Citation Nr: 21032077 Decision Date: 05/25/21 Archive Date: 05/25/21 DOCKET NO. 16-40 623 DATE: May 25, 2021 ORDER Entitlement to service connection for headaches, to include migraines, as secondary to service-connected disabilities is granted. REMANDED Entitlement to service connection for diabetes mellitus, type II, to include as due to exposure to contaminated water at Camp Lejeune, is remanded. FINDING OF FACT Resolving all reasonable doubt in favor of the Veteran, his currently diagnosed headaches, to include migraines, is due to his service-connected disabilities. CONCLUSION OF LAW The criteria for service connection for headaches, to include migraines, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1984 to November 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Although the issue certified to the Board was for migraines, in light of Clemons v. Shinseki, 23 Vet. App. 1 (2009), the issue has been recharacterized to comport with the record. Pursuant to the Veterans Claims Assistance Act (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159. Given the Board's favorable disposition of the service connection claims for headaches, to include migraines, the Board finds that all notification and development action needed to fairly adjudicate this part of the appeal has been accomplished. 1. Entitlement to service connection for headaches, to include migraines, as secondary to service-connected disabilities is granted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Generally, service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166 67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). Based on a careful review of all the subjective and clinical evidence, the Board finds that resolving all reasonable doubt in the favor of the Veteran, secondary service connection for headaches is warranted. Initially, the Board notes that VA treatment records and the May 2017 VA examination show that the Veteran is currently diagnosed with headaches, to include migraines. The question remains whether the Veteran's current headaches disorder is etiologically related to his military service or service-connected disabilities, to include cervical spondylosis, PTSD, and sleep apnea. In a December 2017 VA examination opinion, the VA examiner noted that the Veteran was a Gulf War veteran with service-connected PTSD, a group of individuals who had "nearly double the rate of headaches than the general population." He also noted that headaches were reported by up to 30 percent of patients with obstructive sleep apnea (which the Veteran is service-connected) and those headaches were usually bifrontal and squeezing in quality with no associated nausea, photophobia, or phonophobia, occurring daily and lasting for several hours. These headaches were very similar to the patterns described by the Veteran who also had a diagnosis of obstructive sleep apnea. Further, some studies had correlated the severity of obstructive sleep apnea to the propensity for headaches and the Veteran had severe obstructive sleep apnea. The examiner also noted September 2013 and June 2016 VA treatment records indicating a relationship between the Veteran's service-connected cervical spine condition and his headaches. As the December 2017 VA examiner based his findings on detailed review of the evidence of record and extensive medical research into the nature and etiology of headaches, the Board finds that these findings have great probative value. The Board acknowledges that a May 2017 VA examiner opined that it was less likely than not that the Veteran's migraines was due to or the result of his service-connected cervical spondylosis. However, the Board finds that this opinion to be inadequate because the examiner did not address the aggravation prong for secondary service connection. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). Further, the examiner did not address whether the Veteran's headaches disorder was secondary to his other service-connected disabilities, to include PTSD and sleep apnea. As such, the Board finds that the May 2017 VA examination opinion lacks probative value. Therefore, resolving all reasonable doubt in favor of the Veteran, service connection for headaches, to include migraines, is granted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for diabetes mellitus, type II, to include as due to exposure to contaminated water at Camp Lejeune, is remanded. The Veteran contends that he was exposed to herbicide agents during service in Okinawa and submitted supporting evidence in August 2016, specifically "Map of Defoliants (including Agent Orange) on Okinawa based upon Veterans' testimonies. Additionally, the Veteran was stationed at Okinawa from June 1985 to September 1988. It does not appear that the RO attempted to verify the Veteran's alleged exposure to herbicide agents and more information is needed before the Board can make a fully informed decision. As such, a remand is warranted to verify the Veteran's alleged exposure to herbicide agents at Okinawa. (Continued on the next page) The matters are REMANDED for the following action: Attempt to verify the Veteran's asserted in-service exposure to herbicide agents. If more details are needed, contact the Veteran to request the information. If there is still insufficient information to verify exposure to herbicide agents, issue a Formal Finding outlining the steps taken to assist the Veteran and notify the Veteran of VA's inability to verify the in-service herbicide agent exposure. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Ko, 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.