Citation Nr: 21076780 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 16-12 227 DATE: December 27, 2021 REMANDED Entitlement to an increased rating for a cervical spine disability in excess of 10 percent prior to June 25, 2014, in excess of 20 percent from June 25, 2014, to August 28, 2020, and in excess of 30 percent from August 29, 2020, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1988 to July 2012. This matter is before the Board of Veterans' Appeals (Board) on appeal from a December 2012 decision of a Department of Veterans Affairs (VA) Regional Office (RO). The December 2012 decision granted service connection for a neck disability and assigned a 10 percent disability rating effective August 1, 2012. A January 2016 rating decision increased the Veteran's neck disability to 20 percent effective June 25, 2014. A September 2020 rating decision increased the Veteran's neck disability to 30 percent effective August 29, 2020. The Board notes that the Veteran was awarded a 100 percent temporary total evaluation for the cervical spine disability from November 18, 2014, to January 31, 2015, and that period is not on appeal as he is in receipt of the maximum rating. In July 2019, the Veteran and his spouse testified at a video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. In November 2019 and November 2020, the Board remanded this matter for further evidentiary development. Entitlement to an increased rating for a cervical spine disability in excess of 10 percent prior to June 25, 2014, in excess of 20 percent from June 25, 2014, to August 28, 2020, and in excess of 30 percent from August 29, 2020, is remanded. Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). In May 2021, a VA examiner provided a negative nexus opinion on the question of whether the Veteran's service-connected cervical disability caused or aggravated his headaches. The examiner's rationale was that headaches are due to hyper excitable trigeminal sensory neurons in the brainstem that are stimulated and release neuropeptides which in turn leads to vasodilatation and neurogenic inflammation. The examiner premised this opinion by stating that the Veteran was diagnosed with headaches in September 2014 and that his headaches were stable since then because the Veteran failed to seek treatment for his headaches. The Veteran was afforded a VA examination for his headaches in August 2021. The examiner diagnosed migraine headaches. The Veteran informed the examiner that his headaches began in 2014 after his neck surgery. The Veteran added that initially his symptoms included headaches, but overtime his symptoms worsened to include soreness on both sides of the head in front of the ears and the neck. The examiner opined that the Veteran's headaches were less likely than not related to the Veteran's service-connected neck disability. The examiner's rationale was that there was no evidence in the claims file to indicate that headaches are related to the Veteran's neck disability. The examiner also opined that it was less likely than not the Veteran's headaches were aggravated by his service-connected neck disability. The examiner's rationale was that the "baseline and extent cannot be determined due to no evidence of headaches." The Board finds the May 2021 VA opinion to be inadequate. The examiner's rationale is premised on the basis that the Veteran's headaches remained static since 2014. However, the Veteran indicated that his headaches have worsened since 2014 because his symptoms began as headaches but progressed to include soreness on both sides of the head in front of the ears and the neck. Thus, the examiner's premise that the Veteran's headaches have remained unchanged since 2014 is appears to be inaccurate. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that an opinion based upon an inaccurate factual premise has no probative value). The Board also finds the August 2021 opinion to be inadequate. The examiner's rationale that there was no evidence in the claims file that headaches were related to the Veteran's neck disability is false. In August 2020, the Veteran was afforded a VA examination to determine the severity of his service-connected neck disability. The examiner specifically noted that the Veteran's cervical condition resulted in neurological abnormalities; namely, the Veteran reported developing spinal headaches after his last surgery in 2014. Thus, the examiner's rationale that the claims file is void of any evidence that the Veteran's headaches are related to his neck disability is inaccurate. See Reonal, 5 Vet. App. at 461. Additionally, the examiner's rationale is limited to a conclusory statement without any meaningful explanation. See Nieves-Rodriguez, 22 Vet. App. 295; Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The August 2021 examiner's rationale considering aggravation is also inadequate because it is contradictory. The examiner diagnosed migraine headaches but then states that there was no evidence of headaches. Also, the examiner's rationale is limited to a conclusory statement without any real explanation. See Nieves- Rodriguez, 22 Vet. App. 295; Stefl, 21 Vet. App. at 124. For these reasons, the Board finds the May 2021 and August 2021 opinions to be inadequate and that remand for a new opinion is necessary. The matters are REMANDED for the following actions: 1. Contact the Veteran and afford him the opportunity to identify or submit any additional pertinent evidence in support of his claims, to include records from the Institute of Spinal Disorders (Dr. R.M.) and Texas Health Harris Methodist Hospital. Based on the response received, attempt to procure copies of all records which have not previously been obtained from identified treatment sources. 2. After completing the development above, forward the Veteran's claims file to an appropriate clinician for an addendum opinion on the nature and etiology of the Veteran's headaches. If the reviewing clinician determines that an examination is necessary (including via telehealth interview) to provide the requested opinion, then such must be scheduled. The examiner is asked to provide an opinion on the following: (a.) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's headaches were caused by the Veteran's service-connected neck disability? (b.) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's headaches were aggravated beyond the natural progression of the disability by the Veteran's service-connected neck disability? (Aggravation is any increase in severity beyond the natural progression of the disability.) A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Patel, 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.