Citation Nr: 21074391 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 17-02 568 DATE: December 15, 2021 REMANDED Entitlement to service connection for a disability manifested by abdominal pain, to include gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), and a spleen disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Marine Corps from March 1995 to March 1999. This matter is before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. The Board remanded this matter for further evidentiary development in July 2021. The issue of entitlement to service connection for paratracheal calcified lymphadenopathy was also remanded by the Board in July 2021. In October 2021, the agency of original jurisdiction (AOJ) granted service connection for this disability. As this claim for service connection has been granted in full, it is not before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). The Veteran seeks entitlement to service connection for a disability manifested by abdominal pain, to include GERD, IBS, and/or a spleen disability. He reports experiencing ongoing abdominal pain since service. Service Connection for a Disability Manifested by Abdominal Pain The Veteran's service treatment records (STRs) reveal multiple complaints of abdominal pain. Specifically, in May 1996, the Veteran reported a lump in his stomach and pain associated with the lump for three days. June 1996 STRs show complaints of abdominal pain and tenderness. December 1996 STRs show that the Veteran complained of intermittent abdominal pain. Several August 1997 STRs document lower right quadrant pain. In December 1997, the Veteran complained of pelvic pain that extended into the lower quadrant of the abdomen. As discussed in the July 2021 Board remand, post-service treatment records and examination reports note diagnoses of several disabilities manifested by abdominal pain, to include GERD, IBS, splenomegaly, and splenic granuloma. The July 2021 Board remand found a November 2016 VA examination report to be inadequate for adjudication purposes because the examiner relied entirely on the absence of evidence in contemporaneous medical records to support his negative nexus opinion while ignoring the above-mentioned possible symptoms of these conditions in the Veteran's STRs. Pursuant to the July 2021 Board remand, an additional VA opinion was obtained in September 2021. The examiner provided negative nexus opinions with the rationale that there is no medical documentation found in the Veteran's STRs to establish an injury, event or illness related to abdominal pain, GERD, or IBS. The examiner provided an addendum opinion in October 2021 that reiterated there was no documentation of a specific condition related to abdominal pain in service. The examiner further noted that abdominal pain is a symptom of a diagnosable condition and should not be used as a diagnosis to establish an in-service injury or event. The Board finds the September 2021 examination report and October 2021 addendum opinion to be inadequate for rating purposes. The examiner impermissibly relied on the absence of a clinical diagnosis during and directly after the Veteran's military service. Further, the examiner did not discuss whether the symptoms the Veteran reported in service could have been an early manifestation of his present abdominal disabilities. Additionally, the examiner did not appear to consider the Veteran's lay statements. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Board regrets any further delay; however, compliance with the Board's remand instructions is neither optional nor discretionary. Because there has not been substantial compliance with the Board's previous remand directives, and another remand is required. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter is REMANDED for the following action: Obtain an addendum opinion from a VA examiner of appropriate expertise to ascertain the nature and etiology of the Veteran's current disabilities manifested by abdominal pain. The claims file, including the remand, should be made available to and be reviewed by the examiner in conjunction with the examination. If it is determined that additional in-person physical examination of the Veteran is needed, it should be scheduled in accordance with applicable procedures. After careful review of the record, the examiner should address the following: 1. Identify any currently diagnosed disability manifested by abdominal pain, to include any abdominal disability diagnosed at any time during the appeal period (to include GERD, IBS, splenomegaly, and splenic granuloma). 2. For each diagnosed disability manifested by abdominal pain, provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that disability is due to or the result of the Veteran's military service, specifically to include the Veteran's in-service complaints of abdominal pain as noted in the STRs. 3. The examiner is asked to discuss whether the documented reports of abdominal pain during his military service in May 1996, June 1996, December 1996, August 1997, and December 1997 are an early manifestation of the Veteran's current abdominal disabilities. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. An absence of medical evidence cannot be the sole basis for a negative opinion. The examiner should provide a detailed rationale for all opinions, including a discussion of the evidence of record and medical principles which led to the conclusions reached. If an opinion cannot be provided without resort to speculation, the examiner should explain whether the inability to provide the opinion is due to the limits of the examiner's medical knowledge, the limits of medical knowledge in general, or there is additional evidence that would permit the opinion to be provided. Again, the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. Specifically, the examiner is asked to comment on the Veteran's reports of in-service abdominal pain and his report of abdominal pain since his military service. (Continued on the next page) K. R. FLETCHER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Frazier, Associate Attorney 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.