Citation Nr: A21019148 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 210927-187806 DATE: December 1, 2021 REMANDED Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1966 to January 1970. He served honorably in the U.S. Air Force. The Board thanks the Veteran for his service to our country. The rating decision on appeal was issued in June 2021 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In March 2021, the appellant submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested review of a March 2018 rating decision based on new and relevant evidence. In June 2021, the agency of original jurisdiction (AOJ) issued the rating decision on appeal, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision. In the VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) (NOD), the appellant elected the Direct Review option; therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Entitlement to service connection for tinnitus is remanded. A remand is warranted to correct a pre-decisional duty to assist error. In a March 2021 opinion as to whether the Veteran's tinnitus is related to his service connected migraines, a VA audiologist stated that, she as an audiologist, could only address the relationship between hearing loss, noise exposure, and tinnitus; therefore, the requested opinion was beyond the scope of practice. The audiologist recommended that a medical opinion be provided by a practitioner specializing in migraines. In a June 2021 addendum opinion, a VA general practice clinician concluded that the Veteran's tinnitus is less likely than not proximately due to, or the result of, the service connected disability as there is no credible medical evidence of a causal link between migraine headaches and tinnitus. The clinician referenced an article, "Etiology and diagnosis of tinnitus," accessible via UpToDate. The clinician provided no additional rationale or explanation as to what the article contained or its comprehensiveness; nor did the clinician address whether other sources were considered in reaching this conclusion. Further, the clinician did not address the Veteran's lay evidence, including his report, during the March 23, 2018 VA examination, that the onset of tinnitus was approximately 20 years prior and that he experiences tinnitus when he gets cluster migraines. Moreover, the clinician did not address the claim on the basis of aggravation. Accordingly, a remand is necessary for an adequate opinion addressing the claim on a secondary basis. The matters are REMANDED for the following action: 1. Please refer the claim to an appropriate clinician for an addendum opinion as to the nature and etiology of the Veteran's tinnitus. The Veteran's claims-file must be made available to and reviewed by the clinician. The clinician is requested to respond to the following: (a.) Is the Veteran's tinnitus at least as likely as not (a 50 percent or greater probability) caused by service connected migraine, including migraine variants? (b.) Is the Veteran's tinnitus at least as likely as not (a 50 percent or greater probability) aggravated (any increase in disability) by service connected migraine including migraine variants? The clinician is requested to consider, and address as appropriate, the following: In a March 23, 2018 VA examination report, the Veteran reported the onset of tinnitus approximately 20 years prior and experiencing tinnitus when he gets cluster migraines. In a September 3, 1967 service treatment record, the Veteran complained of headache over the left eye which was relieved slightly by pressure over the temporal artery. In a September 11, 1967 service treatment note, he complained of headache over the left eye for a couple of months but denied visual or auditory difficulties. In an April 22, 1969 report of medical history, the Veteran endorsed frequent or severe headaches and ear, nose, and throat trouble, the latter of which the physician noted referred to an occasional sore throat which was treated symptomatically. In a December 11, 1969 report of medical history, he endorsed frequent or severe headache and denied ear, nose, or throat trouble, running ears, and hearing loss. In a December 11, 1969 report of medical examination, the physician noted frequent headaches since early 1967, diagnosed as cluster headaches, with normal EEG and neurological consultation. ONLY IF the clinician determines that an examination is necessary for the addendum opinion, the Veteran should be scheduled for an appropriate VA examination to determine the nature and etiology of the disorder. The clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. The clinician should take into consideration that the Veteran is competent to report in service and post-service symptom experiences; other witnesses are competent to report observable symptoms. If the clinician cannot provide an opinion without resorting to speculation, the clinician should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. M. ESPINOZA Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Vashaw, 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.