Citation Nr: 21006248 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 15-11 682 DATE: February 3, 2021 REMANDED Entitlement to service connection for migraine headaches is remanded. REASONS FOR REMAND The Veteran had active duty service from October 2006 to October 2010. The record reflects he served honorably in Afghanistan and is in receipt of the Combat Action Ribbon. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2018, the Board remanded the matter for records development. In April 2020, the Board remanded the matter for additional records development and to provide the Veteran an adequate VA examination on the etiology of his migraine headaches. Entitlement to service connection for migraine headaches is remanded. The Veteran asserts he developed headaches in 2009 following exposure to improvised explosive devices (IED) explosions. The Veteran reports proximity to explosions throughout the record, including during medical assessments addressing other disabilities. The Board regrets further delay, but finds a remand is again necessary to provide the Veteran with an adequate VA examination. In October 2020, the Veteran underwent a VA headaches examination as requested by the Board’s April 2020 remand. The examiner diagnosed with migraines but opined that they were less likely than not related to the Veteran’s service. The examiner explained that there are no medical records demonstrating in-service evaluation for headaches due to an event, and, therefore, a nexus was not established. The examiner indicated that the etiology of the Veteran’s migraine headache is instead the Veteran’s stress. The Board finds this opinion inadequate for two reasons. First, the examiner failed to consider the Veteran’s assertions as to service incurrence in her etiological opinion and instead relied on the absence of findings in service. It is well settled that the absence of contemporaneous records does not preclude granting service connection for a claimed disability. See Buchannan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). The Veteran asserts that he did have headaches after exposure to multiple IEDs, but that his complaints were not record properly. Second, the examiner’s statement is contrary to the record. A service treatment record dated in August 20017 shows a complaint of headaches and other symptoms that were assessed as heatstroke. Third, and finally, the examiner’s negative rationale is conclusory. For example, the examiner provided no explanation for concluding the Veteran’s migraine headaches are due to stress and not his military service, simply noting “[e]tiology: [s]tress.” It is also well settled that VA medical opinions require complete rationales, which include clear conclusions, supporting data, and a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (citing Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007)). Accordingly, a remand is required for a supplemental medical opinion. The matter is REMANDED for the following action: Obtain a supplemental medical opinion concerning the etiology of the Veteran’s migraine headaches. The need for an in-person examination is left to the examiner’s discretion. The examiner is asked for an opinion regarding whether it is at least as likely as not that the Veteran’s migraine headaches had their onset during or are otherwise etiologically related to the Veteran’s military service, to include his descriptions of being in close proximity to explosions. A complete rationale for any opinion must be provided. A complete rationale is one with clear conclusions and support data, as well as a reasoned medical explanation connecting the two. In providing the requested opinion and rationale, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service headache symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of his current migraine disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.A. Infante, 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.