Citation Nr: 18142110 Decision Date: 10/15/18 Archive Date: 10/12/18 DOCKET NO. 16-29 438 DATE: October 15, 2018 ORDER Service connection for right knee osteoarthritis with patellofemoral pain syndrome is granted. REMANDED Service connection for sinusitis, including as due to a qualifying chronic disability to include undiagnosed illness, is remanded. Service connection for headaches, including as due to a qualifying chronic disability to include undiagnosed illness, is remanded. FINDING OF FACT The Veteran is currently diagnosed with osteoarthritis and patellofemoral pain syndrome in the right knee (right knee disorder); the Veteran had symptoms of a right knee disorder during active service; the current right knee disorder began during service. CONCLUSION OF LAW Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for right knee osteoarthritis with patellofemoral pain syndrome have been met. 38 U.S.C. §§ 1110, 1112, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran, who is the appellant, served on active duty from October 1989 to October 1995. Service Connection for a Right Knee Disorder Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in service disease or injury and the current disability. The Veteran has advanced that a currently diagnosed right knee disability is the result of a motor vehicle accident during active service. Initially, the Board finds that the Veteran has a current right knee disability. A June 2016 private examination report reflects diagnoses for osteoarthritis and patellofemoral pain syndrome in the right knee. After a review of all the evidence of record, both lay and medical, the Board finds that the evidence is at least in equipoise on the question of whether the Veteran had the onset of symptoms of a right knee disorder in service and since service separation (i.e., whether a right knee disorder was “incurred in” service). The evidence that weighs against an incurrence of a right knee disorder in service includes the claims file, which does not contain any post-service medical records, including those pertaining to treatment or diagnosis of a right knee disorder. Favorable evidence supporting a finding that the Veteran had symptoms of a right knee disorder in service and since service separation includes service treatment records reflecting persistent complaints of right knee pain following a motor vehicle accident in March 1995. See March 1995 service treatment record; April 1995 service treatment record; May 1995 service treatment record. Other favorable evidence includes an April 2014 VA examination report and a June 2016 private examination report that shows the Veteran endorsed right knee pain since being involved in a motor vehicle accident during active service. The Board will resolve reasonable doubt in favor of the Veteran in finding that the Veteran had a right knee disorder in service and since service separation. The foregoing evidence tends to show the onset of a right knee disorder during service following a motor vehicle accident, i.e., that a right knee disorder was “incurred” in service. See 38 C.F.R. § 3.303(d). There is no other competent medical evidence of record against the claim that directly addresses the etiology of the Veteran’s right knee disorder. For these reasons, and resolving reasonable doubt in the Veteran’s favor, the Board finds the criteria for direct service connection for a right knee disorder have been met. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Board recognizes that the chronic disease for arthritis presumptions would apply in this case, both 38 C.F.R. § 3.303(b) and 38 C.F.R. § 3.307; however, because the claim is being granted on the theory of direct service connection, all other theories of entitlement to service connection, including presumptive service connection, have been rendered moot, so will not be addressed. See 38 U.S.C. § 7104 (the Board only decides actual questions of law or fact in a case). REASONS FOR REMAND 1. Service Connection for Sinusitis is Remanded 2. Service Connection for Headaches is Remanded The Veteran generally asserts that sinusitis and a headache disorder are etiologically related to active service, to include service in Southwest Asia Theater of operations during the Persian Gulf War. Service treatment records reflect the Veteran was deployed to Saudi Arabia from September 1990 to April 1991, and was required to take pyridostigmine bromide tablets following possible exposure to nerve agents and exposure to smoke and contaminants from oil well fires. Service treatment records also show that the Veteran complained of frequent headaches and sinusitis since returning from Saudi Arabia, but that such symptoms were not severe enough to prompt him to seek medical treatment. See October 1993 service treatment record; October 1994 service treatment record. The evidence of record reflects the Veteran is currently diagnosed with chronic sinusitis, rhinitis, and sinus headaches. See April 2014 VA examination report; June 2016 private examination report. However, the record does not include any medical opinions as to whether the currently diagnosed chronic sinusitis, rhinitis, and/or sinus headaches are etiologically related to active service, to include possible exposure to nerve agents and exposure to smoke and contaminants from oil well fires. As such, the Board finds that remand is necessary in order to obtain VA medical opinions. The matters are REMANDED for the following action: 1. Request that a VA medical professional review the electronic file and provide the VA medical opinions requested below regarding the claimed sinusitis and headache disorder. The relevant documents in the electronic file should be made available to, and be reviewed by, the VA examiner. The VA examiner should note such review in the requested medical opinion. If the VA examiner determines that additional examination(s) of the Veteran is necessary to provide reliable opinions as to causation, such examination(s) should be scheduled; however, the Veteran should not be required to report for an examination as a matter of course, if it is not found to be necessary. The VA examiner should provide the following opinions: a. It is at least as likely as not (i.e., a 50 percent probability or greater) that the Veteran’s chronic sinusitis/rhinitis is etiologically related to exposure to nerve agents and exposure to smoke and contaminants from oil well fires? b. It is at least as likely as not (i.e., a 50 percent probability or greater) that the Veteran’s sinus headaches are etiologically related to active service, including to the exposure to nerve agents and exposure to smoke and contaminants from oil well fires? The term “at least as likely as not” does not mean merely within the realm of medical possibility, but rather that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of causation as it is to find against it. A rationale should be given for all opinions and conclusions rendered. The opinions should address the particulars of this Veteran’s medical history and the relevant medical science as applicable to this claim. J. PARKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Choi, Associate Counsel