Citation Nr: 21012694 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 15-04 349 DATE: March 5, 2021 REMANDED Entitlement to service connection for a bowel disorder is remanded. Entitlement to service connection for headaches is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1986 to November 1986, and November 1990 to August 1991, to include service in Southwest Asia. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Jurisdiction of this appeal is currently with the RO in Houston, Texas. This case was most recently before the Board in August 2020, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. The case has now been returned to the Board for appellate action. Service Connection The Veteran seeks service connection for a bowel disorder and headaches, to include as due to his service in Southwest Asia. Specifically, the Veteran asserts that his bowel and headache symptoms began during active service while stationed in Southwest Asia and have continued since and were caused by exposure to nerve and chemical agents during service. See VA Form 21-4138 Statement in Support of Claim, May 28, 2010; see also Correspondence, March 21, 2014. As noted above, the claims for entitlement to service connection for a bowel disorder and headaches were most recently before the Board in August 2020, when the matters were remanded to the AOJ for further development. Specifically, the August 2020 Board directed the AOJ to afford the Veteran an additional VA examinations for his claims. In this regard, the August 2020 Board remand found that the January 2020 VA examinations were inadequate. With regard to a bowel disorder, the August 2020 Board remand found that the January 2020 VA examiner did not address the Veteran’s statements that he has experienced burning sensations in his abdomen that radiate to his sternum beginning in 1991; greenish bowel movements while stationed in Saudi Arabia in 1991, which were noted in the service treatment records; and the lay statements regarding the Veteran’s ongoing symptoms since separation from active service. With regard to headaches, the August 2020 Board remand found that the January 2020 VA examiner failed to consider the Veteran’s statements; the lay statements of record; and therefore, did not fully consider the evidence of record. Additionally, the August 2020 Board remand found that the examiner did not thoroughly discuss whether chemical exposures during the Veteran’s military service may have caused his bowel disorder and headache disorder; and therefore, did not fully consider the factual evidence. In its remand directives, the August 2020 Board remand directed the examiner to provide opinions as to whether it was at least as likely as not that the Veteran’s kidney disorder [sic] and headaches were related to his active service, to include exposure to chemicals during his service in the Persian Gulf; specifically address the chronicity of the Veteran’s conditions since service as described by the Veteran and lay witnesses; and provide a complete rationale for any opinion expressed. The examiner was advised that the Veteran’s service treatment records were incomplete and must carefully consider the Veteran’s reports as to the nature and history of all observable symptoms. The Veteran was afforded the directed VA examinations for his claimed bowel disorder and headaches in October 2020, with an addendum opinion obtained in November 2020. With regard to a bowel disorder, the October 2020 VA examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness and reasoned that there was no evidence of a diagnosed bowel condition during active duty or post separation, that the Veteran had never sought treatment for gastrointestinal symptoms and a diagnosis was not warranted. With regard to headaches, the October 2020 VA examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness and reasoned that there was no evidence in the service treatment records that the Veteran suffered from a headache condition, specifically migraine headaches; and while certain smells and chemical exposure can trigger headaches, review of current medical literature does not support chronic headaches, specifically migraines, to continue years after the trigger is no longer present. In the November 2020 VA addendum opinion, the examiner opined that the Veteran’s headaches were less likely than not caused by headaches in service, to include exposure to chemicals during his service in the Persian Gulf. In this regard, the examiner noted that while the Veteran noted headaches during active service, and lay statements reiterated such, these are “not diagnostic of any condition”; and there was no objective medical literature to support a link to chemicals present in the Persian Gulf to ongoing chronic migraine condition. Moreover, the examiner noted that the Veteran’s headaches were diagnosed many years after service. With regard to a bowel disorder, in the November 2020 VA addendum opinion, the examiner opined that the Veteran’s bowel disorder was less likely than not incurred in or caused by the bowel disorder during service. In this regard, the examiner noted that while the Veteran noted having gastrointestinal problems during service, and lay statements reiterated such, these are “not diagnostic of any condition”; noted that the 1991 treatment during active service was a viral infection that resolved without residuals; the claims folder was silent for a diagnosed chronic intestinal condition; and that there was no evidence to support an intestinal condition manifesting in service that has required continuous care and treatment. The Board finds the October 2020 and November 2020 VA opinions incomplete to decide the claims. In this regard, the examiner did not provide a detailed rationale for any of the opinions rendered and did not specifically address the chronicity of the Veteran’s conditions since service as described by the Veteran and lay witnesses. Rather, the examiner provided mere conclusory statements that the claimed bowel disorder and headaches did not have chronicity, and was less likely than not related to his service in Southwest Asia; and did not provide any supporting rationale for the conclusions reached as directed by the August 2020 Board remand. Given these deficiencies, the Board is unable to find that substantial compliance with the prior remand has been achieved. See D’Aries, 22 Vet. App. at 105; see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999). As such, remand is again required to afford the Veteran an additional VA examinations that complies with the Board’s prior remand directives. See Stegall v. West, 11 Vet. App. at 268, 271 (1998). The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an opinion from an appropriate clinician to determine the nature and etiology of his bowel disorder and headaches. Any and all indicated evaluations, studies and tests deemed necessary by the examiner should be accomplished. The need for in-person examination is left to the discretion of the examiner. The examiner should respond to the following: For a bowel disorder and headaches, is it at least as likely as not (50 percent or greater probability) that such condition had its onset during any period of service, or is otherwise related to such period of service? The examiner should specifically consider the Veteran’s reports of exposure to chemicals during his service in Southwest Asia. (Continued on the next page)   A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance. If the examiner opines that any of the above questions cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, 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.