Citation Nr: 21066511 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 16-34 150 DATE: November 1, 2021 REMANDED Service connection for migraines (claimed as severe headaches) is remanded. Service connection for mild constipation and gastric ileus is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1974 to May 1974. This matter comes before the Board of Veterans' Appeals (Board) from a March 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In February 2016, the Veteran testified before a Decision Review Officer (DRO). In July 2019, the Veteran testified before the undersigned Veterans Law Judge. Transcripts are of record. The Board denied this matter in November 2019. The Veteran appealed the November 2019 Board decision to the United States Court of Appeals for Veterans Claims (the Court). In a December 2020 Joint Motion for Partial Remand (JMPR), the Court remanded, in part, the November 2019 Board decision for readjudication consistent with the JMPR. In July 2021, the Board remanded this matter for further development consistent with the JMPR. 1. Service connection for migraines (claimed as severe headaches) is remanded. 2. Service connection for mild constipation and gastric ileus is remanded. Although the Board regrets the additional delay, another remand is necessary. Unfortunately, the Board cannot make a fully-informed decision on this matter because no VA examiner has adequately opined on the etiology of the Veteran's migrianes and mild constipation and gastric ileus. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). In compliance with the Board's July 2021 remand directives, addendum opinions were obtained in September 2021. However, the September 2021 VA examiner opined that the Veteran's conditions were less likely than not related to service because had his migraines and/or constipation and gastric ileus been caused by service, 'one would expect complaints or treatment for such to be documented during the 40 years between his military service and the first mention of' such symptoms after service. Regarding constipation, the examiner additionally noted that 'occasional constipation is very common and not considered a chronic disability.' The Board notes that the July 2021 remand directives instructed that the opinion should not rely solely on the absence of medical documentation of headaches or gastrointestinal symptoms or other such objective medical evidence, which is what appears to have occurred here in the addendum opinions received. Thus, on remand, addendum opinions should be obtained. The matters are REMANDED for the following action: Obtain addendum opinions from an appropriate clinician regarding whether the Veteran's migraines and constipation and gastric ileus are at least as likely as not related to his active military service, to include his in-service complaints of headaches and constipation. See, e.g., April 1974 service treatment record. The examiner must provide a rationale for all proffered opinions. In doing so, the medical examiner should not rely solely on the absence of medical documentation of headaches or gastrointestinal symptoms in his medical treatment records to reach a nexus opinion. In providing the requested opinion and supporting rationale, consider the Veteran's description of his in-service symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's recurrent constipation and headache symptoms in service and reportedly thereafter represented the onset of his current migraine headache and gastric ileus disabilities, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disabilities are known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.Aoughsten, Associate 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.