Citation Nr: 21007444 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 16-33 996 DATE: February 9, 2021 REMANDED Entitlement to service connection for a disability manifested by migraine headaches, to include as due to service in the Persian Gulf during the Persian Gulf War is remanded. REASONS FOR REMAND The Veteran had active duty service from July 1990 to July 1996. In July 2019, the Board of Veterans’ Appeals (Board) denied the issue addressed in this decision. The Veteran appealed. In a July 2020 Joint Motion for Partial Remand (JMFPR), Court of Appeals for Veterans Claims (CAVC) remanded the claim finding that the Board did not provide sufficient analysis to support its conclusion that the Veteran’s headaches were not considered part of a presumptive illness. However, under 38 U.S.C. § 1117(g) a headache is one of many other signs and symptoms that may be a manifestation of a chronic multi-symptom illness. Secondly, the Board failed to address whether the medical evidence of record was sufficient to determine whether the Veteran’s headaches were part of a medically unexplained chronic multi-symptom illness (MUCMI). The Board relied on an April 2015 VA examination report; however, in the report, the examiner only addressed whether the Veterans migraines had a partially explained etiology, but not whether they had a partially explained pathophysiology. As such, it was essentially concluded that examination was not fully adequate for rating purposes. Entitlement to service connection for a disability manifested by migraine headaches, to include as due to service in the Persian Gulf during the Persian Gulf War is remanded. The Veteran Contends that the onset of his migraine headaches is related to part of a MUCMI related to his service in the Persian Gulf during the Gulf War. As noted above, a remand is necessary for the April 2015 examiner to provide an opinion and rationale concerning whether the Veteran’s migraine headaches had a partially explained pathophysiology. The examiner should also discuss the Veteran’s migraine headaches as related to a MUCMI due to exposure to environmental contaminants in the Persian Gulf. In order to extend all due process considerations to the Veteran, an examiner opinion is necessary. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. The matters are REMANDED for the following action: 1. Return the Veteran’s claims file to the examiner who conducted the April 2015 VA examination for a migraine headaches disorder related to a MUCMI due to exposure to environmental contaminants in the Persian Gulf so a supplemental opinion may be provided. If that examiner is no longer available, provide the Veteran’s claims file to a similarly qualified clinician. The entire claims file must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. A new examination is only required if deemed necessary by the examiner. After a thorough review of the medical history the examiner is requested to prepare a detailed opinion which answers the following: Taking into consideration the Veteran’s lay statements and post service VA and private treatment records, is it as likely as not (that is a probability of 50 percent or greater) that the Veteran’s migraine headaches are related to or aggravated by a MUCMI due to exposure to environmental contaminants in the Persian Gulf, or are otherwise related to any in-service event or occurrence? In the opinion, the examiner should also address whether the Veteran’s migraine headaches had a partially explained pathophysiology. If a pathology, etiology, or pathophysiology for the Veteran’s migraine headaches disorder is not found to be related to or aggravated by a MUCMI due to exposure to environmental contaminants in the Persian Gulf, that should be specifically set out with the factors considered in making that determination. Please provide a complete rationale for all opinions entered and review the entire record including lay statements. If an examiner cannot provide any of the requested opinions, he/she must affirm that all procurable and assembled data was fully considered, and a detailed rationale must be provided for why an opinion cannot be rendered.   The AOJ must ensure that the examiner’s report complies with this remand and answers the questions presented in the request. The AOJ must also ensure that the examiner documents consideration of the electronic claims file. If the report is insufficient, the AOJ should take corrective action. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Harris, Michael E. 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.