Citation Nr: 21001949 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 16-00 220A DATE: January 12, 2021 ORDER Entitlement to service connection for a disability manifested by constipation, including as secondary to pain medication, is denied. REMANDED Entitlement to service connection for hypertension, including as secondary to pain from service-connected disabilities, is remanded. FINDING OF FACT The evidence does not demonstrate that the Veteran suffers from a disability manifested by constipation. CONCLUSION OF LAW The criteria for service connection for a disability manifested by constipation have not been satisfied. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1959 to February 1962. This matter comes before the Board of Veterans’ Appeals (Board) from an October 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing with the undersigned in November 2018. This issue was previously remanded by the Board in March 2019 and has since been returned for further adjudication. Service Connection for Constipation The Veteran contends that he suffers from constipation due to the pain medication that he takes for his service-connected disabilities. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. Treatment records are silent for any disability resulting in constipation. In July 2020, the Veteran denied suffering from constipation. The Veteran underwent a VA examination in November 2020 where he was not found to suffer from constipation. The examiner opined that it was less likely than not that the Veteran suffered from constipation due to pain medication. According to the examiner, the Veteran has been reluctant to take pain medications and there is no mention of chronic constipation in his records. Also, the pattern of bowel movements as described by the Veteran is not unusual or uncommon and the complaints do not constitute a diagnosis. The examiner also determined the complaints did not impact the Veteran’s ability to work. The Board finds this opinion highly probative as it was offered by a medical professional after examination of the Veteran and consideration of his medical history, to include his statements regarding experiencing constipation. The claim must be denied as there is no diagnosed disability resulting in constipation and no showing of functional impairment as a result of the Veteran’s complaints of constipation. Notably, the examiner determined the Veteran’s description related to his bowel habits is not uncommon and does not result in functional impairment or constitute a disability. There is no competent evidence in significant conflict with this finding. As such, service connection for a disability manifested by constipation is denied. REASONS FOR REMAND Service connection for hypertension Although the Board regrets additional delay, remand is necessary to obtain an addendum opinion. In March 2019, the Board remanded the issue to determine if the Veteran’s pain from the residuals of his left foot laceration aggravated his hypertension. The Veteran underwent a VA examination in November 2020 where the examiner opined that his left foot laceration did not cause or aggravate his hypertension. In so doing, the examiner appears to have relied heavily on findings related to the foot in 2011, with some suggestion of the absence of left foot pain or at worst mild pain. The Veteran has undergone multiple foot examinations since that time, to include in February 2018 when foot pain was noted. In addition, the Veteran is now service-connected for additional disabilities that appear to result in pain, including a low back disability and nerve injuries to the lower extremities. As such, remand is necessary to obtain an addendum opinion. This matter is REMANDED for the following action: Send the claims file to an appropriate examiner to offer an opinion as to whether the Veteran’s hypertension is at least as likely as not (a) caused by, or (b) aggravated by (worsened beyond natural progression) pain from his service-connected disabilities. In offering the opinion, the examiner is asked to consider the private medical opinion from January 2015 that related the Veteran’s hypertension to the pain from his service-connected disabilities. The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as adjudicators are precluded from making any medical findings. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Hofmeister, Attorney Advisor 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.