Citation Nr: 21067628 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 15-42 799A DATE: November 4, 2021 REMANDED Entitlement to service connection for a headache disorder is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service from February 1976 to February 1979. This matter is before the Board following his appeal of an August 2013 rating decision. Most recently, these issues were remanded by the Board in May 2021. Service Connection - Headache Disorder The Veteran contends that his headache disorder is related to his exposure to contaminated water during his service at Camp Lejeune. The Veteran's personnel record confirms the requisite service laid out in 38 C.F.R. § 3.307(a)(7), such that he may be presumed to have been exposed to the contaminants in the water supply. In May 2021, the Board remanded the Veteran's claim for service connection for headaches for an additional examination, noting there was medical evidence suggesting a diagnosis of headaches during the appeal period and noting the Veteran was competent to report experiencing headaches. The Board asked that an examiner address whether the Veteran had a headache disorder or symptoms that cause functional impairment. The Board also asked the examiner to specifically consider a September 2014 finding of headache syndromes and the Veteran's lay reports of headaches throughout the appeal period. Finally, the Board asked the examiner to opine whether it was at least as likely as not that any diagnosed headache disorder was related to service, to include exposure to contaminated water at Camp Lejeune. The Veteran underwent the requested examination in July 2021. The examiner reviewed the Veteran's history of headache complaints and found that the 2012 complaints were likely due to an upper respiratory infection. The examiner found the Veteran's headache disorder to be unrelated to service. In support of that opinion, the examiner stated twice that there was no confirmation that the Veteran was exposed to contaminated water at Camp Lejeune. However, as explained above, the Veteran's service personnel records confirm the requisite Camp Lejeune service. As the July 2021 examiner's opinion was based, in part, on an inaccurate factual premise, an additional medical opinion is needed on remand. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). TDIU The issue of entitlement to a TDIU is inextricably intertwined with the claim for entitlement to service connection for a headache disorder remanded herein. Harris v. Derwinski, 2 Vet. App. 180, 183 (1991). Hence, a determination on the claim for entitlement to service connection for a TDIU should be deferred pending a final disposition of the claim for entitlement to service connection for a headache disorder. The matters are REMANDED for the following action: Send the claims file to an appropriate clinician other than the one who provided the July 2021 medical opinion. If an examination is deemed necessary to respond to the questions posed, one should be scheduled. The clinician must review the claims file. Following review of the claims file, the clinician is asked to respond to the following: (1) Please identify any headache disorder present at any time since April 2012. In doing so, please specifically consider the September 2014 finding of headache syndromes, as well as the Veteran's lay reports of headaches throughout the appeal period. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, please consider the symptoms a "disability" for the purpose of providing the requested opinion below. (2) Please state whether it is at least as likely as not (50 percent or greater probability) that any headache disability had its onset during the Veteran's active service or is otherwise etiologically related to such service, to include the Veteran's presumed exposure to contaminated water at Camp Lejeune. In forming the opinion, please specifically consider and discuss the Veteran's lay statements regarding the continuity of his symptoms. Please note that a negative opinion cannot be based solely on the fact that headaches are not on the list of diseases that are presumptively associated with exposure to contaminants in the water supply at Camp Lejeune. (Continued on the next page) A complete and detailed rationale for all opinions expressed must be provided. L. STEPANICK Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Andrew Ledman II 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.