Citation Nr: 21023496 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 14-08 019 DATE: April 20, 2021 REMANDED Entitlement to service connection for a headache condition is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1968 to December 1969. The Veteran died in March 2020. The Appellant is the Veteran’s widow, who was formally substituted in a July 2020 administrative decision. There has not been substantial compliance with the Board’s November 2020 remand directives and another remand is required. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for a headache condition is remanded. The claim must be remanded again because the December 2020 VA opinion is inadequate. The examiner stated that the Veteran clearly and unmistakably had a headache condition that existed prior to his entry onto active duty. Specifically, the examiner noted the medical evaluation completed by the Veteran’s neurologist in 1966 (prior to service) that indicated the Veteran was suffering from headaches secondary to a motor vehicle accident. However, the examiner did not provide an opinion as to whether the evidence of record clearly and unmistakably shows (i.e., it is undebatable) that the preexisting headache condition was not aggravated by service or that any increase in disability was due to the natural progression of the condition. The matters are REMANDED for the following action: 1. Obtain an addendum from the December 2020 opinion provider, or other appropriate clinician, that addresses the specific questions related to the likely etiology of the diagnosed headache disorder. Copies of all pertinent records must be made available to the examiner for review. (a) In providing the opinion, the examiner must review the December 2020 opinion that concluded that the Veteran had a headache disability that existed prior to service. Does the evidence of record clearly and unmistakably show (i.e., it is undebatable) that the preexisting headache condition was not aggravated by service or that any increase in disability was due to the natural progression of the condition? Please identify any such evidence with specificity. (b) If the answer to either (a) is no, is it at least as likely as not (50 percent or higher degree of probability) that the Veteran’s headaches had their onset in service? The examiner may NOT rely on the absence of a medical record or evidence of medical treatment as the sole rationale for any negative medical nexus opinion. A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training) and note what, if any, additional evidence would permit such an opinion to be made. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.E. Bresler, 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.