Citation Nr: 22017770 Decision Date: 03/26/22 Archive Date: 03/26/22 DOCKET NO. 14-22 929 DATE: March 26, 2022 REMANDED Entitlement to service connection for a headache disability, to include as due to undiagnosed illness or other qualifying chronic disability pursuant to 38 U.S.C. § 3.317, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1986 to January 1989 and from September 1990 to July 1991, including service in the Southwest Asia theater of operations during the Persian Gulf War from October 1990 to June 1991, with additional service in the Alabama Army National Guard. This matter is on appeal from a July 2012 rating decision. In June 2017, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge of the Board. A transcript of the hearing is associated with the record. In February 2018, the Board remanded the case for further development by the originating agency. In a December 2019 decision, the Board denied service connection for various disabilities, including a sinus disability, a right knee disability, a bilateral ankle disability, and a headache disability. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (CAVC). In December 2020, the CAVC granted a Joint Motion for Remand, which vacated and remanded the December 2019 decision, as it pertained to the service connection claims for sinus, headache, right knee, and bilateral ankle disabilities. In June 2021 the Board remanded the claims of entitlement to service connection for sinus, headache, right knee, and bilateral ankle disabilities for further development. In November 2021, the Board denied the Veteran's claims of entitlement to service connection for sinus, right knee, and bilateral ankle disabilities and remanded the claim of entitlement to service connection for headache disability for further development. Headache disability Unfortunately, a remand is required in this case. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is an adequate and complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. The Board most recently remanded the claim in November 2021 noting that pursuant to a June 2021 remand a June 2021 examiner opined that the Veteran's claimed headache disability, diagnosed as migraines, was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran's statements were taken into consideration, including frequent exposures to environmental hazards and burn pits/fuel. However, the examiner failed to explain why the Veteran's potential exposure to burn pits and fuel during his active service in the Persian Gulf did not cause his headache disability. As such, the Board found that the opinion was incomplete and therefore, inadequate for evaluation purposes. Pursuant to the Board's November 2021 remand, in January 2022 a VA examiner opined that the Veteran's migraines are less likely than not related to his Persian Gulf service based, in part, on the rationale that, "Clinically it is known that migraines cause is unknown." The examiner also cited risk factors for developing migraines include hormone changes; alcohol; caffeine; stress; sensory stimulation such as sound, light, and smell; getting too much or too little sleep; physical activity/too little/too much; sexual activity; weather changes; medications; foods; and food additives. However, the examiner failed to specifically state an opinion as to the relationship between the cause of the Veteran's migraine headaches and any of the cited risk factors. Moreover, although she stated that she considered the Veteran's testimony and lay statements regarding burn pit exposure, the examiner again failed to did not explain why the Veteran's potential exposure to burn pits and fuel during his active service in the Persian Gulf did not cause his headache disability Accordingly, in light of the foregoing, and due to the inadequacies in the January 2022 addendum, the Board must once again remand the claim for an addendum as to whether the Veteran's headache disability is related to his service. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); Stegall v. West, 11 Vet. App. 268 (1998). The matter is REMANDED for the following actions: Obtain an appropriate addendum by an examiner, other than the January 2022 VA examiner, regarding the nature and etiology of the Veteran's claimed headache disability. Unless the examiner finds that a new examination is required, the Veteran need not be examined again. The claims file, including a copy of this remand, must be made available to the examiner for review who should indicate that the claims file was reviewed. The examiner must address the following questions: 1. Identify the Veteran's objective indications of a disability. See 38 C.F.R. § 3.317(a)(3). 2. By history, physical examination, or laboratory testing, can the Veteran's objective indications of a headache disability be attributed to a known clinical diagnosis? 3. If the Veteran's objective indications cannot be attributed to a known clinical diagnosis, is there affirmative evidence that the undiagnosed illness was not incurred during service in the Persian Gulf War or that it was caused by a supervening condition or event that occurred since the Veteran's departure from service during the Persian Gulf War? 4. If the Veteran's objective indications can be attributed to a known clinical diagnosis, is the etiology of the Veteran's disability (1) inconclusive, (2) partially understood, or (3) fully understood? 5. If both the etiology and pathophysiology are partially understood or fully understood, then is it at least as likely as not (a 50 percent or greater probability) that the Veteran's diagnosed disability was incurred in, or is otherwise related to service? The examiner must specifically discuss the Veteran's testimony and other lay statements regarding exposure to burn pits during service. See e.g., June 2017 Transcript; September 2019 VA Form 21-4138. (Continued on the next page) The Board, by this remand, makes no determination, expressed or implied, concerning the credibility of any statements on file. The addendum should include the complete rationale for all opinions expressed. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Adams, 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.