Citation Nr: 21016117 Decision Date: 03/19/21 Archive Date: 03/19/21 DOCKET NO. 15-31 054A DATE: March 19, 2021 REMANDED Entitlement to service connection for migraines and bilateral leg disability, to include consideration as an undiagnosed illness, and as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 1990 to May 1992, to include service in the Southwest Asia Theater of Operations. For his meritorious service, he was awarded (among other decorations) the Southwest Asia Service Medal with 3 Bronze Stars and the Kuwait Liberation Medal. This matter is on appeal from an October 2013 rating decision. In September 2018, the Board remanded the claim for further development, including an opinion regarding the etiology of the Veteran’s migraines and bilateral leg disability which an October 2013 VA examiner attributed to alcohol use. In a November 2019 decision, the Board denied the Veteran’s claims of entitlement to service connection for migraines and a bilateral leg disability and rhinitis. The Veteran appealed the denial of the claims for service connection for migraines and a bilateral leg disability to the United States Court of Appeals for Veterans Claims (Court). In October 2020, the Court granted a Joint Motion for Partial Remand (JMPR), vacating the portion of the November 2019 Board decision that denied entitlement to service connection for migraines and a bilateral leg disability. The Veteran did not challenge the part of the Board decision that denied entitlement to service connection for rhinitis. The Parties requested that the Court dismiss the appeal with respect to that claim. In the JMPR the Parties agreed that remand was required, because the Board failed to provide an adequate statement of reasons or bases. Specifically, the Parties found that the Board determined that 38 C.F.R. § 3.303(b), regarding continuity of symptomatology for chronic diseases, did not apply, but provided inadequate reasons or bases for its determination, where both migraine headaches and peripheral neuropathy are organic diseases of the central nervous system which are considered chronic disabilities pursuant to 38 C.F.R. § 3.309(a). The Parties also found that on July 2019 VA headaches and peripheral neuropathy examination, the examiner provided an opinion that failed to consider the Veteran’s lay testimony. Accordingly, in light of the foregoing, the Board finds that an addendum opinion is necessary. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matters are REMANDED for the following actions: Obtain an appropriate addendum by an examiner regarding the nature and etiology of the Veteran’s service-connected migraines and bilateral leg disability. Unless the examiner finds that a new examination is required, the Veteran need not be examined again. The claims file, including a copy of the October 2020 Joint Motion for Partial Remand and September 2018 remand, must be made available to the examiner for review who should indicate that the claims file was reviewed. The examiner should provide the following opinion(s): a) Is it at least as likely as not (50 percent or more probability) that the Veteran’s alcohol use disorder is (a) proximately due to or the result of the Veteran’s service-connected PTSD, or (b) aggravated (any incremental increase in the alcohol use disorder beyond its normal progression) by the Veteran’s service-connected PTSD? b) If the examiner finds a relationship between the Veteran’s PTSD and his alcohol use disorder, is it at least as likely as not (50 percent or more probability) that the Veteran’s migraines and bilateral lower extremity disability are (a) proximately due to or the result of the Veteran’s service-connected PTSD, or (b) aggravated (any incremental increase in the migraines and bilateral leg disability beyond their normal progression) by the Veteran’s service-connected PTSD? The examiner should consider the October 2013 VA examination which addresses a relationship between the Veteran’s migraines and bilateral leg disability and alcohol use. c) If the examiner does not find a relationship between the Veteran’s PTSD and his alcohol use disorder, is it at least as likely as not (50 percent or more probability) that the Veteran’s migraines and bilateral leg disability had their onset in or are etiologically-related to the Veteran’s active duty service, to include exposure to environmental hazards while serving in Southwest Asia, or were manifested within the first post-service year? The examiner is asked to consider and discuss as necessary the pertinent evidence of record to include the Veteran’s lay statements, testimony and complaints concerning the onset of his migraines and bilateral leg disability, including those made to medical providers. The Board, by this remand, makes no determination, expressed or implied, concerning the credibility of any statements on file. The report of examination and/or addendum opinion should include the complete rationale for all opinions expressed. The phrase “at least as likely as not” does not mean within the realm of medical possibility, but rather the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of that conclusion as it is to find against it. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Adams, 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.