Citation Nr: 21042081 Decision Date: 07/11/21 Archive Date: 07/11/21 DOCKET NO. 17-34 658 DATE: July 11, 2021 REMANDED Entitlement to service connection for tension headaches is remanded. Entitlement to service connection for migraine headaches is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from June 2000 to June 2005. This matter is before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) in July 2015. During the process of the current appeal, the Veteran appears to have received a new diagnosis of migraine headache, in addition to the previously diagnosed tension headaches. See, e.g., Private treatment records, August 2020-January 2021. As a result, the Board has included entitlement to service connection for migraine headaches as a separate issue to specifically identify that the response to the remand below must address both tension headaches and migraine headaches for the period that each diagnosis is applicable. 1. Entitlement to service connection for tension headaches is remanded. 2. Entitlement to service connection for migraine headaches is remanded. This appeal was last before the Board in June 2020 at which time additional evidentiary development was requested to comply with due process requirements. Specifically, the Board required that a VA examiner was "REQUIRED to consider and discuss the Veteran's report of a head injury incurred during a training exercise, two episodes of heat exhaustion that occurred in August 2000 and 2003 and oxygen deprivation that occurred as part of a swimming accident at the Marine Corps Recruit Depot in San Diego." Board remand, June 2020 (emphasis in the original). Although a March 2021 medical opinion addendum states that the in-service events in question were "reviewed and considered", the opinion does not discuss these events beyond this mere mention and does not provide a detailed explanation for discounting a causal connection between the current diagnosis and the in-service events beyond describing that intervening examinations and medical treatment did not show "identifiable neurologic damage." Although this reasoning may be clear to the medical professional, it is not clear to the Board that the only causal route is by necessity neurologic damage. As a result, the Board finds that there has not been substantial compliance with the Board's previous remand directives regarding the issue of entitlement to service connection for headaches, and another remand is required to obtain the necessary information. Stegall v. West, 11 Vet. App. 268, 271 (1998) (conferring the right to compliance with remand orders as a matter of law). Additionally, the Veteran has stated that his headaches may be attributable to his service-connected psychiatric disability. See VA Form 9, August 2017. An April 2018 VA opinion found that the Veteran's tension headaches were not caused or aggravated by his service-connected depressive disorder with anxiety, but did not address the Veteran's migraine headaches which were not yet diagnosed. A subsequent March 2021 opinion stated that the Veteran's tension and migraine headaches were "primary headaches" and by definition not secondary to other causes. This opinion however does not address whether the Veteran's tension or migraine headaches might be aggravated or worsened by the service-connected psychiatric disability. The matters are REMANDED for the following action: 1. Please note that this Veteran's case has been advanced on the docket and, by law, ALL remanded claims must be processed expeditiously. 2. Obtain updated medical treatment records (i.e., those not already of record) from VA and any adequately identified private treatment provider from whom the Veteran has received care for his headache disabilities. 3. Obtain an opinion, from an examiner other than the examiner providing the March 2021 opinion and preferably a neurologist if available, to determine whether it is AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that the Veteran's tension headaches and/or migraine headaches are related to the Veteran's military service, including his report of a head injury incurred during a training exercise, two episodes of heat exhaustion that occurred in August 2000 and 2003 and oxygen deprivation that occurred as part of a swimming accident at the Marine Corps Recruit Depot in San Diego. A new personal examination of the Veteran is not required unless the examiner determines this to be necessary. The examiner is also asked to opine whether the Veteran's tension or migraine headache disability is at least as likely as not (a) proximately due to the Veteran's service-connected depression and anxiety, or (b) aggravated beyond its natural progression by service-connected depression and anxiety. All opinions must include a detailed explanation (rationale). (By law, the Board may not rely on any conclusion that is unsupported by a thorough explanation.) The Board recognizes that the complex nature of the medical questions involved may require significant work on the part of the medical examiner. Full and thoroughly explained answers to each of the questions will prevent delays in adjudication and are very much appreciated. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. McDonald, 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.