Citation Nr: 22017364 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 17-56 498 DATE: March 24, 2022 REMANDED Entitlement to service connection for headaches is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1966 to April 1969. This matter comes before the Board of Veterans' Appeals (Board) from a May 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). While the Veteran requested for a Board hearing in his Form 9, he later indicated his intent to "withdraw his appeal scheduled for September 20, 2019." See VA 21-4138 form. Notwithstanding the word choice, subsequent statements thereafter indicate that the Veteran's intent was solely to withdraw the hearing request and not the appeal in its entirety. Thus, the matter is still properly before the Board here. The Board regrettably finds another remand is required, as there has not been substantial compliance with its prior remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for headaches is remanded. The Veteran contends that his headaches are either due to his military service or secondary to his service-connected tinnitus. In support of this claim, the Veteran's representative submitted a September 2021 appellate brief, noting that the recently obtained VA examination (i.e., Section II of the January 2020 VA examination) shows a causal relationship between headaches and tinnitus. The Board finds remand is required for obtaining a medical addendum opinion, as the January 2020 VA medical nexus opinion addressing secondary service connection is inadequate, as will be explained below. In the Medical History portion (Section II) of the January 2020 VA examination, the examiner included a medical article submitted by the Veteran's representative, which provides "research shows that tinnitus can be associated with multiple types of headache disorders. One headache type where tinnitus is sometimes seen is migraine. Some claimants report that their tinnitus worsens only and consistently during migraine attacks. Both tinnitus claimants and headache claimants often share common complaints. These complaints include but are not limited to depression, anxiety, sleep disturbances, and increased stress levels. Cognition can also be affected." However, the examiner ultimately furnished a negative causation opinion (secondary service connection), and in doing so, underlined that the review of the medical record failed to show any link between the Veteran's current headaches and his service-connected tinnitus, and noted that the Veteran has chronic daily headache, not migraines, despite his report of "migraines." However, as addressed above, the cited medical article provides that tinnitus can be associated with multiple types of headaches, with migraine being only one of those headache disorders. Thus, the Board finds the examination is inherently ambiguous as to whether the examiner considered the possibility of other types of headache disorders being related to tinnitus aside from migraines. Clarification is warranted. The examiner's aggravation opinion is similarly inconsistent and ambiguous, requiring clarification. That is, on the one hand, the examiner checked the "yes" box to "[the Veteran's] headaches condition is at least as likely as not aggravated..." beyond its natural progression by service-connected tinnitus. On the other hand, the examiner opined the opposite, that the Veteran's tinnitus was not associated with the Veteran's headaches with a cursory rationale (i.e., "enlistment was negative for headache. No medical evidence that the Veteran's service-connected tinnitus is a factor in aggravating his headache condition"). For all these reasons, the Board finds the VA examination and medical opinion of record is inadequate for adjudication purposes and remand for a new medical opinion is appropriate. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's headaches are at least as likely as not proximately due to or aggravated beyond its natural progression by service-connected tinnitus. The claims file should be reviewed. The VA examiner is cautioned that the term "aggravated," as used in 38 C.F.R. § 3.310(b), does not require that there be "permanent worsening" of the nonservice-connected disability. Instead, secondary service connection is warranted for "any incremental increase in disability and any additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase regardless of its permanence." See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). The examiner should consider the Veteran's lay statements reporting the nature, severity, and continuity of his symptoms, as well as any other relevant lay statements, in-service treatment records, private treatment records, or VA treatment records pertaining to the Veteran's headaches and/or tinnitus, to include relevant medical literature. If any lay statements are discounted, the examiner should provide a rationale for doing so (e.g., whether there is any medical reason to accept or reject his contentions). 2. After completion of the above development, and of any other development deemed necessary, readjudicate the claim. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lee, Catherine 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.