Citation Nr: 18145351 Decision Date: 10/26/18 Archive Date: 10/26/18 DOCKET NO. 16-00 781 DATE: October 26, 2018 REMANDED Entitlement to service connection for chronic sinusitis, is remanded. Entitlement to service connection for chronic bronchitis, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1991 to March 1996. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for chronic sinusitis and chronic bronchitis are remanded. The Veteran claims he is entitled to service connection for chronic sinusitis and chronic bronchitis. The Veteran filed his claim for these conditions in September 2012. In a February 2013 VA Form 21-4138, Statement in Support of Claim, the Veteran argued that he had recently been seen at the Dorn VA Medical Center where a consulting surgeon, after performing a physical examination, mentioned that she could tell he had experienced long-term sinus problems. He also noted that his sinuses wake him up nightly due to sinus drainage or congestion and that in the mornings he has yellow/brown discharge from his throat and nasal passage, along with crusty eyes. He reported that during the days his nasal passages stay partially blocked and that some days the sinus pressure extends from just behind his eyes to his ears also. As related to the claim for chronic bronchitis, the Veteran reported that he devolves into coughing fits when he is around “excessively strong perfumes, chemicals, and cigarette smoke”, and that he has a constant wheeze when he exhales. Finally, he reported that his sinus and bronchitis conditions have been constant and persistent since leaving active duty. The Veteran was provided VA examinations in May 2013 for both claimed conditions. The VA examiner provided that the Veteran had both chronic sinusitis and chronic bronchitis with an onset date of 1991 in both cases. The VA examiner opined that the Veteran’s claimed conditions were less likely than not related to the treatment received in service. The Veteran was provided another set of VA examinations in October 2015. The VA examiner at those examinations declined to provide a diagnosis for either chronic sinusitis or chronic bronchitis and opined that the Veteran’s claimed conditions were less likely than not related to service as he had no current diagnosis. The October 2015 VA examiner also noted that there was no “new evidence to support the claim from the prior exam and opinion on May 2013.” When VA undertakes to provide a VA examination or to obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that both the May 2013 and October 2015 VA examinations are inadequate. First, the May 2013 VA examiner noted that the Veteran had current conditions and treatment in service. However, the examiner did not provide a rationale for the conclusion that the conditions and treatments noted in service were less likely than not related to the Veteran’s current sinus and respiratory conditions. Second, the October 2015 VA examiner did not find that the Veteran had current diagnoses of chronic sinusitis or chronic bronchitis as the May 2013 VA examiner did, which in and of itself does not make the opinions inadequate; however, the October 2015 VA examiner did not address and discuss how she came to a different conclusion than the May 2013 VA examiner regarding diagnosis. In addition, the October 2015 VA examiner, in developing her negative nexus opinions, did not provide a clear rationale for the conclusions reached. As such, the Board finds the October 2015 VA examination and nexus opinions are also inadequate for rating purposes. In his December 2015 VA Form 9, Substantive Appeal, the Veteran argued that the VA examiners did not consider his allegations that his conditions were related to the environmental conditions he was exposed to in service, such as dry air in Arizona, industrial pollution in Korea, diesel fumes in Germany, and second-hand smoke throughout his service. As the Veteran has alleged exposures in several different locations, his personnel records should be obtained and associated with the claims file to determine the locations of his service. The Board finds that since the Veteran is in receipt of both private and VA treatment for his claimed conditions, on remand, and with any necessary assistance from the Veteran, applicable updated treatment records should be obtained. The matters are REMANDED for the following actions: 1. Obtain the Veteran’s complete service personnel records. 2. With any needed assistance from the Veteran, including securing from him an updated VA Form 21-4142, obtain any applicable records from any identified private treatment providers. Obtain the Veteran’s VA treatment records from October 2015 to the present. 3. After completion of 1 and 2 above, schedule the Veteran for a VA examination or examinations by the appropriate clinician(s) to determine the nature and etiology of claimed chronic sinusitis and chronic bronchitis. The VA examiner(s) must: (a) Identify any current sinusitis, rhinitis, or other nose, throat, larynx and pharynx condition(s) and any respiratory conditions, including bronchitis, shown during the pendency of the claim (since September 2012). (b) Opine as to whether it is at least as likely as not that any diagnosed condition(s) is related to in-service complaints and treatment, including as due to exposure to various environmental elements during the Veteran’s service. In providing the above opinion, the examiner(s) should consider and discuss the Veteran’s statements regarding continuity of symptomatology since service and his in-service environmental exposures as described in his December 2015 VA Form 9. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular clinician. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD LM Stallings, Associate Counsel