Citation Nr: 21032143 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 20-14 135 DATE: May 26, 2021 REMANDED Entitlement to service connection for a headache disorder, to include migraines, is remanded. REASONS FOR REMAND The Veteran, who is the appellant, served on active duty from February 1996 to August 1997, and had service in the Army Reserves with active duty for training from October 1998 to February 1999, from June 2010 to August 2010, and from September 2011 to January 2012. This matter originally came before the Board of Veterans' Appeals (Board) on appeal from an August 2018 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). In May 2020, the Board, in pertinent part, denied the claim of service connection for migraines. Thereafter, the Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). The parties to the appeal filed a Joint Motion for Partial Remand (JMPR) requesting that the Board decision be vacated and that the matter be remanded to the Board for action consistent with the JMPR. Later that month, the granted the JMPR and ordered that the matter be remanded for actions consistent with the JMPR. In the January 2021 JMPR, the parties agreed that vacatur and remand were warranted because the Board failed to provide an adequate statement of reasons or bases as to whether the March 2020 medical article the Veteran submitted was relevant, and whether a VA examination or opinion was warranted based on the Veteran's complaints of anxiety and the March 2020 medical article that suggested that anxiety symptoms may aggravate migraines. The parties noted that in its decision, the Board found that the March 2020 article the Veteran provided was irrelevant because the Veteran's diagnosed adjustment disorder was a separate and distinct category from both 'Anxiety Disorders' and 'Depressive Disorders'; the article's researchers did not ask the subjects about comorbidities other than migraines in the presence of anxiety; and the article called into question its own conclusion "in the presence of 'biological variables,' which was present in this case based on the Veteran's menstrual cycle. The parties indicated that the Board mischaracterized the March 2020 article. They noted that a review of the article indicated that its purpose was to examine how symptoms of anxiety and depression, not diagnoses of anxiety disorder and depressive disorder, might relate to migraines. Specifically, the article found that symptoms of anxiety aggravated migraines more than symptoms of depression and that one should consider more than just a diagnosis under the DSM, but that "a trait, or a minimal amount of worry, inability to control anxiety symptoms, feeling afraid, nervous, or anxious can play a critical role in migraine, by triggering an attack, making it last longer, affecting headache frequency and duration, quality of life, health care expenditures, and "chronification." The parties noted that here the record documented that the Veteran had been diagnosed with adjustment disorder with depressed mood, and that she experienced anxiety symptoms. The parties stated that because the article suggested that anxiety symptoms "can play a critical role in migraine, by triggering an attack, making it last longer, affecting headache frequency and duration, quality of life, health care expenditures, and chronification," and the record reflected that the Veteran experienced symptoms of anxiety, the Board failed to adequately address whether a VA examination was warranted to address whether the Veteran's migraines had been affected by her symptoms of anxiety. The parties indicated that a remand was warranted for the Board to provide adequate reasons or bases addressing whether the Veteran warranted a VA examination or opinion based on her complaints of anxiety and the March 2020 medical article that suggested that anxiety symptoms may aggravate migraines. In addition to the directives in the JMR above, the Board notes that subsequent to the JMR, and in conjunction with the remand portion of the May 2020 Board decision that remanded the issues of service connection for a psychiatric disorder and asthma further development; the RO in a March 2021 rating determination granted service connection for asthma and assigned a noncompensable disability evaluation from February 13, 2018 to May 26, 2020, and a 60 percent disability evaluation thereafter. Moreover, in an April 2021 rating determination, the RO granted service connection for PTSD and assigned a 30 percent disability evaluation effective February 13, 2018. Service connection may be granted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, at 448 (1995) (holding that service connection on a secondary basis requires evidence sufficient to show that the current disability was caused or aggravated by a service-connected disability). To establish secondary service connection, the law states that there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between a service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998), 7 Vet. App. 439, at 448 (1995) (holding that service connection on a secondary basis requires evidence sufficient to show that the current disability was caused or aggravated by a service-connected disability). The matter is REMANDED for the following action: 1. Undertake appropriate development to obtain all outstanding VA and/or private treatment records related to the Veteran's outstanding claim. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified. 2. Schedule the Veteran for a VA examination to determine the nature and etiology of any current headache disorder, to include migraines. All indicated tests and studies should be performed and all findings must be reported in detail. The claims folder and a copy of this remand must be available for review and the examiner should note such review in his/her report. The examiner is requested to offer the following opinions: Is it as likely as not (50 percent probability or greater) that any current headache disorder, to include migraines, is etiologically related to the Veteran's periods of active service? If not, is it as likely as not (50 percent probability or greater) that any current headache disorder, to include migraines, is caused by any service-connected disorder, to include PTSD and/or asthma? If not, is it at least as likely as not (50 percent probability or greater) that any current headache disorder, to include migraines, is aggravated by any current service-connected PTSD or asthma? If aggravation is found, to the extent that is possible, the examiner is requested to provide an opinion as to approximate baseline level of severity of the nonservice-connected disorder before the onset of aggravation. When rendering the above opinions, the examiner must address the March 2020 medical article and any other medical treatises submitted in support of the Veteran's claim. Complete detailed rationale is requested for each opinion that is rendered. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. S. Kelly, 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.