Citation Nr: 18147412 Decision Date: 11/05/18 Archive Date: 11/05/18 DOCKET NO. 16-34 168 DATE: November 5, 2018 REMANDED Entitlement to service connection for sinusitis is remanded. Entitlement to service connection for a skin disorder of the bilateral feet, to include onychomycosis, is remanded. REASONS FOR REMAND The Veteran had active service in the United States Navy from November 1976 to March 1981, and February 1983 to May 1985. This matter comes to the Board of Veterans’ appeals (Board) on appeal from a September 2014 rating decision. 1. Entitlement to service connection for sinusitis and entitlement to service connection for a skin disorder of the bilateral feet, to include onychomycosis, are remanded. The record reflects that the AOJ initially attempted to provide the Veteran with VA examinations and medical opinions related to his service connection claims for sinusitis and a skin disorder of the bilateral feet in July 2014. The Veteran failed to report for these examinations. However, prior to the June 2014 request for the examinations, the Veteran notified VA that his address had changed. See June 2014 Statement. As the examination request indicates that the Veteran had been notified of the July 2014 VA examination at his previous address, the AOJ rescheduled the examinations in September 2014. The Veteran also failed to report for these examinations. However, the Veteran later explained that he had been out of town due to a family emergency at the time of these examinations. See October 2014 Notice of Disagreement. As the Board finds that the Veteran has provided good cause to reschedule the examinations, a remand is necessary. 38 C.F.R. § 3.655(a). The Board also notes that in the February 1983 enlistment examination for the Veteran’s second period of active service from February 1983 to May 1985, the clinical evaluation noted that the Veteran’s toenails were infected. An associated February 1983 dermatology consultation report stated in the impression that the Veteran had onychomycosis. The presumption of soundness therefore does not apply to the Veteran’s second period of active service for his claimed onychomycosis. See 38 U.S.C. §§ 1111, 1153; 38 C.F.R. § 3.306. However, when there is an increase in a preexisting disability during service, it is presumed to have been aggravated by service, unless there is a specific finding that the increase was due to the natural progress of the disease, with clear and unmistakable evidence required to rebut this presumption of aggravation. 38 U.S.C. § 1153; 38 C.F.R. § 3.306. As such, the opinion on remand should address whether any current onychomycosis increased in severity during the Veteran’s second period of active service, and if so, whether there is clear and unmistakable evidence that the onychomycosis was not aggravated beyond the normal progression of the disorder The Veteran has also asserted that he never received a copy of the Veterans Claims Assistance Act (VCAA) letter that was mailed to him in May 2014. See October 2014 Notice of Disagreement. As such, the AOJ should send him another copy upon remand. The matters are REMANDED for the following action: 1. The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for his sinusitis and skin disorder of the bilateral feet, to include onychomycosis. The AOJ should also secure any outstanding, relevant VA medical records, to include records from the Hampton VA Medical Center dated since September 2016. 2. The AOJ should send the Veteran another copy of the VCAA letter that was mailed to him on May 7, 2014. 3. After completing the preceding development in paragraphs 1 and 2, schedule the Veteran for a VA examination to determine the nature and etiology of his sinusitis. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. 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. A clear explanation for all opinions based on specific facts of the case as well as relevant medical principles is needed. The Veteran is competent to attest to observable symptoms. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should state whether the Veteran has a current diagnosis for sinusitis. The examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the sinusitis manifested during or is otherwise related to the Veteran’s active service. 4. After completing the preceding development in paragraphs 1 and 2, schedule the Veteran for a VA examination to determine the nature and etiology of his skin disorder of the bilateral feet, to include onychomycosis. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. 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. A clear explanation for all opinions based on specific facts of the case as well as relevant medical principles is needed. The Veteran is competent to attest to observable symptoms. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should identify all current skin disorders of the bilateral feet, to include onychomycosis. The examiner should provide an opinion as to the following questions: (a) For each identified disorder other than onychomycosis, is it at least as likely as not (a 50 percent or greater probability) that the disorder manifested during or is otherwise related to, the Veteran’s periods of active service? (b) If onychomycosis is identified, is it at least as likely as not (a 50 percent or greater probability), that the onychomycosis manifested during, or is otherwise related to, the Veteran’s first period of active service from November 1976 to March 1981? (c) If onychomycosis is identified, the examiner should indicate whether the Veteran's onychomycosis worsened or increased in severity during his second period of active service from February 1983 to May 1985. (d) If the answer to question (c) is yes, is there is clear and unmistakable evidence that the onychomycosis was NOT aggravated beyond the normal progression of the disorder during the Veteran's second period of active service from February 1983 to May 1985? GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K.C. Spragins, Associate Counsel