at least as likely as not that the Veteran's migraines and/or tension headaches were aggravated by his service-connected PTSD. The examiner should consider the Veteran's statement that a lack of sleep seems to be a trigger for his migraine headaches in relation to whether sleep impairment is a symptom of his service-connected PTSD. Whether it is at least as likely as not that the Veteran's migraines and/or tension headaches were caused or aggravated by his service-connected sleep apnea. The examiner should consider the Veteran statements that a lack of sleep seems to be a trigger for his migraine headaches and that he seems to experience improvement in his headache condition when using a CPAP machine to treat his sleep apnea. Note that in this context aggravated means any increase in severity beyond the natural progress of the disease. A complete rationale should be provided for any opinions reached. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Gray, 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.