Citation Nr: 22017672 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 19-06 151 DATE: March 25, 2022 REMANDED The issue of entitlement to service connection for migraine headaches is remanded. REASONS FOR REMAND The Veteran served on active duty in the Navy from March 1972 to March 1976. This matter comes before the Board of Veterans' Appeals (Board) from an August 2018 rating decision. The Veteran testified at a Board hearing in January 2021. *** The Veteran seeks service connection for chronic migraine headaches. 07/26/2018, VA 21-526EZ, Fully Developed Claim. A July 2017 VA treatment note reflects that the Veteran complained of chronic headaches that had gotten worse over the past three or four months. 08/09/2018, CAPRI, at 2. A separate July 2017 VA treatment note shows a diagnosis of headaches of probable tensional origin. 07/18/2018, CAPRI, at 18. More recently, a letter from the Veteran's private primary care provider (received February 2020) indicates that the Veteran's headaches are due to cervical disease. 02/11/2020, Medical Treatment Record - Non-Government Facility. At his Board hearing, the Veteran testified that his primary care provider had referred him to a private spine specialist, who told the Veteran that his headaches were due to his back condition. Treatment records from that private spine specialist, however, appear to indicate that the headaches are related to the Veteran's neck condition. 03/02/2021, Medical Treatment Record - Non-Government Facility, at 11 & 24. The Veteran also testified that he has had headaches since service. This assertion, however, is inconsistent with multiple active and reserve service examinations (from 1972 to 1993) that fail to show a continuous history of headaches. Rather, a March 1988 examination report indicates that the Veteran received hospital treatment for severe headaches in January 1987 but clarifies that the Veteran had never had any other trouble with headaches. 01/14/2022, STR-Medical, at 26. Service connection is not in effect for a neck or back condition. The record, however, shows that the Veteran submitted claims of service connection for neck and back disabilities in November 2021. 11/24/2021, VA 21-526EZ, Fully Developed Claim. A January 2022 rating decision denied service connection for neck and back disabilities. However, in March 2022, the Veteran requested higher-level review of this decision. 03/08/2022, VA Form 20-0996 Request for Higher-Level Review. The Board finds that due to the Veteran's testimony and the private treatment report received in February 2020, the issue on appeal before the Board of service connection for headaches is inextricably intertwined with the issue under review at the Agency of Original Jurisdiction (AOJ) of service connection for neck and back disabilities. Under these circumstances, the Board finds that the appropriate course of action is to defer adjudication of the claim of service connection for headaches until after the claims of service connection for neck and back disabilities have been adjudicated. To that end, the present appeal is remanded back to the AOJ. Additionally, the Veteran testified at the 2021 Board hearing that his headaches began towards the end of his first four years. As the Veteran has an assessment of headaches and the testified to them worsening over the years since discharge, the Board finds that VA's duty to assist to provide a medical examination and opinion is triggered. This matter is REMANDED for the following actions: 1. Schedule the Veteran for a VA examination with an appropriate clinician to assess the Veteran's headaches and provide an etiological opinion. The examiner must review the claims file to become familiar with the Veteran's pertinent medical history. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. Please complete the "Functional Impact" section of the report. The examiner is asked to provide a response to the following: (a.) Are the headaches at least as likely as not related to service? (b.) Is it at least as likely as not that the headaches (1) began during active service, (2) manifested within a year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? The examiner must provide a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 2. Once higher-level review of the January 2022 rating decision denying service connection for neck and back disabilities has been completed, readjudicate the issue of service connection for migraine headaches, to include on a secondary basis. If the claim of service connection for headaches remains denied, issue a supplemental statement of the case and return the matter to the Board. Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. López, 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.