Citation Nr: 21007321 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 16-06 210 DATE: February 9, 2021 REMANDED Entitlement to service connection for short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome, to include short-lasting unilateral neuralgiform headache autonomic symptoms (SUNA) syndrome and claimed as right eye condition, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1993 to September 1995, July 2006 to May 2007, and March 2010 to March 2011. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). In September 2019, the Veteran testified at a Board videoconference hearing before the undersigned and a transcript of those proceedings is of record. The above-named representative is acting on a one-time basis pursuant to 38 C.F.R. § 14.630. The Board previously considered this matter in November 2019 and August 2020, when it remanded for additional development. It has now returned to the Board for appellate review. Although the additional delay is regrettable, the Board finds that there has not been substantial compliance with the August 2020 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Also, further records development is necessary prior to the adjudication of this appeal. In the August 2020 remand, the Board directed the Agency of Original Jurisdiction (AOJ) to schedule a VA examination by a neurologist to determine the etiology of the Veteran’s SUNCT/SUNA syndrome, to include whether any symptoms of SUNCT/SUNA syndrome are due to an undiagnosed illness or medically unexplained chronic multi-symptom illness resulting from service in Southwest Asia, to include during the Persian Gulf War. See 08/13/2020 BVA Decision at 7. In addition, the August 2020 remand requested that the examiner consider all pertinent lay and medical evidence. Id. The Veteran was afforded a VA examination by a neurologist in August 2020. See 08/26/2020 C&P Exam. The VA examiner provided a diagnosis of SUNCT/SUNA syndrome and opined that the Veteran’s symptoms are less likely than not related to an undiagnosed illness or medically unexplained chronic multi-symptom illness resulting from service in Southwest Asia, to include during the Persian Gulf War. As rationale, the examiner reasoned that the Veteran’s symptoms are instead due to SUNCT/SUNA, a disease with a clear and specific etiology, trigeminal autonomic cephalgia, and are not in any way related to environmental exposure. See id. The Board acknowledges the August 2020 medical opinion, but finds that it is inadequate for decision-making purposes. When VA provides an examination or obtains an opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). When an examination is inadequate, the Board must remand the case for further development. Bowling v. Principi, 15 Vet. App. 1 (2001); 38 C.F.R. § 4.2. Here, the August 2020 examiner only addressed service connection for a chronic multi-symptom Gulf War illness, and failed to address entitlement to service connection for SUNCT/SUNA syndrome on a direct basis or as secondary to service-connected sinusitis. See 09/06/2019 VA 21-4138 Statement in Support of Claim at 2. Further, the August 2020 examiner failed to show consideration of pertinent evidence of record, to include service treatment records (STRs) which document the Veteran’s complaints of and treatment for headaches and eye conditions while in service. See 03/12/2009 STR – Medical – Photocopy; 07/01/2009 STR – Medical Photocopy. The August 2020 examiner also failed to show consideration of the April 2020 VA examination report and medical opinion of record, as well as the Veteran’s lay statements regarding an in-service onset of SUNCT/SUNA syndrome symptoms while engaged in combat in Iraq. See 04/22/2020 C&P Exam; see also 09/06/2019 VA 21-4138 Statement in Support of Claim and 09/06/2019 Hearing Transcript at 4. Finally, evidence of record indicates that the Veteran had service in the U.S. Navy Reserve, however Reserve service records have not been associated with the claims file, nor is there any indication that the AOJ made attempts to obtain such records. VA has a duty to assist the Veteran with the development of facts pertinent to the appeal. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). This duty includes obtaining "relevant" records in the custody of a federal department or agency under 38 C.F.R. § 3.159(c)(2), such as Reserve service records. Here, evidence of record reveals that the Veteran had Reserve service through the year 2013, potentially corresponding with the onset of symptoms of SUNCT/SUNA syndrome. See 02/04/2014 VA 21-8951, Notice of Waiver of VA Compensation or Pension to Receive Military Pay and Allowances (showing 35 Reserve training days in 2013); see also 01/05/2016 C&P Exam (reporting the onset of SUNCT/SUNA syndrome symptoms in late spring or early summer 2013). The Board finds that the precise dates of the Veteran’s Reserve service are relevant for purposes of determining whether his SUNCT/SUNA syndrome was incurred in during a period of active duty for training (ACDUTRA) or inactive duty for training (INACDUTRA); accordingly, a remand is required to attempt to obtain Reserve service records that have not been associated with the claims file in order to verify the Veteran’s Reserve service dates. The matter is REMANDED for the following actions: 1. Request from the appropriate federal records custodian(s) all outstanding STRs and military personnel records, to include those from Reserve service through the year 2013. Then, prepare a memorandum identifying the exact nature and dates of the Veteran's active and inactive service, including active duty service and service in the U.S. Navy Reserve, to include all periods of ACDUTRA and INACDUTRA. All efforts to obtain these records must be documented in the claims file. If, after conducting all due diligence, the AOJ determines that any of the aforementioned records are unavailable or that further efforts to obtain them would be futile, the Veteran and his representative should be so advised in accordance with the provisions of 38 C.F.R. § 3.159(e). 2. Only after the development requested above in Directive 1 has been completed, obtain an addendum VA medical opinion from a neurologist (if possible, different than the one who authored the August 2020 opinion) regarding the etiology of the Veteran’s SUNCT/SUNA syndrome. The entire claims file, to include a copy of this Board remand, is to be made available for the clinician’s review. The neurologist’s addendum opinion is to specifically respond to the following: (a.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s SUNCT/SUNA syndrome began during active military service or service in the U.S. Navy Reserve? (b.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s SUNCT/SUNA syndrome was 1) caused by, OR 2) worsened (aggravated) by service-connected sinusitis? The clinician must specifically address the following pertinent evidence: (1) STRs showing complaints of and treatment for headaches and eye conditions while in service; (2) the April 2020 examination report and medical opinion; and (3) the Veteran’s lay statements regarding an in-service onset of SUNCT/SUNA syndrome symptoms. See 03/12/2009 STR – Medical – Photocopy, 07/01/2009 STR – Medical Photocopy; see also 04/22/2020 C&P Exam; see also 09/06/2019 VA 21-4138 Statement in Support of Claim, 09/06/2019 Hearing Transcript at 4. All relevant lay and medical evidence is be considered. The examiner must provide a comprehensive rationale for all opinions provided. If an opinion cannot be provided without resorting to speculation, the examiner must explain why this is so and state whether the need to speculate is due to a deficiency in the state of general medical knowledge, the record, or the examiner. (Continued on the next page)   If the examiner cannot provide the requested opinion without another VA examination, then the AOJ must schedule one (or telehealth interview, if an in-person examination is not feasible due to the current pandemic). Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Tremont 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.