Citation Nr: 21025526 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 17-44 793 DATE: April 28, 2021 REMANDED Entitlement to service connection for headaches, to include as secondary to service-connected rhinitis, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1982 to November 1983 and from December 1968 to June 2005. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. The Board notes the Veteran has another active appeal stream for entitlement to service connection for sleep apnea. The Veteran requested a hearing for entitlement to service connection for headaches, but withdrew his hearing request for entitlement to service connection for sleep apnea. Furthermore, the issue of entitlement to sleep apnea was remanded by the United States Court of Appeals for Veterans Claims (Court) and is awaiting further development. Therefore, the appeal streams are not merged. Entitlement to service connection for headaches is the only issue on appeal at this time. The Veteran has two theories of causation in this case. First, the Veteran contends he has had headaches since active service. Second, the Veteran contends his headaches are the result of his service-connect rhinitis. In March 2013, the Veteran underwent a VA examination for his headaches. The examiner noted the Veteran had been diagnosed with a headache condition, but found the Veteran’s claims file was silent, except for headaches associated with sinusitis and seasonal allergic rhinitis. Overall, the examiner found there was insufficient evidence to warrant or confirm a current diagnosis of an acute or chronic condition of headaches. Recent private treatment records and the Veteran’s hearing testimony show he still experiences headaches, usually about once or twice a week. See May 2019 Woodlands Medical Specialists, Acute Visit Note; February 2021 Hearing Transcript. Unfortunately, the Board cannot make a fully-informed decision on the issue of service connection for headaches because no VA examiner has opined whether headaches are proximately due to or aggravated by the Veteran’s service-connected rhinitis. Therefore, the Veteran must be afforded a VA examination for his claimed headaches, to include as secondary to service-connected rhinitis. The matters are REMANDED for the following action: 1. Associate with the claims file any outstanding VA treatment records. 2. After obtaining all needed authorizations from the Veteran, associate with the claims file any outstanding private treatment records. If possible, the Veteran’s representative should submit any new pertinent evidence that the Board does not have. This would greatly help the Board. 3. Schedule the Veteran for a VA examination with a qualified medical professional to address the etiology of his headaches. The claims file should be made available and reviewed by the examiner in conjunction with conducting the examination. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. Following consideration of the evidence of record (both lay and medical) and all evidence obtained during the examination, the examiner is asked to address the following: a. Provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that a headache disability was caused by the Veteran’s military service. b. Provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s headache disability was caused by his service-connected rhinitis. c. Provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s headache disability was aggravated by his service-connected rhinitis. In providing answers to the above question the examiner should consider and discuss the service treatment records, including when the Veteran was seen in service for headaches. In providing answers to the above question the examiner should consider and discuss the Veteran’s competent lay claims regarding observable symptomatology. In providing answers to the above questions, the examiner is also advised that the term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it. In providing the etiology opinion, the examiner should be aware of the facts that the Court held in Ward v. Wilkie, 31 Vet. App. 233 (2019), that a “permanent worsening” of a non-service-connected disability is not required to establish secondary service connection on the basis of aggravation (i.e., aggravation may include temporary worsening of a disability). The examiner must include in the medical report the rationale for any opinion expressed. However, if the examiner cannot respond to an inquiry without resort to speculation, he or she should so state, and further explain why it is not feasible to provide a medical opinion, indicating whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or in the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Laura Cochran, 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.