Citation Nr: A21020545 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 210901-182286 DATE: December 27, 2021 REMANDED Entitlement to service connection for headaches/tension headaches is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from November 1966 to November 1968. As a result of his exemplary service, the Veteran received numerous awards, including the Purple Heart and the Bronze Star. This appeal comes to the Board of Veterans' Appeals (Board) following a November 2020 higher-level review rating decision in which the Agency of Original Jurisdiction (AOJ) denied the Veteran's claim for entitlement to service connection for headaches/tension headaches. In September 2021, the Veteran filed a timely VA Form 10182 and selected the Board's Evidence Submission Docket. Accordingly, the Board may consider the evidence of record at the time of the November 2020 rating decision and any evidence submitted with the Veteran's VA Form 10182 or within 90 days of the Board's receipt of the VA Form 10182. 38 C.F.R. §§ 20.300, 20.303. Entitlement to service connection for headaches/tension headaches is remanded. A brief discussion of the procedural history is necessary. The Veteran's claim for service connection for headaches/tension headaches was denied in a January 2008 rating decision. The Veteran timely appealed the decision with a notice of disagreement in January 2008. After the issue was again denied in an April 2013 statement of the case, the Veteran substantively appealed the claim. The issue was previously remanded by the Board for further development in November 2018 and November 2019. Following a June 2020 supplemental statement of the case that denied entitlement to service connection for headaches/tension headaches, the Veteran submitted a VA Form 20-0996 Decision Review Request: Higher-Level Review in June 2020. As noted above, the Veteran submitted a VA Form 10182 in September 2021 after his claim was denied in a November 2020 higher-level review rating decision. When this issue was last before the Board in November 2019, the Board found the March 2019 VA examination to be inadequate because the examiner failed to address post-service treatment records prior to February 2016 in which the Veteran reported symptoms of and/or sought treatment for a headache disorder. Consequently, the Board remanded the issue for a new VA examination to determine the nature and etiology of the Veteran's headache disorder. Pursuant to the November 2019 Board remand directives, the Veteran was afforded a new VA examination in June 2020. The June 2020 VA examiner opined that the Veteran's headache disorder was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. As rationale, she explained that there was no objective evidence of a chronic headache condition diagnosed in the service treatment records or within one year of separation from service. She noted that the 1968 separation examination was silent for headaches and noted a normal neurological exam. She explained that headaches are not associated with herbicide exposure and noted some causes of a primary headache, including overactivity of or problems with pain-sensitive structures in your head. However, the Board finds the examiner's finding conclusory and did not otherwise provide sufficient rationale as to why headaches are not associated with herbicide exposure. Further, although the June 2020 examiner generally addressed direct service connection, she did not address whether the Veteran's headaches could be related to his reported in-service head injury. In a June 2013 VA treatment record, the Veteran reported that he hit his head when diving into a foxhole while he was serving in Vietnam. He further stated that this injury caused headaches. Additionally, in a December 2014 VA treatment record, the Veteran related his headaches to his service-connected tinnitus. The Veteran also noted throughout VA treatment records that his headaches are worse when he is stressed. Moreover, in a January 2008 notice of disagreement, the Veteran asserted that his headaches were secondary to his hypertension. However, no medical opinion has yet been provided to determine whether the Veteran's claimed headaches are secondary to one or more of his service-connected disabilities, to include tinnitus, posttraumatic stress disorder (PTSD), and hypertension. VA has a duty to address all arguments put forth by a claimant or theories under which entitlement to benefits sought may be awarded. See, generally, Schroder v. West, 212 F.3d 1265 (Fed. Cir. 2000); Buckley v. West, 12 Vet. App. 76, 83 (1998). Given the aforementioned statements, the Board finds that the issue of secondary service connection was reasonably raised by the record prior to the decision on appeal. The Board finds that these constitute duty to assist errors under 38 C.F.R. § 3.159(c)(4) which existed at the time of the appealed November 2020 higher-level review rating decision. As such, further medical commentary is needed before reaching a conclusion. Additionally, although a February 2020 VA treatment record notes that the Veteran has a private medical provider, these private treatment records have not been associated with the claims file. When VA is informed of any potentially relevant private treatment records, VA must seek to obtain the records prior to deciding the case or explain its failure to do so. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991); Sullivan v. McDonald, 815 F.3d 786, 793 (Fed. Cir. 2016) (VA has a duty to assist in obtaining sufficiently identified VA medical records regardless of their relevance). Therefore, this matter must also be remanded to obtain these missing records. The matters are REMANDED for the following action: 1. With any necessary assistance from the Veteran, make all efforts to obtain all relevant private medical treatment records for the Veteran's headache disorder for the entire appellate period prior to November 2020 in accordance with the duties set forth in 38 C.F.R. § 3.159(c). Document all requests for information, as well as responses in the claims file. 2. Once the above development has been completed, obtain an addendum medical opinion from an appropriate clinician regarding the Veteran's headache disorder. The claims file should be made available to and reviewed by the examiner. All findings should be reported in detail. The examiner is asked to answer the following questions: (a.) Is at least as likely as not (50 percent or greater probability) that any diagnosed headache disorder had its onset in service or is otherwise etiologically related to active service, to include presumed exposure to herbicide agents in Vietnam? The examiner is asked to consider the July 1968 notation of severe headaches, as well as the Veteran's June 2013 assertion that he experienced headaches after injuring his head while diving in a foxhole when he was serving in Vietnam. (b.) If not, is it at least as likely as not (50 percent or greater probability) that any diagnosed headache disorder is proximately due to one or more of the Veteran's service-connected disabilities, to include tinnitus, hypertension, and PTSD? (c.) If not, is it at least as likely as not (50 percent or greater probability) that any diagnosed headache disorder was aggravated (i.e., worsened beyond its natural progression) by one or more of the Veteran's service-connected disabilities, to include tinnitus, hypertension, and PTSD? In providing these opinions, the examiner is asked to specifically address the Veteran's lay statement relating his headaches to his tinnitus, and his lay statement that his headaches are worse when he is stressed. The examiner must provide any and all opinions as to etiology in the form of a probability and must provide a complete rationale for any opinion expressed. The need for another examination and/or telephonic or video interview of the Veteran is left to the discretion of the examiner selected to offer the requested opinions. Richard Kettler Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Fairlie, 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.