Citation Nr: 21021480 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 16-01 560 DATE: April 13, 2021 REMANDED Entitlement to an initial compensable rating for residuals of a traumatic brain injury (TBI) is remanded. Entitlement to an initial compensable rating for tension headaches prior to October 19, 2015 is remanded. Entitlement to an initial rating in excess of 30 percent for tension headaches from October 19, 2015 is remanded. REASONS FOR REMAND The Veteran had active service from January 2007 to April 2010, to include service in Southwest Asia. These matters come before the Board of Veterans’ Appeals (Board) on appeal of rating decisions issued in August 2014 by a Department of Veterans Affairs (VA) Regional Office (RO). In connection with this appeal, the Veteran requested a hearing before the Board, and this hearing was scheduled for January 2019; however, the Veteran failed to appear for this hearing and has not presented good cause for doing so. As such, the request for a hearing is considered withdrawn. 38 C.F.R. § 20.704(d). In July 2019, the Board remanded the issues currently on appeal to the agency of original jurisdiction (AOJ) for additional development. After taking further action, the AOJ confirmed and continued the prior denials and returned the case to the Board. See November 2020 supplemental statement of the case. 1. Entitlement to an initial compensable rating for residuals of a TBI is remanded. The Board finds that there is a conflict in the evidence with respect to the nature and extent of the Veteran’s TBI residuals that requires an addendum medical opinion to resolve. In July 2019, the Veteran submitted a Quantitative Single Photon Emission Computed Tomography (qSPECT) report, which noted that the results were primarily consistent with scientific literature pertaining to TBI and the Veteran’s clinical history. The report noted a perfusion pattern that is inconsistent with posttraumatic stress disorder (PTSD) or an anxiety disorder, and appeared therefore to link the Veteran’s reported symptoms of difficulty concentrating, flashbacks, insomnia, and nightmare symptoms to his TBI. A VA examination conducted in November 2020 indicated that the Veteran’s complaints with respect to memory loss, attention, concentration, or executive function could not be established on objective testing, and indicated that there were no neurobehavioral effects associated with the Veteran’s TBI. The examiner concluded that it is impossible to state which emotional/behavioral signs and symptoms are associated with TBI verus his service-connected PTSD due to “significant symptom overlap.” However, the examiner did not provide a rationale, or otherwise explain the reasoning, for this finding. Based on the foregoing, and given that the evidence submitted by the Veteran in July 2019 appears to indicate that the Veteran’s symptom pattern is attributable to his TBI and not PTSD, the Board finds that a remand for an addendum opinion is required in order to obtain clarification as to the nature and extent of the Veteran’s TBI residuals. 2. Entitlement to an initial compensable rating for tension headaches prior to October 19, 2015 is remanded. 3. Entitlement to an initial disability rating in excess of 30 percent for tension headaches from October 19, 2015 is remanded. The November 2020 VA examination provides evidence of the interrelated nature of the Veteran’s headaches and his TBI. Accordingly, the Board finds that the claims of entitlement to higher ratings for the tension headaches disability are inextricably intertwined with the issue of entitlement to a higher rating for residuals of a TBI that is being remanded. See, e.g., Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 2 Vet. App. 180, 183 (1991) (issues are “inextricably intertwined” when a decision on one issue would have a “significant impact” on an appellant’s claim for another issue). As such, the Board will remand the tension headaches higher rating claims as well. The matters are REMANDED for the following actions: 1. Arrange for the Veteran’s claims file to be reviewed by the VA examiner who prepared the November 2020 VA TBI examination report (or a suitable substitute if that VA examiner is unavailable) for the purpose of preparing an addendum opinion. If the examiner finds that another examination of the Veteran is required, one should be undertaken. After reviewing the record, the examiner is requested to state, to the extent possible, which emotional/behavioral signs and symptoms are attributed to the Veteran’s PTSD and which signs and symptoms are attributed to his TBI. In providing this opinion, the examiner is requested to comment on the significance of the qSPECT report submitted by the Veteran in July 2019. A complete medical rationale for all opinions expressed must be provided. If an opinion cannot be provided without resorting to speculation, the examiner should provide complete explanations of why this is so. In so doing, the examiner is requested to explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or the limits of current medical knowledge have been exhausted in providing an answer to that particular question. 2. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issues on appeal should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. J. Ragheb Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Steven H. Johnston, 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.