Citation Nr: 21040484 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 15-31 513A DATE: July 3, 2021 REMANDED Service connection for headaches. REASONS FOR REMAND The Veteran served on active duty from August 1998 to November 1999, to include a prior period of inactive duty for training (INACDUTRA). The claim is on appeal from a February 2013 rating decision. In July 2019, the Veteran testified at a Board hearing. The case was last before the Board in December 2020. At that time, the Board remanded the claim of service connection for headaches for further development. Service connection for headaches. The Veteran contends that his headaches were caused by service, or alternatively caused or aggravated by his service-connected pilonidal cyst and/or lumbar sprain. Service treatment records (STRs) show the Veteran complained of symptoms of a headache in November 1999 are silent for complaint or treatment for headaches, including the Veteran's entrance and separation examinations. Post-service medical records provide that following the removal of a pilonidal cyst, the Veteran reports he has been unable to work due to chronic headaches. In August 2013, he was seen for a consultation about his headaches, during which he described being affected with headaches since 1998. Again, in June 2014, he was seen by a neurologist and started on Propanol for chronic migraines. The Veteran was afforded a VA examination in January 2020. The examiner concluded that it was less likely than not that the Veteran's headaches were incurred in or caused by service. The examiner reasoned that the only time the Veteran complained about headaches was when he has acute upper respiratory infection with presumed sinusitis. His headaches are part of syndrome of acute upper respiratory infection and sinusitis. Moreover, the examiner explained, the Veteran no longer presents with symptoms of sinusitis or sore throat and his separation examination in February 1999 did not mention headaches as part of his chronic problems. The examiner also provided that back pain and pilonidal cysts do not caused headaches. There is no available literature to support such causal aggravation or increase in severity beyond natural progress of the disease or temporary flare-up. Following the Board's December 2020 remand, medical records from the Social Security Administration (SSA) were associated with the Veteran's file. In these records, there are numerous references to the Veteran experiencing migraines during service, the condition continuing post-service, and eventually becoming progressively worse. As the January 2020 VA examiner did not consider the Veteran's lay statements of his headaches beginning following the removal of the pilonidal cyst nor the medical records from SSA, the January 2020 medical opinion is not entirely sufficient. Accordingly, another VA medical opinion should be obtained. The matters are REMANDED for the following action: Obtain an opinion from an appropriate clinician regarding the Veteran's headaches. The need for an in-person diagnostic examination should be determined by the appointed examiner. The examiner must provide a diagnosis for any conditions found extent related to headaches and/or migraines. In doing so, the examiner must conduct all necessary testing, unless it can be explained why such testing is not medically necessary. If headaches and/or migraines are notand were not been diagnosed --it should be explained why this is so. For each identified diagnosis, the examiner should provide an opinion as to: (1) whether it is at least as likely as not (i.e., at least equally probable) that the disability had its onset during, or is otherwise related to, the Veteran's service. The examiner should also opine as to whether the Veteran's headaches and/or migraines were at least as likely as not (probability of 50 percent or greater) caused or aggravated by his service-connected lumbar sprain and/or pilonidal cyst, including the removal thereof. The term "aggravation" means an increase in severity beyond the natural progress of the disease. Consideration should be given to all lay statements of record, including the Veteran's assertion that improper removal of the pilonidal cyst may be the cause of his headaches according to research he conducted. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Becton, 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.