Citation Nr: 21022706 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 17-49 420 DATE: April 19, 2021 REMANDED Issue of entitlement to service connection for tension headaches, to include as secondary to major depressive disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1987 to April 1992. This appeal to the Board of Veterans’ Appeals (Board) arose from a June 2014 rating decision issued by the Department of Veterans Affairs (VA). See August 2014 Notice of Disagreement (NOD); September 2017 Statement of the Case (SOC); September 2017 Substantive Appeal (VA Form 9). The Veteran testified at a July 2019 hearing before a Decision Review Officer. July 2019 Hearing testimony. The Veteran also testified before the undersigned Veterans Law Judge in a January 2020 hearing. See January 2020 Hearing transcript. In May 2020, the Board found that new and material evidence warranted reopening the Veteran’s claim of entitlement to service connection for tension headaches and remanded the underlying service connection claim for further development. May 2020 Board decision. The Agency of Original Jurisdiction (AOJ) developed the evidence and denied the Veteran’s claim. See January 2021 Supplemental Statement of the Case (SSOC). The case is now back before the Board. The Board notes that May 2020 Board decision also remanded the Veteran’s claim of entitlement to service connection for a left knee disability, which was then granted in a January 2021 rating decision. The issue is, thus, no longer in appellate status or before the Board. Issue of entitlement to service connection for tension headaches, to include as secondary to major depressive disorder, is remanded. Unfortunately, the Board cannot make a fully-informed decision on the issue of entitlement to service connection for tension headaches because further evaluation and clarification is needed by a VA. The Board remanded the claim of entitlement to service connection for tension headaches for an opinion about whether the Veteran’s headaches are caused by or aggravated by his service connected major depressive disorder. See May 2020 Board decision. The VA examiner was directed by the Board to address the prior reports that the Veteran’s headaches may be related to his depression. Id. However, the November 2020 VA examiner’s opinion obtained on remand did not discuss any prior reports. November 2020 VA examination medical opinion. In addition, the November 2020 VA examiner opined that the Veteran’s headaches are not proximately due to, the result of, or aggravated by his major depressive disorder because they are “anatomically and different physiological systems.” Id. It is unclear why the Veteran’s headaches and major depressive disorder, both which seem to affect the brain, would be considered conditions from different anatomical and physiological systems. Clarification is needed. The Board finds that the Veteran should be provided another addendum opinion about his tension headache disability. The matters are REMANDED for the following action: 1. Obtain an addendum opinion to determine the nature and cause of the Veteran’s tension headaches. If the medical professional determines that it is necessary, schedule the Veteran for a VA examination. The medical professional should respond to the following: (a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s tension headaches are proximately due to or the result of his service connected disabilities, including major depressive disorder? If not proximately due to or the result of, the examiner(s) should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s tension headaches are aggravated (any incremental increase in severity) by one or more service connected disabilities, to specifically include major depressive disorder. The examiner(s) should consider and discuss the Veteran’s lay testimony and assertions regarding any pertinent complaints and symptoms, including his January 2020 testimony that the treating physician for his depression indicated his headaches may be related to depression. The examiner(s) should also specifically consider and discuss September 2020 VA examiner’s opinion that the Veteran’s depression may be the cause of his headaches. A detailed explanation (rationale) is requested, including citing to supporting clinical data (and/or medical literature), as appropriate. (Continued on the next page)   2. Readjudicate. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Lin 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.