Citation Nr: 21013468 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 16-40 907A DATE: March 9, 2021 REMANDED Entitlement to service connection for fibromyalgia (claimed as joint pains) is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1988 to November 1994. This appeal comes to the Board of Veterans Appeals (Board) from an April 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. In November 2019, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A hearing transcript is associated with the record. In February 2020 and October 2020, the Board remanded the claim for further development. During remand status, a January 2021 rating decision granted service connection for migraine headaches disability. The Board finds that the Veteran’s claimed symptoms, for her migraine headaches disability, are encompassed by the RO’s grant. In this regard, at the February 2020 VA examination, the Veteran described her migraine headaches symptomology as causing: Nausea, blurred vision, throbbing pain and shooting pain through the right eye. She additionally stated that her symptomology limited social and occupational functions, such as having to call out or leave work until a migraine subsides. The Veteran’s migraine headaches disability is rated pursuant to Diagnostic Code 8100, which considers characteristic prostrating attacks occurring on an average of one in 2 months over last several months or once a month over last several months. See 38 C.F.R. § 4.124a. Thus, as the RO granted in full the benefit sought by the Veteran in this matter, there is no remaining allegation of error of fact or law for appellate consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). The RO, additionally, sent to the Veteran a January 2021 supplemental statement of the case that addressed the remaining above issue on appeal. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.800(c). 38 U.S.C. § 7107(b). Entitlement to service connection for fibromyalgia (claimed as joint pains) is remanded The Veteran, and her representative, contends that her fibromyalgia had its onset during service and has continued therefrom. See Hearing Transcript at 11 (November 2019). The Board finds there has not been substantial compliance with its prior remand, and therefore further remand is required. Stegall v. West, 11 Vet. App. 268 (1998). As an initial matter, the Board notes that, in October 2020, the claim was remanded for a VA medical opinion. Although a VA medical opinion was obtained in January 2021, the medical opinion, however, is inadequate as it does not fully answer the Board’s questions. In this regard, the remand directives directed the clinician to provide an opinion on the etiology of the Veteran’s fibromyalgia. Although the opinion reflects the conclusion that the Veteran’s fibromyalgia did not have its onset in service, it does not provide a conclusion or reasoned rationale on the question of whether the Veteran’s fibromyalgia is secondary to service-connected disability. See C&P Exam (January 2021). Indeed, as discussed in the October 2020 Board remand, there is competent medical evidence indicating that the Veteran’s disability may be secondary to service-connected migraines headaches disability. The record, however, reveals that an opinion was not provided by the clinician because the clinician found that there was “no etiological basis for a migraine headache condition incurred in or caused by service.” However, as mentioned in the introduction, the Veteran was granted service connection for migraines headaches disability in a January 2021 rating decision. Accordingly, as the Board has a duty to ensure compliance with the terms of its remand, remand is again required. Stegall, 11 Vet. App. 268. Where VA provides an examination or obtains an opinion, it must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran’s assertions. Neither the Veteran’s credibility nor any lack thereof should be presumed in this remand. The matter is REMANDED for the following actions: 1. Obtain all VA treatment records dated from September 2020 to the Present. 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s fibromyalgia. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. Based on review of the record, detail the Veteran’s reported symptoms, including the nature, onset, progression and severity of any symptoms consistent with fibromyalgia. The opinion should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). An adequate medical opinion may not be predicated solely on the absence of an in-service diagnosis or documented complaints. The clinician must opine on: Direct Service Connection (a) Whether the Veteran’s fibromyalgia at least as likely as not (1) began during active service or (2) is related to an in-service injury, event, or disease. Consider and expressly address the in-service complaints of body aches, muscle aches, or fatigue, at least as likely as not, represent the onset of fibromyalgia in service and indicate whether such symptoms may be due to other causes. Explain. Secondary Service Connection (b) Whether the Veteran’s fibromyalgia is at least as likely as not (1) proximately due to service-connected migraine headaches disability, or (2) aggravated beyond its natural progression by service-connected migraine headaches disability. Provide a rationale that deals with causation and aggravation as independent concepts. Explain. (c) Whether the Veteran’s fibromyalgia is at least as likely as not (1) proximately due to service-connected depressive disorder, or (2) aggravated beyond its natural progression by service-connected depressive disorder. Provide a rationale that deals with causation and aggravation as independent concepts. Explain. 3. Ensure that the VA medical opinions obtained include a complete rationale for the conclusions reached. The medical opinions must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 4. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Griffey, 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.