Citation Nr: 21008901 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 16-15 693A DATE: February 18, 2021 REMANDED Entitlement to service connection for headaches is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1972 to May 1976. The case was previously before the Board in March 2016 when the issue was remanded so that a Statement of the Case (SOC) could be furnished to the Veteran in accordance with Manlincon v. West, 12 Vet. App. 238 (1999). This was accomplished and the case was returned. The issue of service connection for headaches was again, in February 2020, remanded for further development of the evidence. For reasons set forth below, the Board finds that the development obtained is not adequate for rating purposes and, unfortunately, an addendum opinion must be obtained. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for headaches is remanded. The Board notes that there are two medical opinions in the record regarding whether the Veteran’s headache disorder is aggravated by his service-connected tinnitus and hearing loss. Of note is a November 2014 private physician opinion that the Veteran’s tension headaches are aggravated by the service-connected disabilities. In the February 2020 remand, the Board found that the November 2014 opinion was inadequate for rating purposes because the examiner did not indicate the degree of aggravation caused by the Veteran’s service-connected tinnitus and did not provide a detailed rationale for the opinion aside from attaching anecdotal articles. The Board requested additional medical comment concerning the claim. The Veteran was examined by VA in May 2020, at which time negative nexus opinions were rendered. Review of the opinions, however, demonstrates inconsistencies that must be reconciled. The examiner opined that the Veteran’s headaches were not proximately due to hearing loss or tinnitus with the rationale being that the Veteran had tension headaches that were caused by muscle contractions in the head and neck regions that could be caused by a variety of food, activities, or stressors. Other triggers of tension headaches were also noted to include alcohol, eye strain, fatigue, a cold or flu, a sinus infection, decreased water intake and lack of sleep. The examiner went on to state that research studies suggested that repeated headaches could trigger the development of tinnitus so that headaches tended to precede tinnitus. Regarding aggravation by tinnitus and hearing loss, the examiner’s rationale was that there was no actual documentation in the available records that would support that the Veteran’s migraine headaches were aggravated by his tinnitus and bilateral hearing loss. It was noted that the Veteran’s head pain was aggravated by physical activity. Therefore, it was the examiner’s opinion that the claimed migraine headaches were less likely than aggravated beyond its natural progression by the Veteran’s tinnitus and bilateral hearing loss. The Board finds inconsistencies in the rationale provided by the VA examiner in February 2020. The examiner first stated that the Veteran had tension headaches that could not be proximately due to tinnitus. The examiner then stated that the Veteran had migraine headaches that were not aggravated by tinnitus and hearing loss. Thus, there is a question as to the precise diagnosis of the Veteran’s headache disorder. Moreover, the examiner did not provide the additional medical comment requested by the Board. As such, the matter must be returned for an additional opinion. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s chronic headache disorder is at least as likely as not proximately due to service-connected disability or aggravated beyond its natural progression by his service-connected bilateral hearing loss and tinnitus. In addressing the above, the examiner should clarify the diagnosis of the Veteran’s chronic headache disorder and provide comment on the medical opinions already of record, expressing agreement or disagreement, and the reasons thereof. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Joseph P. Gervasio 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.