Citation Nr: 21070723 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 17-45 316 DATE: November 24, 2021 REMANDED Entitlement to service connection for headaches, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1994 to June 2000. This appeal comes before the Board of Veterans' Appeals (Board) from a July 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran submitted a notice of disagreement in October 2014 and timely perfected his appeal in September 2017. The Board notes that though the Veteran requested a Board hearing on his substantive appeal, in August 2020, his attorney requested to withdraw this request. In McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006), the United States Court of Appeals for Veterans Claims held that an examination is required when (1) there is evidence of a current disability, (2) evidence establishing an "in-service event, injury or disease," or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case. Here, VA treatment records show the Veteran was provided with medication for his migraines. See, e.g., July 2019 Pharmacy Medication MGT Consult from Dayton VA Medical Center. The Veteran's service treatment records also show the Veteran reported experiencing headaches beginning during his active-duty service. See, e.g., May 1998 entries in the Veteran's service treatment records. The Veteran asserts his current headaches manifested during his military service and may be related to his service-connected disabilities. See, e.g. April 2020 Third Party Correspondence from the Veteran's representative. On remand, VA should afford the Veteran an examination of his headaches to assist the Board in determining the extent to which they may be related to the Veteran's military service, to include as secondary to service-connected disabilities. The Board REMANDS this matter for the following actions: 1. VA should contact the Veteran and all current representatives and request their assistance in identifying any outstanding relevant records. VA should make reasonable attempts to obtain all identified outstanding records and associate them with the Veteran's claims file. 2. After associating all outstanding records with the Veteran's claims file, VA should afford the Veteran an examination with an appropriate examiner of the Veteran's headaches. VA should provide the examiner with a complete copy of the claims file. VA should ensure that the examiner follows these directives: (a.) The VA examiner should identify all current disabilities associated with the Veteran's headaches based on a review of the claims file and an examination of the Veteran. VA treatment records show the Veteran's VA treatment providers provided him with medication for his migraines. See, e.g., July 2019 Pharmacy Medication MGT Consult from Dayton VA Medical Center. (b.) For each current disability identified, the examiner should opine whether the disability at least as likely as not (an approximate balance of negative and positive evidence) manifested during or was otherwise caused by events during the Veteran's military service. The examiner should explain why or why not. The examiner should consider pertinent evidence including multiple documented reports of headaches during the Veteran's service. See, e.g., May 1998 entries in the Veteran's service treatment records. The examiner should consider the Veteran's competent statements about the continuity of relevant symptoms over time. (Continued on the next page) (c.) For each current disability identified, the examiner should opine whether the disability was at least as likely as not (an approximate balance of negative and positive evidence) worsened beyond normal progression (aggravated) by the Veteran's PTSD and other service-connected disabilities as supported by the evidence. See, e.g. April 2020 Third Party Correspondence from the Veteran's representative (indicating the Veteran's headaches may be related to his PTSD). Temporary aggravation may suffice for secondary service connection. See Ward v. Wilkie, 31 Vet. App. 233 (2019). K.A. KENNERLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael Duffy 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.