Citation Nr: 21039693 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 15-00 185 DATE: July 1, 2021 REMANDED Entitlement to service connection for a chronic headache disability, to include as secondary to the service-connected disability, is remanded. REASONS FOR REMAND The Veteran had active duty service with the United States Air Force from October 1970 to December 1990. This appeal before the Board of Veterans' Appeals (Board) arises from a November 2013 rating decision in which a Department of Veterans Affairs (VA) Regional Office (RO), inter alia, denied entitlement to service connection for headaches. The Board remanded the current claim on appeal for further evidentiary development in June 2018 and February 2021. The Board also disposed of additional claims on appeal in the June 2018 and February 2021 decisions. Following the June 2018 remand, the Veteran requested a Board hearing, and subsequently testified at a Board hearing before the undersigned Veterans Law Judge in December 2020. A hearing transcript is of record. Service connection for a chronic headache disability The Board remanded the Veteran's headache disability claim in June 2021 to obtain a VA opinion addressing the secondary relationship between the claimed headache disability and the Veteran's service-connected bipolar disorder and posttraumatic stress disorder (PTSD). In remanding the claim, the Board in particular noted that the Veteran's psychiatric treatment records document his complaints of stress in connection with his psychiatric disorder and that he had reported at his December 2019 VA examination that he believed that stress brought on his headaches. In the most recent VA opinion addressing the etiology of the Veteran's headaches, obtained in March 2021, the examiner determined, based on the evidence, that the Veteran most likely experienced migraine headaches. The examiner opined that it was less likely than not that his headaches were proximately due to, the result of, or aggravated by his service-connected acquired psychiatric disorder. The examiner based this opinion on a lack of current studies showing a direct cause and effect relationship between PTSD/bipolar disorder or other mental health disorder actually causing or aggravating migraines beyond the natural progression. The examiner also based this opinion on the facts that Divalproex/Depakote is used to treat seizure disorders and mental/mood conditions (such as manic phase of bipolar disorder), and to prevent migraine headaches, and that it does not cause migraines. Notably, however, the examiner did not address the Veteran's contentions that his service-connected psychiatric disorder caused him stress and that his stress brought on his headaches. The examiner also did not address any additional medications to treat the Veteran's service-connected psychiatric disorder apart from Divalproex. Importantly, the record reflects that the Veteran has used additional medications for the psychiatric disorder. Also, in a January 2015 VA psychiatric clinical consultation report, the Veteran reported that his headaches usually resolved after taking blood pressure medication. Thus, the record indicates that the Veteran's headaches may also be secondarily related to his service-connected hypertension. Thus, to afford the Veteran every possible consideration, the Board finds that a VA opinion must also be obtained to address this possible secondary relationship. Accordingly, this matter is hereby REMANDED for the following action: Arrange for the Veteran's claims file to be reviewed by an appropriate VA examiner to obtain new opinions as to the etiology of the Veteran's claimed headache disability. The claims file and a copy of this REMAND should be made available to the examiner for review. If the examiner determines that a new examination is warranted in order to provide any requested etiology opinion, arrange for the Veteran to be afforded such examination. If the Veteran is examined, any and all indicated studies and tests deemed necessary by the examiner should be accomplished. After review of the record, and completion of any examination (including any necessary tests and studies), the VA examiner should: (a.) clearly identify all headache disabilities currently present or present at any point pertinent to the claim on appeal (even if now asymptomatic or resolved). The examiner should specifically address the likely migraine headache diagnosis identified in the March 2021 VA opinion. (b.) For each such identified headache disability, the examiner should provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability), that such disability was caused, or aggravated (made worse) beyond its natural progression by the Veteran's service-connected bipolar disorder and PTSD, and/or his service-connected hypertension, to include as a result of any medications that have been used to treat these disabilities. In addressing the above, the examiner must consider and discuss all pertinent medical evidence and lay evidence of record, to include the Veteran's assertions made during VA examinations and VA clinical treatment, that he suffered from stress as a result of his service-connected psychiatric disorder, and that his headaches were brought on by stress, and that his headaches were resolved with the use of his blood pressure medication. The examiner should additionally consider and address lay reports as to the nature and onset, and continuity of symptoms of the claimed headache disability. If lay assertions in any regard are discounted, the examiner should clearly so state, and explain why. In this regard, a discussion of the facts and medical principles involved would be of considerable assistance to the Board. No action is required of the Veteran until he is notified by VA. However, he is advised of his obligation to cooperate in ensuring that the duty to assist is satisfied. Kowalski v. Nicholson, 19 Vet. App. 171 (2005). His failure to report for a VA medical examination, if scheduled, may impact determinations made. 38 C.F.R. § 3.655. The Veteran is also advised that he has the right to submit additional evidence and argument with respect to this matter. Kutscherousky v. West, 12 Vet. App. 369 (1999). This appeal must be afforded prompt treatment. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael Wilson, 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.