Citation Nr: 21014739 Decision Date: 03/15/21 Archive Date: 03/15/21 DOCKET NO. 12-02 958 DATE: March 15, 2021 REMANDED Service connection for cluster headaches is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1988 to August 1988 and February 1990 to December 1993, including foreign service in Iraq. For his meritorious service, the Veteran was awarded (among other decorations) the Combat Medical Badge and the Southwest Asia Service Medal with Bronze Service Star. He testified during a July 2017 videoconference hearing. A transcript of this proceeding has been associated with the record. Historically, the Veteran was service-connected for fatigue with various symptoms including headaches. See March 2005 rating decision. In August 2016, the Board remanded a claim seeking a higher rating for fatigue. In the body of its decision, the Board also noted the Veteran’s contention that his headaches should be separately service-connected. Subsequently, the Veteran’s service-connected disability was recharacterized as chronic fatigue syndrome (CFS), and his headaches were no longer identified as a symptom of this disorder. See May 2020 rating codesheet. Thus, in November 2019, the Board denied the Veteran’s claim seeking a higher rating for CFS. Therein, the Board also remanded a separate service connection claim for cluster headaches for additional development, which has since been completed. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In January 2021, the Veteran was informed that the Veterans Law Judge (VLJ) who presided over his 2017 hearing was no longer with the Board, and offered a hearing before a different VLJ. As the Veteran did not request a new hearing within 30 days of this notice, the Board may proceed with its review of the matter on appeal. 38 U.S.C. § 7107(c); 38 C.F.R. § 20.707. Briefly, the Veteran has also perfected an appeal seeking service connection for sleep apnea. This matter has been certified under a separate docket number (12-02 958) and development appears ongoing. As such, this issue will be addressed in a subsequent Board decision, should such action be required. Turning to the instant matter, the Board recognizes that this appeal has been part of a lengthy procedural history. Regrettably, further action is necessary prior to its adjudication. First, the etiology of the Veteran’s headaches was assessed by VA examiners in July 2015, December 2016, and August 2020. However, these opinions do not account for the full scope of entitlement theories as presented by the record, to include the Veteran’s contention that his headaches onset during active duty; are causally related to in-service sarin exposure; or constitute a qualifying chronic disability per 38 C.F.R. § 3.317. Although the July 2015 and August 2020 examiners report that the cause of his headaches is unknown, this does not equate an official medical finding that the Veteran presents with a qualifying chronic disability; rather, remand for a complete nexus opinion is now required. See Colvin v. Derwinski, 1 Vet. App. 171 (1991) (finding that the Board is not a medical body and must base its findings from competent sources). Additionally, there may be relevant Social Security Administration (SSA) records for this Veteran. See December 2019 letter. A February 2020 request for records was rejected, as the provided name and social security number did not correspond with SSA records. Although a new request was submitted later that month, no response has been received from SSA to date. As such, an additional effort to obtain these records is warranted. The matter is REMANDED for the following actions: 1. Obtain any medical records relevant to the Veteran’s cluster headaches and in the care of the Social Security Administration and associate them with the Veteran’s claims file. 2. Obtain an addendum opinion addressing the questions below.  If the reviewing examiner determines that the opinions requested may not be offered without first examining the Veteran, then consider whether a telehealth interview may be appropriate.  Schedule an in-person examination only if deemed necessary to answer the questions below.    The claims file and a copy of this remand must be made available for review, and the examination report must reflect that review of the claims file occurred.    In particular, the examiner must address the following: (a.) Does the Veteran present with a distinct diagnosis of cluster headaches, or are his headaches merely a symptom of his service-connected posttraumatic stress disorder (PTSD) or chronic fatigue syndrome (CFS)? (b.) If the Veteran presents with a distinct diagnosis of cluster headaches: (i.) Is it at least as likely as not (50 percent probability or more) that the disorder began during a period of active duty service, was caused by service, or is otherwise related to service, to include various in-service environmental exposures to sarin and cyclosarin? (See, e.g., July 1997 exposure letter). The examiner must also directly address the Veteran’s hearing testimony that he first experienced headaches during service. (ii.) Is it at least as likely as not that the condition is proximately due to, the result of, or aggravated by the Veteran’s service-connected PTSD, CFS, or neck disability, or the treatment thereof (to include medication use)? Here, the examiner must directly address the July 2015 examiner’s notation that the Veteran attributed his headaches to “analgesic overuse.” (c.) If the Veteran does not present with a distinct diagnosis of cluster headaches, and his symptoms are not otherwise attributable to one of his service-connected disabilities, then indicate whether his reported symptoms are attributable to a qualifying chronic disability, to include an undiagnosed illness or a medically unexplained chronic multisymptom illness per 38 C.F.R. § 3.317. In formulating the opinion, the examiner is advised that the term “at least as likely as not” does not mean “within the realm of possibility.”  Rather, it means that the weight of the medical evidence for and against the claim is so evenly divided that it is as medically sound to find in favor of the claim as it is to find against it.   A complete rationale should be provided for all opinions or conclusions expressed.  It should be noted that the Veteran is competent to attest to observable symptomatology.  If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation.   Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Kovarovic, 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.