Citation Nr: 21065179 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 17-06 895 DATE: October 25, 2021 REMANDED Entitlement to service connection for migraine headaches is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1983 to April 2003. These matters come before the Board of Veterans' Appeals (Board) on appeal from a February 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. In March 2021, the Veteran testified at a Board virtual hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. This matter was previously remanded in May 2021 for additional development. Entitlement to service connection for migraine headaches is remanded. The Veteran and her representative assert that the Veteran is entitled to service connection for her headaches because they originated during her active-duty service and were aggravated by her service-connected disabilities. Although further delay is regrettable, the Board finds that additional development is necessary prior to appellate review. The evidence of record shows that the Veteran was diagnosed with headache syndromes and migraine headaches, pursuant to the December 2015 and June 2021 VA examinations. Therefore, the first element for direct and secondary service connection has been established. The record shows that the Veteran complained of headaches during active-duty service. Therefore, the second element for direct service connection has been established. During the March 2021 Board hearing, the Veteran explained her belief that her headache disability originated during, and has continued since, active-duty service based on the symptoms she perceives and experiences. Additionally, the Veteran noted that her service-connected Bell's palsy, sinusitis, and cervical spine disability aggravate her headache disability. The December 2015 VA examiner provided a negative nexus opinion based on direct service connection. The rationale was based on the lack of a diagnosis of chronic headaches during active-duty service. In May 2021, the Board found that the December 2015 VA examiner's opinion rationale was insufficient to properly assess the nature and etiology of the Veteran's disability. Additionally, the VA examiner did not address whether the Veteran's service-connected disabilities impact her headache disability, as she has contended in her statements and testimony. As previously noted, pursuant to the May 2021 Board remand, the Veteran was afforded a VA examination in June 2021. The June 2021 VA examiner opined that the Veteran's service treatment records are negative for any treatment of headaches, however she was seen several times for symptoms of headaches, but there was no diagnosis of a chronic headache disability. The examiner relied on the assertion that the Veteran did not complain of or seek treatment for headaches until three years after separation from active-duty service. The examiner also opined that the Veteran's service-connected disabilities did not cause or aggravate the Veteran's headache disability, as the private treatment records on file did not note a link between the Veteran's service-connected disabilities and the Veteran's migraine headaches. The Board finds that the June 2021 opinion did not adequately address the Veteran's credible statements regarding continuity of symptoms. In addition, the examiner's comment regarding the lack of a "link" contained within treatment records is overly broad and does not constitute an adequate rationale with respect to the issue of secondary service connection. Therefore, in order to comply with the May 2021 Board remand, another remand is necessary to obtain an adequate VA examination and opinion by a different examiner. Stegall v. West, 11 Vet. App. 268 (1998) (holding that where the remand orders of the Board are not satisfied the Board itself errs in failing to ensure compliance). The matter is REMANDED for the following action: The Veteran must be afforded a VA examination by a new examiner with appropriate expertise to determine the nature and etiology of the Veteran's migraine headache disability. Any and all studies, tests, and evaluations that are deemed necessary by the VA examiner should be performed. The claims folder, including a copy of this remand, the Veteran's lay statements, and medical records, should be made available and be reviewed by the examiner. Following a complete review of the record, the examiner is asked to: a. Provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's migraine headache disability originated during, or is etiologically related to, active-duty service. b. Provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's migraine headache disability was caused or aggravated by the Veteran's service-connected disabilities, to include her Bell's Palsy, sinusitis, and cervical spine disorder. A complete rationale must be provided for all opinions rendered. If the examiner cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. The examiner is advised that the Veteran is considered competent to be able to report injuries and symptoms, and that her reports must be considered in formulating the requested opinions. If the Veteran's reports are discounted, the examiner should provide a reason for doing so. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. R. Montalvo, 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.