Citation Nr: 22017767 Decision Date: 03/26/22 Archive Date: 03/26/22 DOCKET NO. 19-13 003 DATE: March 26, 2022 REMANDED Entitlement to service connection for a headache disability is remanded. Entitlement to service connection for ulcerative colitis is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1993 until September 1994 and from January 2000 to January 2006. These matters come to the Board of Veterans Appeals (Board) on appeal from an April 2018 Department of Veterans Affairs (VA) regional office (RO) rating decision. In October 2021, the Veteran participated in a hearing before the undersigned; a transcript is associated with the claims file. Entitlement to service connection for a headache disability is remanded. When VA undertakes to obtain an opinion, it must ensure that the opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). At a January 2018 VA examination, the examiner opined that the Veteran's headache disability was less likely than not related to service. The examiner reasoned that while the Veteran injured his head in 2000, it resolved without sequelae, "that he was only seen once in service for a headache," and the earliest evidence in the file indicating the Veteran seeking treatment for headaches was in 2014. At an August 2018 VA examination, the examiner opined that the Veteran's headache disability was less likely than not caused or aggravated by his service-connected sleep apnea. The examiner reasoned that the "records really did not show he was having consistent migraines until around 2014. Therefore, the migraines cannot be said to have been caused by the [sleep apnea], or they would have manifested sooner." The examiner additionally reasoned that there are no medical notes "to support that the [sleep apnea] (which he has had for over 10 years) has aggravated his migraines which he has only for about 4 years. . . One would expect the migraines would have manifested in a disabling way years prior." However, the Veteran testified at his hearing that he had migraine headaches "the whole time I was in the Army," and that they continued thereafter. The Veteran testified that he was seen for migraine headaches more than once and was treated for them right after separation. Namely, he states that he was treated for migraine headaches at the VA Medical Centers in Hawaii and El Paso beginning in 2006. A review of the claims file shows that the Veteran was seen for head pain several times during service, to include January 18, 2001, and January 25, 2001, not just "once." Review of the file, to include the 2006 post-service treatment records, does not show specific treatment notes for migraine headaches. Nevertheless, the Veteran's testimony regarding the onset of his migraines and continuity thereafter was not specifically considered by the VA examiner. As such, remand is necessary to consider them. See Miller v. Wilkie, 32 Vet. App. 249 (2020) (holding that an examiner must address the Veteran's lay statements to provide an adequate medical opinion). Entitlement to service connection for ulcerative colitis is remanded. The Veteran has not been afforded a VA examination for his service connection claim regarding his ulcerative colitis. VA's duty to assist includes providing a medical examination and obtaining an opinion when it is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of a diagnosed disability or symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006). The threshold for finding a link between a current disability and service so as to require medical examination is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006). A November 2013 surgical pathology report shows that the Veteran is diagnosed with chronic active ulcerative colitis. The Veteran's service treatment records also show that he was seen for symptoms of rectal bleeding, constipation, nausea, loose and dark stools, and having numerous bowel movements. The Veteran also underwent a June 2005 colonoscopy which showed "small hemorrhoids." Additionally, while not performed in this context, a September 2014 VA examiner opined that while his ulcerative colitis "began in 2009 per colonoscopy showing a friable colon," it has some role in the Veteran's rectal bleeding along with his service-connected hemorrhoids. Further, at his hearing, he testified that he sought treatment shortly after separation for his bowel symptoms. He also stated that his bowel symptoms have continued to the present. Of note, while the Veteran is currently service connected for hemorrhoids, he has argued that his in-service bowel symptoms were "ulcerative the whole time." The Veteran has not yet had a VA examination to determine whether his ulcerative colitis is related to service, or to service-connected disability. As the Veteran's service treatment records reflect bowel treatment, post-service treatment records reflect ongoing treatment, and the Veteran's statements indicate that his bowel symptoms have continued since service, a remand is required to obtain a VA examination and opinion addressing the nature and etiology of this disability. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records, specifically any records from VA Medical Centers in Hawaii and El Paso, Texas, beginning in 2006. 2. Obtain a VA medical opinion to determine the nature and etiology of the Veteran's migraine disability. The need for another VA examination (or telehealth interview, review of the record, or similar, if an in-person examination is not feasible) is left to the discretion of the examiner. The claims folder must be reviewed in conjunction with the opinion. The examiner must provide a well-reasoned opinion as to each of the following: Whether it is at least as likely as not that the Veteran's migraine disability onset in service or is otherwise directly related to service. Whether it is at least as likely as not that the Veteran's migraine disability was caused by his service-connected sleep apnea. Whether it is at least as likely as not that the Veteran's migraine disability was aggravated by his service-connected sleep apnea. In answering these questions, the examiner must review the Veteran's service treatment records showing numerous dates of treatment, to include January 18, 2001, and January 25, 2001, for head pain and headaches. The examiner must also comment on the Veteran's lay testimony that his headaches onset in service and continued thereafter. 3. Obtain a VA examination (or telehealth interview, review of the record, or similar, if an in-person examination is not feasible) to determine the nature and etiology of the Veteran's ulcerative colitis. The claims folder must be reviewed in conjunction with the examination and opinion. The examiner must provide a well-reasoned opinion as to each of the following: Whether it is at least as likely as not that the Veteran's ulcerative colitis onset in service or is otherwise directly related to service. Whether it is at least as likely as not that the Veteran's ulcerative colitis was caused by his service-connected hemorrhoids. Whether it is at least as likely as not that the Veteran's ulcerative colitis was aggravated by his service-connected hemorrhoids. In answering these questions, the examiner must review the Veteran's service treatment records showing symptoms of rectal bleeding, constipation, nausea, loose and dark stools, and having numerous bowel movements. The examiner must also address the September 2014 VA examiner's opinion that while his ulcerative colitis "began in 2009 per colonoscopy showing a friable colon," it has some role in the Veteran's rectal bleeding along with his service-connected hemorrhoids. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Finelli, 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.