Citation Nr: 21068936 Decision Date: 11/16/21 Archive Date: 11/16/21 DOCKET NO. 17-35 554 DATE: November 16, 2021 REMANDED Entitlement to service connection for migraines, to include as secondary to service-connected sinusitis, allergic rhinitis, and/or generalized anxiety disorder and persistent depressive disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1985 to August 1989. This matter is before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board issued a prior remand on this claim in September 2019. 1. Entitlement to service connection for migraines, to include as secondary to service-connected sinusitis, allergic rhinitis, and/or generalized anxiety disorder and persistent depressive disorder is remanded. In the September 2019 Board remand, the Board noted that the Veteran had put forth multiple theories of entitlement for her migraine headaches, including reporting that they began during her active service. In addition to direct service connection, the Board noted that the Veteran claimed secondary service connection for which additional medical opinions were required. Thus, the Board remanded the claim instructing the RO to obtain an addendum opinion regarding whether the Veteran's migraines were proximately due to or aggravated by her sinusitis, allergic rhinitis, or acquired psychiatric disorder. The Board further asked that the examiner "review and discuss the medical literature identified by the Veteran's representative in the Written Brief Presentation, received in September 2019." In November 2020 an addendum opinion was uploaded into the Veteran's electronic file. Here, the examiner provided "There is no evidence that migraine headaches are caused by sinusitis, allergic rhinitis, or an acquired psychiatric disorder. The conditions can occur together, but there is no evidence of causation." The examiner did not provide an opinion with regard to direct service connection. Moreover, the Board notes that the examiner did not provide an adequate rationale for his opinion, or review and discuss the medical literature as instructed in the prior remand. Accordingly, another remand is required to obtain an adequate addendum opinion. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding remand by the Board confers on the claimant the right to compliance with the remand requests). The Board notes that while the claim was in remand status the Veteran submitted additional medical literature and provided several additional statements in support of her claim. This evidence will also be considered by the examiner on remand. The matters are REMANDED for the following action: 1. Update the electronic file with any new VA treatment records and private treatment records. 2. Obtain an addendum opinion with regard to the Veteran's migraine headaches. The examiner should be given a complete copy of the Veteran's electronic file and a note that such was reviewed should be included in the examiner's report. The examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's current migraines are etiologically related to her active service? (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's current migraines are proximately due to, the result of, or aggravated by her service-connected chronic maxillary sinusitis? (c.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's current migraines are proximately due to, the result of, or aggravated by her service-connected allergic rhinitis? (d.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's current migraines are proximately due to, the result of, or aggravated by her service-connected generalized anxiety disorder and persistent depressive disorder? In formulating an opinion, the examiner must consider and address: (1) the Veteran's October 26, 2019 statements in support of claim; (2) the Veteran's October 29, 2019 statement in support of claim; (3) the Veteran's November 28, 2020 statements in support of claim; (4) the Veteran's December 2, 2020 statement in support of claim; (5) the Veteran's December 5, 2020 statement in support of claim; (6) the Veteran's representative brief dated December 22, 2020; (7) the Veteran's December 24, 2020 statement in support of claim; and (8) the numerous pages of medical literature provided by the Veteran and her representative entitled "Coping with Noise Triggered Headaches", "Loud Noises, Bright Lights, and Migraines", "Weather as a Headache and Migraine Trigger", "Sleep and Migraine", "Association Between Allergic Rhinitis and Migraine", "Headaches Connected to Allergies and Sinus Problems", "What to Know about the Connection between Seasonal Allergies and Migraine", "Sleep, Migraine, and Insomnia", "Migraine and Depression", "Can Sinus Pressure Cause Migraines?", and "Post-Traumatic Stress Disorder in Episodic and Chronic Migraine". A detailed rationale for the opinion must be provided. If the reviewing clinician is unable to offer the requested opinion, it is essential that the reviewing clinician offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Ruiz, 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.