Citation Nr: 21013368 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 15-32 884 DATE: March 9, 2021 REMANDED Entitlement to service connection for headaches, to include tension headaches and migraines is remanded. Entitlement to service connection for a gastrointestinal disorder, to include gastritis with rectal prolapse, diarrhea, constipation, and history of functional bowel disease and black stool is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from May 1961 to May 1965. This matter originally came before the Board of Veterans’ Appeals (Board) on appeal from a November 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in March 2019. A transcript of the hearing is associated with the claims file. The Board remanded this case in September 2019 to obtain VA examinations, and again in September 2020 for addendum opinions. 1. Entitlement to service connection for headaches, to include tension headaches and migraines is remanded. 2. Entitlement to service connection for a gastrointestinal disorder, to include gastritis with rectal prolapse, diarrhea, constipation, and history of functional bowel disease and black stool is remanded. While the Board sincerely regrets further delay, a fully-informed decision on the issues of entitlement to service connection for headaches and a gastrointestinal disorder can not be made because there has not been substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268 (1998).   Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007).  A VA examiner must consider the Veteran’s lay statements regarding the incurrence of a disorder, and his statements regarding the continuity of symptomatology. Dalton v. Nicholson, 21 Vet. App. 23, 39-40. A Veteran is competent to report symptoms that are capable of lay witness observation. See Layno v. Brown, 6 Vet. App. 465, 469 (1994).   In September 2020, the Board found that the July 2020 VA examination for the Veteran’s headaches was inadequate, and remanded for an addendum opinion to determine whether the Veteran’s tension headaches are related to service, and to specifically address the Veteran’s lay statements from his March 2019 hearing. An addendum opinion was provided in November 2020. The November 2020 examiner opined that the Veteran’s headaches were less likely than not related to service because of a lack of complaints shortly after the Veteran’s head injury in service. The examiner also stated there was no evidence of a chronic headache condition in service, and that if the head injury in service caused a headache condition, it would not have gone unreported for approximately 40 years. However, the November 2020 examiner did not take into consideration the Veteran’s lay statements regarding his symptoms during and since service. At his March 2019 hearing, the Veteran specifically described his symptoms while on active duty as “pressure on the side of his brain” and stated he was “sucking up Aspirins like no tomorrow.” Additionally, he said his symptoms continued after service, stating he had headaches everyday and took about 6 to 10 Aspirins a day. He also stated he drank a lot during that time to relieve the pain. He reported that he currently has headaches less often, about once per month, and believes this is due to taking Ibuprofen and Hydrocodone. When he does have these headaches, he described them as so debilitating that he does not want to do anything but scream. The Veteran stated that he has tried staying in a dark room with a cold compress, and that he just has to stay home on those days. None of these statements were addressed in the November 2020 addendum opinion for the Veteran’s headaches. In September 2020, the Board also found that the July 2020 VA examination for the Veteran’s gastrointestinal disorders was inadequate, and remanded for an addendum opinion to specifically address the Veteran’s lay statements from his March 2019 hearing. An addendum opinion was provided in November 2020. The November 2020 examiner opined the Veteran’s current gastrointestinal disorders are less likely than not related to service. He stated the Veteran’s current gastrointestinal symptoms are not consistent with gastroenteritis. Additionally, he reasoned that after 1964, there is no evidence of a chronic condition or gastrointestinal complaints. However, he did not consider the Veteran’s statements regarding his symptomatology since service that suggest his symptoms in service are the same or similar to his current symptoms, to include diarrhea and constipation. As such, a remand is necessary to afford the Veteran addendum opinions that properly address his lay statements from his March 2019 hearing for his headaches and gastrointestinal disorders. The matters are REMANDED for the following action: 1. Obtain all VA treatment records not currently associated with the claims file. 2. Obtain an addendum opinion for the Veteran’s headaches. The entire file should be made available to the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any currently diagnosed headache disorder, had its clinical onset during active service or is related to any in-service disease, event, or injury, to include the Veteran’s car accident in May 1964 and suspected concussion in July 1964. The examiner must also consider and address the Veteran’s lay statements from his March 2019 hearing, to include statements regarding the pressure on the side of his brain during service, the pain medication and other methods he has used to treat his headaches over the years, and his current symptoms. The examiner should discuss whether the Veteran's assertions are generally inconsistent with medical knowledge or implausible, and whether the Veteran's reports about in-service and post-service symptoms align with how the claimed disorder is known to develop. The examiner is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. 3. Obtain an addendum opinion for the Veteran’s gastrointestinal disorders. The entire file should be made available to the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any currently diagnosed gastrointestinal disorder, to include IBS, with alternating diarrhea and constipation, had its clinical onset during active service or is related to any in-service disease, event, or injury, to include symptoms over the years. The examiner must also consider and address the Veteran’s March 2019 hearing testimony regarding the Veteran’s gastrointestinal symptoms during and after service, to include diarrhea and constipation. The examiner should discuss whether the Veteran's assertions are generally inconsistent with medical knowledge or implausible, and whether the Veteran's reports about in-service and post-service symptoms align with how the claimed disorder is known to develop. The examiner is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Papacalos, Law Clerk 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.