Citation Nr: 22017244 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 17-12 700 DATE: March 24, 2022 REMANDED Entitlement to service connection for a headache disorder is remanded. REASONS FOR REMAND The Veteran had active service from July 1976 to December 1976 and from March 1980 to September 1981. In March 2020, the Veteran testified at a videoconference hearing before the undersigned. A transcript of the hearing is of record. By way of background, the Veteran initially claimed entitlement to service connection for an acquired psychiatric disorder, to include PTSD and bipolar disorder (also claimed as bipolar disorder, mental condition, sleep condition, can't sleep, and lost memories). See November 2015 VA Form 21-526; see also September 2016 Notice of Disagreement. The Board notes that these issues were originally part of the Veteran's appeal and were most recently before the Board in January 2021, at which time the Board remanded the issues for evidentiary development. Subsequent to the Board's January 2021 remand, in October 2021, the agency of original jurisdiction (AOJ) issued a rating decision granting entitlement to service connection for PTSD (also claimed as a sleep condition, bipolar disorder, and lost memories). This decision represents a full grant of benefits sought on appeal for these issues. As such, those issues are considered granted in full and are no longer on appeal. See Grantham v. Brown, 114 F.3d. 1156 (Fed. Cir. 1997) (where an appealed claim for service connection is granted during the pendency of the appeal, a second notice of disagreement ("NOD") must thereafter be timely filed to initiate appellate review of the claim concerning "downstream" issues such as the compensation level assigned for the disability and the effective date); see also 38 C.F.R. § 20.200. At that same time, the AOJ issued a supplemental statement of the case (SSOC) denying entitlement to service connection for a headache condition. That issue remains on appeal and is before the Board once again. Entitlement to service connection for a headache disorder is remanded. The Veteran was afforded a headache examination in June 2021, after which the examiner noted the Veteran's 2015 diagnosis of acute intermittent tension headaches. The examiner opined that the Veteran's headache disorder was less likely than not related to service, to include after an alleged in-service head injury. She explained that a post-traumatic headache (PTHA) is defined as a secondary headache that develops within 7 days after head trauma (or after regaining consciousness following head trauma); and post-traumatic headache is regarded as chronic (CPTHA) when it continues for more than 2 months after incurrence of the injury, although duration of 6 months has also been suggested. See June 2021 VA examination report. Given that the Veteran did not receive care for headaches shortly after the alleged incident in service and reported no symptoms at separation, the examiner concluded that the headaches were unrelated to an in-service injury. Since the Board's last remand, VA has awarded service connection for PTSD (also claimed as a sleep condition, bipolar disorder, and lost memories). There is evidence of record that suggests the Veteran's headaches may be secondary to his now service-connected PTSD. See an October 22, 2015 VA treatment report (noting that the Veteran's headaches "may be exacerbated by poor sleep/nightmares"). As there remains an open medical question about this potential relationship, remand is necessary for an examiner to assess whether the Veteran's headaches are be caused or aggravated by service-connected PTSD. The matter is REMANDED for the following action: 1. Schedule the Veteran for a headaches examination. The examiner should review the record and take a history from the Veteran as to the progression of his claimed headache disorder. The examiner is asked to respond to the following: Is it at least as likely as not (approximately 50 percent or greater probability) that that the Veteran's headache disability was caused or aggravated by his service-connected PTSD? Please consider the October 22, 2015 VA treatment report noting that the Veteran's headaches "may be exacerbated by poor sleep/nightmares." A complete rationale should be given for all opinions and conclusions expressed. 2. After completing the above, readjudicate the Veteran's claim based on the entirety of the evidence. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Fulmer, 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.