Citation Nr: 21005319 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 15-04 606 DATE: February 1, 2021 REMANDED Entitlement to service connection for migraine headaches is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1988 to July 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in February 2018 at which time it was remanded for further development. In September 2019, the Board denied the claim for service connection for migraine headaches. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In a June 2020 order, CAVC granted a joint motion for remand (JMR), vacated the Board’s decision and remanded the claim for further proceedings consistent with the JMR. 1. Entitlement to service connection for migraine headaches is remanded The parties agreed that the Board provided inadequate reasons or bases for its decision to deny service connection for migraine headaches because it failed to address the theory of secondary service connection after it had been raised in the record. It was noted that a June 2018 Disability Benefits Questionnaire (DBQ) completed by a private physician stated that the Veteran’s migraine headaches pertain to posttraumatic stress disorder (PTSD) and depression. Additionally, in a July 2019 informal hearing presentation, the Veteran, through his representative, referenced medical literature and alleged that his migraine headaches are secondary to his PTSD. In the January 2021 appellate brief, the Veteran’s representative argued that the Veteran’s migraine headaches are caused or aggravated by sleep apnea. The Veteran was afforded a VA examination in April 2019. The examiner provided a medical opinion on direct service connection. However, an opinion on secondary service connection was not obtained. Further, while the June 2018 DBQ referenced above notes that migraine headaches “pertain” to PTSD, the exact relationship is unclear. Thus, a remand is warranted to obtain a medical opinion on whether the Veteran’s migraine headaches is related on a secondary basis to his service-connected PTSD or sleep apnea. The matter is REMANDED for the following action: 1. Arrange for an appropriate clinician to provide an opinion in the case regarding the etiology of the Veteran’s migraine headaches. It is up the discretion of the selected clinician as to whether an examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) of the Veteran is required to provide the opinion. The examiner is requested to provide opinions regarding: a) Whether it is at least as likely as not (50 percent probability or greater) that the migraine headaches had causal origins in service or is otherwise related to the Veteran’s active duty service. b) If not, the examiner should indicate whether it is at least as likely as not, (50 percent probability or greater), that the migraine headaches were (A) caused or (B) aggravated beyond its normal progression by the service-connected PTSD. c) If the answer to the first two questions is no, the examiner should indicate whether it is at least as likely as not, (50 percent probability or greater), that the migraine headaches were (A) caused or (B) aggravated beyond its normal progression by the service-connected sleep apnea. Aggravation means an increase in disability – any additional impairment of earning capacity – of the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. In formulating the requested opinions, the examiner should review the June 2018 private DBQ, April 2019 VA Examination, and the Veteran’s statements and medical literature referenced in July 2019 and January 2021 appellate briefs. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 2. After undertaking any additional development deemed appropriate and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran’s pending claim in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Amanda Baker, 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.