Citation Nr: 21077022 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 17-35 657 DATE: December 28, 2021 REMANDED The issue of entitlement to service connection for headaches, to include migraine headaches, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1986 to July 1987 and from November 1990 to June 1991, including service in the Southwest Asia Theater of Operations. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Des Moines, Iowa. Jurisdiction is currently with the RO in St. Petersburg, Florida. This matter was previously before the Board at which times it was remanded for further development. Entitlement to service connection for headaches, to include migraine headaches, is remanded. In a December 2021 Informal Hearing Presentation, the Veteran's representative raised the contention that the Veteran has headaches secondary to his service-connected posttraumatic stress disorder (PTSD). Specifically, the representative noted that stress has been linked to the occurrence of headaches and symptoms of PTSD can contribute to very high levels of stress and emotional strain. Such contention has not been previously addressed. Therefore, the Board finds that a remand for an addendum opinion is necessary. Additionally, in light of the remand herein for an addendum opinion addressing secondary service connection, the Board will also take the opportunity to obtain a more comprehensive opinion addressing direct service connection, considering the Veteran's lay statements regarding continuity of symptomatology. The matters are REMANDED for the following action: 1. Request that the Veteran provide or authorize VA to obtain records of his relevant treatment that have not yet been associated with the claims file, and associate with the claims file any outstanding VA treatment records. 2. Return the record to the September 2021 VA examiner. The record and a copy of this Remand must be made available to the examiner. If the examiner is not available, the record should be provided to an appropriate medical professional so as to render the requested opinion. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran has headaches that had their onset during active service, or within one year of the Veteran's separation from active service, or is otherwise related to service? The examiner is asked to address the Veteran's lay statements regarding continuity of symptomatology since service. (b.) Is it at least as likely as not that the Veteran has headaches that were caused or aggravated (worsened beyond normal progression) by service-connected PTSD? The examiner is asked to address both causation and aggravation. The examiner is also asked to address the relationship between headaches, PTSD, and stress; and the articles cited in the December 2021 Informal Hearing Presentation. (c.) If the examiner finds that the Veteran's headaches have been worsened beyond normal progression (aggravated) by the Veteran's service-connected PTSD, the examiner should attempt to quantify the degree of aggravation beyond the baseline level that is attributed to the service-connected disability. (d.) All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith-Jennings, 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.