Citation Nr: 21012009 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 19-22 670 DATE: March 3, 2021 REMANDED Entitlement to service connection for a headache disability, to include as secondary to service-connected major depression with alcohol use disorder or medication used to treat this service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1986 to April 1996. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In a September 2019 decision, the Board denied entitlement to service connection for a headache disability. The Veteran subsequently appealed the United States Court of Appeals for Veterans Claims (Court). Pursuant to a Joint Motion for Partial Remand (JMPR), the Court remanded the issue of entitlement to service connection for a headache disability in July 2020. Additional issues adjudicated in the September 2019 Board decision were not disturbed. The Board subsequently remanded the issue in September 2020 for additional development. A January 2021 supplemental statement of the case was most recently issued, and the claim is once again before the Board. Entitlement to service connection for a headache disability, to include as secondary to service-connected major depression with alcohol use disorder or medication used to treat this service-connected disability. While further delay of this matter is quite unfortunate, the Board finds additional development is yet again required before the claim on appeal is decided. On Remand, the Veteran was afforded an October 2020 VA opinion. Unfortunately, it does not appear that the October 2020 VA examiner considered all of the Veteran’s service treatment records, noting complaints of headaches, when providing a negative opinion. In providing rationale for her negative etiological opinion, the examiner incorrectly noted that the Veteran’s service treatment records were silent for any complaints of or treatment for chronic headaches. She based her negative opinion on this incorrect finding. Rather, the Board notes that in-service treatment records reflect complaints of severe headaches in June 1987. The Veteran was diagnosed with headaches secondary to trauma. At a March 1993 service treatment visit, the Veteran again complained of headaches. An additional undated service treatment record reflects treatment for headaches. Post-service treatment records reflect continued complaints of headaches. VA treatment records reflect that the Veteran self-medicates with over the counter medication. See May 2018 VA treatment record and August 2019 Attorney Statement. The Board finds that an addendum medical opinion is warranted, so that all of the Veteran’s in-service treatment can be considered. The Board additionally notes that the October 2020 VA examiner provided negative secondary service connection etiological opinions. However, the VA examiner failed to address treatise information submitted by the Veteran’s attorney, with her notice of disagreement, attempting to support their assertion that there is a relationship between the Veteran’s service-connected psychiatric disability and her headaches. The Veteran, through her attorney, asserted in her notice of disagreement that her headache disability is also being claimed secondary to her service-connected depression with alcohol use disorder or medication used to treat this service-connected disability. These contentions were not addressed in the secondary service connection opinions provided. Additional addendum secondary opinions are necessary. The matters are REMANDED for the following action: Forward the Veteran’s claims folder to an examiner(s) for addendum opinion regarding the Veteran’s headache disability. The examiner is requested to review the claims folder, to include this remand. If further examination of the Veteran is found to be necessary, such should be arranged. Following review of the claims file the examiner should provide opinions on the following: Whether it is at least as likely as not (a probability of 50 percent or greater) that any headache disability had its clinical onset during the Veteran’s active duty service or is otherwise etiologically related to her active service, to include treatment in service. Whether it is at least as likely as not (i.e., there is at least a 50% probability) that any headache disability is caused by her service-connected major depression with alcohol use disorder disabilities, to include medications taken for this disability. Whether it is at least as likely as not (a probability of 50 percent or greater) that any headache disability is aggravated by her service-connected major depression with alcohol use disorder, to include medications taken for this disability. The term “aggravated” in the above context refers to a permanent worsening of the underlying condition, as contrasted to temporary or intermittent flare-ups of symptomatology which resolve with return to the baseline level of disability. In rendering the requested opinions, the examiner should address the treatise evidence of record concerning the relationship between a psychiatric disability and headache disability. Rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. M. Clark, 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.