Citation Nr: 21009970 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 15-22 994 DATE: February 23, 2021 REMANDED Entitlement to an initial rating in excess of 0 percent for migraine headaches is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1973 to August 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) dated September 2012. In June 2018, the Veteran testified at a Board video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is included in the claims file. The Veteran is seeking a higher initial rating for migraine headaches, that he contends has worsened since his initial rating of 0 percent, effective from June 13, 2012. Specifically, he contends that his migraine headaches occur four times a week causing him to lay down and stop whatever he is doing. See June 2018 Video Conference Hearing Transcript. He has also reported 12 headache free days per month, which means that he had at least 18 or more days that he suffered from headaches. Notably, the Board in November 2018 remanded this matter for additional development and consideration. However, upon review of the September 2019 VA opinion additional clarification is warranted. See September 2019 Headaches DBQ. Specifically, the Veteran has additional treatment records that the Board finds relevant as they indicate a potential worsening since the September 2019 VA examination. In January 2019 the Veteran underwent a hemorrhoidectomy, which "involved awkward positioning for longer than planned” and may have resulted in a worsening of his migraine headaches. In general, the Veteran reports that his headaches impact his day to day activities. He currently treats his headaches with acetaminophen or naproxen with cyclobenzaprine, as well as with ice, with mild relief. The Veteran was prescribed prochlorperazine for nausea during migraines. See August 2020 Houston VA Medical records. As such, even if the September 2019 VA examination report was adequate, a new VA examination is warranted to ascertain the current severity and manifestations of the Veteran’s service-connected migraine headaches. See Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994). The matter is REMANDED for the following action: 1. With the Veteran's assistance as appropriate, obtain and associate with the Veteran's electronic claims file all outstanding VA records from September 2019 to current. 2. Schedule the Veteran for a VA migraine and headaches examination. The examiner is asked to comment on the frequency, severity and duration of the Veteran’s migraine headaches. See 38 C.F.R. § 4.124A, DC 8100. Even if the migraine headaches are found not to be prostrating, whether they average once a month, or one every two months. The examiner should specifically comment on: (a.) Whether or not the Veteran’s hemorrhoidectomy may have resulted in a worsening of his migraine headaches. (b.) Whether or not the Veteran’s lay statements regarding headaches four times a week or 18 days a month are in fact migraine headaches. (c.) Whether or not the Veteran’s increase of medication from once every six hours to once every four hours is associated with the severity of his service-connected migraine headaches. • For all opinions, the examiner is instructed to consider the lay statements of record and set forth the medical reasons for accepting or rejecting the Veteran's statements regarding his symptomatology. • Any opinion expressed by the VA examiner should be accompanied by a rationale, and if medical literature is relied upon, the VA examiner should identify the referenced material. • The term "incremental increase in disability" means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. • The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be acknowledged and considered in formulating any opinion. • THE EXAMINER SHOULD ADDRESS ANY AND ALL TREATISES OF RECORD. 3. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE, CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board David B. Scheirich, 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.