Citation Nr: 21030840 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 17-24 474 DATE: May 19, 2021 REMANDED Service connection for headaches, to include as secondary to service-connected conditions, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1968 to March 1970. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision issued by the Department of Veterans' Affairs (VA) Regional Office (RO) in Columbia, South Carolina The Board previously remanded this matter in January 2021 for additional development. As will be discussed in more detail below, the Board finds substantial compliance with the January 2021 remand directives has not been met. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding when a remand is issued, the Veteran is entitled, as a matter of law, the right to compliance with the remanded order). The Veteran contends his headaches were caused or incurred during service, or in the alternative, are secondary to either his service-connected posttraumatic stress disorder (PTSD) or his service connected lumbar degenerative disc disease (DDD). The Board finds the evidence currently of record is insufficient to resolve the Veteran's claim. In January 2021, the Board found a November 2020 VA examiner's opinion that addressed the etiology of the Veteran's headaches to be insufficient to decide the claim. The Board found the November 2020 VA examiner's opinion that the Veteran's headaches were less likely than not aggravated by his service-connected PTSD or back condition in conflict with records indicating that the Veteran had complaints of headaches following back pain. The Board also determined that the VA examiner had failed to address whether the Veteran's PTSD symptoms had aggravated any headache condition, despite evidence showing that the Veteran had reported sleep problems stating that he woke-up with headaches and that he experienced headaches when he recalled service-related events. Thus, the Board remanded the claim to obtain an addendum opinion from the November 2020 examiner addressing whether the Veteran's headache condition had been aggravated by his service-connected PTSD or DDD. In answering the question as to whether it was at least as likely as not (50 percent or greater probability) that the Veteran's headache condition had aggravated by his service-connected PTSD or lumbar degenerative disc disease, the Board specifically directed the examiner to address the Veteran's lay statements of having experienced headaches following episodes of back pain, as well as awakening with headaches in relation to his PTSD sleep problems. The examiner was also directed to address the Veteran's many PTSD symptoms. See January 2021 Board remand at page (pg.) 3. The November 2020 VA examiner provided the requested opinion in March 2021. In response to the Board's remand the examiner opined, "There is no nexus statement stating that his headaches have worsened beyond their natural progression due to either his back pain nor his PTSD and there are no objective measures that can corroborate this." See March 2021 opinion. The VA examiner did not address the Veteran's PTSD symptoms, as requested by the Board, and instead stated "defer to psych." In response to VA's question to provide medical rationale, the VA examiner again indicated "defer to psych." However, a VA psychiatric clinician has not examined the Veteran or reviewed the record, as instructed by the March 2021 VA examiner. Additionally, the "beyond the natural progression of the disability" language used by the examiner is the incorrect legal standard for aggravation in a secondary service connection case. Rather the correct standard is whether the service connected disability made the non-service connected condition worse. Thus, a remand is necessary in order to obtain an opinion from a VA psychiatric clinician as directed by the March 2021 examiner. Moreover, in providing the requested opinion, the March 2021 VA examiner did not provide a discussion of the Veteran's lay assertions of having experienced headaches following episodes of back pain, as well as awakening with headaches in relation to his PTSD sleep problems. Thus, a remand is necessary in order for the substantial compliance with the Board's January 2021 remand directives. Stegall, supra. The matters are REMANDED for the following action: Obtain medical opinions from an examiner(s), other than the physician who authored the November 2020 and March 2021 VA opinions. If a physical examination is necessary to answer the Board's questions, one should be scheduled. The examiner is requested to answer the following questions and support such answers with a complete rationale: i.) Does the Veteran have a headache disability? Why or why not? ii.) Is it at least as likely as not (50 percent or greater) that the Veteran's headache disability began in or was otherwise caused by the Veteran's active military service? Why or why not? In answering this question, the examiner is requested to comment on the Veteran's February 2021 statement that his headaches were related to the stress caused by having to perform service-related duties, such as crashing into other soldiers, running into vines/trees, and hitting the ground. See Veteran's statement to VA, received in February 2021. iii.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's headache disability is directly caused or aggravated (made worse) by his service-connected low back disability? Why or why not? The examiner should consider the Veteran's lay assertions of having experienced headaches following episodes of back pain. iv.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's headache disability is directly caused or aggravated (made worse) by his service-connected PTSD? Why or why not? The examiner should consider the Veteran's lay assertions of awakening with headaches in relation to his PTSD sleep problems as well as his many PTSD symptoms. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Carole Kammel, 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.