Citation Nr: 21040677 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 17-48 342 DATE: July 6, 2021 REMANDED Entitlement to service connection for a chronic headache disorder, to include migraine headaches and tension headaches, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1975 to July 1997. This matter comes before the Board of Veterans Appeals (Board) on appeal from a June 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO or AOJ). The Veteran indicated in his October 2017 substantive appeal that he wished to appear at a Video Conference Board Hearing. The Veteran filed a statement in October 2019 indicating that he wished to withdraw his request for a formal hearing. Accordingly, the Board deems the Veteran's hearing request withdrawn. This case was previously before the Board in April 2021, when it was remanded for additional development. The case has since been returned to the Board for further appellate action. The Veteran contends that his headache disability is related to an in-service head injury he sustained in a motor vehicle accident, in 1988, and that his headache disability has progressively gotten worse over the years. See February 2016 statement, April 2017 notice of disagreement (NOD), and October 2017 VA Form 9. The Board has expanded the Veteran's claim of service connection for migraine headaches to include non-migraine headaches. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (when a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled). Pursuant to the April 2021 Board Remand directives, an addendum VA medical opinion was obtained in April 2021. The April 2021 VA medical opinion is not entirely sufficient to decide the claim. The examiner who provided the April 2021 VA medical opinion clearly delineated findings pertaining to migraine headaches and non-migraine headaches. The basis for his negative conclusion was the absence of a diagnosed migraine-type headaches until 19 year post separation. In relation thereto, and in the context of the expanded claim for service connection for a chronic headache disorder, the examiner did not address evidence to include the Veteran's service treatment records (STRs) dated March 1988 indicating the Veteran reported residual frontal headache following the in-service motor vehicle accident, or the STRs dated September 1993 indicating the Veteran's report of dizziness, dull frontal headache, nausea, and positive blurry vision. Additionally, the examiner did not address the Veteran's STRs indicating that the Veteran again sought treatment in February 1995, March 1995, May 1995, and December 1995 for complaints of nausea, left sided headaches, blurry vision, and occipital scalp pain. The examiner similarly did not address the Veteran's complaints of headache pain prior to the March 1988 motor vehicle accident as indicated in the Veteran STRs dated September 1974, September 1976, and June 1977 STR. The clinical significance of the Veteran's report that he was advised to take 1 Fioricet per day following an in-service head injury, for which he was, at that time, taking up to 6 tabs per day and that he gave a 20 year history of headaches was not discussed. See November 2015 VA treatment record and February 2016 VA treatment record. Thus, the question as to whether the Veteran's headaches disability had its onset in, or is related to, the Veteran's military service remains unanswered with a sufficient explanation. The Board finds there has not been substantial compliance with the Board's previous remand directives regarding this issue and another remand is required. See Stegall v. West, 11 Vet. App. 268, 271 (1998); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Additionally, the Veteran has identified treatment at Youngsan Army Medical Center in Seoul, South Korea, and at Osan Air Force Base Medical Center/Hospital, in South Korea. See February 2016 application for benefits. There is no indication in the record that the AOJ sought to obtain these records. The matter is REMANDED for the following action: 1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran's claim, to include any outstanding treatment records from Youngsan Army Medical Center in Seoul, South Korea, and at Osan Air Force Base Medical Center/Hospital, in South Korea. If such efforts yield negative results, a notation to that effect should be inserted in the file. The Veteran must also be informed of any unobtainable treatment medical records. 2. Schedule the Veteran for an examination with an appropriate clinician, preferably one who has not previously examined the Veteran, to determine whether the Veteran has current diagnoses for any and all headache disabilities, to include migraine headaches and/or tension headaches. If the Veteran previously had any such medical condition, but is no longer extant, the examiner should identify when that condition resolved. Following review of the claims file and examination of the Veteran, the examiner should provide the following opinions: (a) whether the Veteran's migraine condition is a separate and distinct condition from the headache condition indicated in the Veteran's STRs. (b) whether it is at least as likely as not related that the Veteran's headache disability, to include migraine headaches and/or tension headaches had its initial onset in service or is otherwise etiologically related to an in-service injury, event, or disease, to include the in-service 1988 motor vehicle accident. In providing this opinion, the examiner must address the Veteran's lay statements regarding the onset and continuity of symptomatology since onset and/or since separation from service, to include: (i) the Veteran's report that he was advised to take 1 Fioricet per day following an in-service head injury; and (ii) the Veteran's report of headaches for "20 years." The examiner must also address any other pertinent evidence of record, to include, the Veteran's service treatment records documenting complaints of headache pain: (iii) following the March 1988 motor vehicle accident to include the STRs dated March 1988, September 1993, February 1995, March 1995, May 1995, and December 1995; and, (iv) prior to the March 1988 motor vehicle accident, to include the STRs dated September 1974, September 1976, and June 1977. Rationale for the requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, provide an explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or the limits of current medical knowledge with respect to the question. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith, 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.