Citation Nr: 21071146 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 13-19 799 DATE: November 29, 2021 REMANDED Entitlement to service connection for headaches is remanded. REASONS FOR REMAND The Veteran was a member of the Army National Guard from 1979 to 2009, when he retired. The Veteran served on active duty from July 2004 to October 2005, to include service in Southwest Asia. The Veteran also served a period of active duty for training (ACDUTRA) from June 1, 1979, to August 24, 1979. The Veteran is in receipt of a combined 100 percent rating effective January 23, 2014. This matter comes before the Board of Veterans' Appeals (Board) following November 2017 and June 2021 Board Remands and a February 2020 Board Decision. This matter was originally on appeal from a May 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. In August 2016, the Veteran testified at a hearing before the undersigned. A transcript of the hearing is of record. The Board denied the Veteran's claim for service connection for headaches in the February 2020 decision, and the Veteran appealed this Board decision to the Court of Appeals for Veterans Claims (CAVC). In November 2020, CAVC granted a Joint Motion for Partial Remand (JMR) in which the parties found there was a duty to assist error in which the Board relied on an inadequate medical opinion in denying the Veteran's claim. The matter was remanded in June 2021. 1. Entitlement to service connection for headaches is remanded. The Veteran contends he suffers from migraine headaches as a result of his time in service. The June 2021 Board remand directed the examiner to opine whether it is at least as likely as not that the Veteran's headaches were incurred in or caused by his service in the Gulf War and opine whether it is at least as likely as not that the Veteran's service-connected diabetes mellitus type 2, posttraumatic stress disorder, irritable bowel syndrome, and/or his hypertension aggravated his headaches. In July 2021 the Veteran was provided a VA opinion. The examiner opined the Veteran's condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner stated at the time of discharge from Southwest Asia the Veteran's report of medical assessment is silent for any headache conditions. As such, it is less likely than not due to any specific exposure event experienced by the Veteran during service in Southwest Asia. The examiner also noted an August 2005 post deployment health assessment notes the Veteran responded he did not have headaches in response to the question of do you have any of these symptoms now or did you develop them anytime during this deployment. The examiner also noted the Veteran's post-service treatment records show the Veteran indicated he experienced headaches one to two times per week in June 2016. The examiner also stated since that time the Veteran has noted "no" to headaches multiple times in 2020 and 2021, as such it has not worsened over time. The examiner provided no opinion in regard to whether the Veteran's claimed headaches are aggravated by any other condition to include, diabetes mellitus type 2, posttraumatic stress disorder, irritable bowel syndrome, and/or his hypertension as specified in the prior remand. The Veteran testified that his doctor told him that high blood pressure can cause headaches. The Veteran is service connected for hypertension associated with diabetes mellitus. As stated above, the examiner was directed to offer secondary opinions regarding the Veteran's headaches relation to any diabetes mellitus type 2, posttraumatic stress disorder, irritable bowel syndrome, and/or his hypertension. The examiner has offered no such opinion. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding the issue of entitlement to service connection for headaches. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Significantly, the issue of whether the Veteran's service-connected diabetes mellitus type 2, posttraumatic stress disorder, irritable bowel syndrome, and/or his hypertension aggravated his headaches was not addressed in the July 2021 VA opinion obtained. Accordingly, remand is warranted to ensure compliance with prior Remand instructions and obtain sufficient medical evidence for the Board to render a decision. See Stegall, 11 Vet. App. at 271 (1998); Colvin v. Derwinski, Vet. App. 171, 175 (1991). The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Obtain an addendum opinion for the Veteran's headache condition. The claims file must be provided to and be reviewed by the examiner. The examiner is advised to review the pertinent evidence in medical treatment records, and the Veteran's lay statements regarding his symptoms. The examiner is asked to opine: (a) Whether it is at least as likely as not (probability of at least 50 percent) that the Veteran's service-connected diabetes mellitus type 2, posttraumatic stress disorder, irritable bowel syndrome, and/or his hypertension AGGRAVATED his claimed headaches. A clear rationale must be provided for all opinions expressed. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Daley, 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.