Citation Nr: 21010072 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 09-36 661 DATE: February 24, 2021 REMANDED Entitlement to service connection for diabetes mellitus is remanded. Entitlement to service connection for migraine headaches is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1987 to November 2007. This matter again comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2008 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. The Veteran testified before a Veterans Law Judge (VLJ) other than the undersigned in July 2015; a transcript is of record. The Board previously remanded this matter in March 2016 and February 2019. 1. Entitlement to service connection for diabetes mellitus is remanded. 2. Entitlement to service connection for migraine headaches is remanded. First, regarding the Veteran’s claim for diabetes mellitus, the Board acknowledges receipt of a May 2019 opinion concluding that the Veteran’s diabetes mellitus is less likely than not etiologically linked to his active service. However, the examiner noted that diabetes mellitus is accompanied by other comorbidities, including hypertension, a condition for which the Veteran has been awarded service connection. Accordingly, the Board finds that there is a question as to whether the Veteran’s diabetes mellitus is etiologically related to his service-connected hypertension and an addendum opinion must be obtained. Second, concerning the Veteran’s claim for migraine headaches, the Board acknowledges receipt of a May 2019 opinion finding that his headaches are less likely than not etiologically linked to the Veteran’s active service and service-connected conditions. The examiner found that the Veteran’s migraine headaches were not permanently worsened by his service-connected disabilities. However, secondary service connection based on aggravation is warranted for “any incremental increase in disability . . . regardless of its permanence.” Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). Because the examiner only opined as to whether the Veteran’s migraine headaches were permanently worsened, and not as to any incremental increase in severity, the Board finds that an addendum opinion must be obtained on remand using the correct standard. The matters are REMANDED for the following action: 1. Return the claims file to the clinician who authored the May 2019 opinion regarding the Veteran’s diabetes mellitus for an addendum opinion. The entire claims file, including a copy of this remand, must be made available to the clinician, who must note its review. If the clinician determines that a new examination (or telehealth interview, etc., if an in-person examination is not feasible) would be beneficial, one is to be obtained. (a) The clinician should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diabetes mellitus manifested during, or is the result of, his active service. (b) The clinician should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diabetes mellitus was either (i) caused or (ii) aggravated by his service-connected disabilities, to include hypertension. NOTE: With respect to the question concerning aggravation, the clinician is advised that aggravation under 38 C.F.R. § 3.310(b) does not require “permanent worsening” of the nonservice-connected disability. If aggravation is found, the clinician should attempt to identify the baseline level of disability prior to such aggravation. In formulating his or her opinions, the clinician should consider and address the competent medical and lay evidence of record, including but not limited to: (i) The Veteran’s service treatment records; (ii) The Veteran’s post-service VA medical records; (iii) The Veteran’s post-service private medical records; and (iv) The Veteran’s competent lay statements, including numerous VA Forms 21-4138 and July 2015 hearing testimony, regarding the onset and continuity of his symptomatology. If the clinician determines that the Veteran’s diabetes mellitus is less likely than not due to his active service and/or less likely than not caused and/or aggravated by his service-connected disabilities, including hypertension, the clinician should discuss what other factor(s) caused the disorder. The clinician must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. 2. Return the claims file to the clinician who authored the May 2019 opinion regarding the Veteran’s migraine headaches for an addendum opinion. The entire claims file, including a copy of this remand, must be made available to the clinician, who must note its review. If the clinician determines that a new examination (or telehealth interview, etc., if an in-person examination is not feasible) would be beneficial, one is to be obtained. (a) The clinician should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s migraine headaches manifested during, or are the result of, his active service. (b) The clinician should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s migraine headaches are either (i) caused or (ii) aggravated by his service-connected disabilities. NOTE: With respect to the question concerning aggravation, the clinician is advised that aggravation under 38 C.F.R. § 3.310(b) does not require “permanent worsening” of the nonservice-connected disability. If aggravation is found, the clinician should attempt to identify the baseline level of disability prior to such aggravation. In formulating his or her opinions, the clinician should consider and address all competent medical and lay evidence of record, including but not limited to: (i) The Veteran’s service treatment records; (ii) The Veteran’s post-service VA medical records; (iii) The Veteran’s post-service private medical records; and (iv) The Veteran’s competent lay statements, including numerous VA Forms 21-4138 and July 2015 hearing testimony, regarding the onset and continuity of his symptomatology. If the clinician determines that the Veteran’s migraine headaches are less likely than not due to service and/or caused and/or aggravated by his service-connected disabilities, the clinician should discuss what other factor(s) caused the disorder. The clinician must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Seserman 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.