Citation Nr: 18109448 Decision Date: 06/08/18 Archive Date: 06/08/18 DOCKET NO. 15-11 013 DATE: June 8, 2018 REMANDED Entitlement to service connection for a thoracic spine disability, to include as secondary to service-connected lumbar spine degenerative joint disease and degenerative disc disease with disc narrowing from L2-3 to L4-5 is remanded. Entitlement to service connection for allergic rhinitis (claimed as chronic sinusitis), to include as due to herbicide exposure is remanded. REASONS FOR REMAND The Veteran had active military service from October 1966 to October 1968, including service in the Republic of Vietnam. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a December 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. 1. Entitlement to service connection for a thoracic spine disability, to include as secondary to service-connected lumbar spine degenerative joint disease and degenerative disc disease with disc narrowing from L2-3 to L4-5. The Veteran has contended that his thoracic spine disability is secondarily-related to his service-connected lumbar spine degenerative joint disease (DJD) and degenerative disc disease (DDD). Specifically, the Veteran believes that his lower lumbar spine arthritis has “mov[ed] up” into the thoracic spine region. A review of post-service treatment records show that the Veteran complained of mid-back pain in August 2002 and was later diagnosed with severe arthritis of the thoracic spine in August 2004. In August 2011, the Veteran was afforded a VA examination. The examiner opined that the Veteran had thoracic DDD changes which was less likely as not related to his service-connected DDD. Additionally, the examiner opined that the Veteran’s thoracic spine disability was not at least as likely as not aggravated beyond its natural progression by his service-connected lumbar spine DJD and DDD. He determined that the Veteran’s thoracic DDD was more likely related to and consistent with age-related changes. The Board finds that the August 2011 VA examiner did not adequately explain why the Veteran’s thoracic spine disability was more likely related to and consistent with aging in view of the Veteran’s documented medical history, including thoracic spine arthritis. For these reasons, the August 2011 examination is inadequate, and remand is necessary to determine the nature and etiology of the Veteran’s thoracic spine disability. 2. Entitlement to service connection for allergic rhinitis (claimed as chronic sinusitis), to include as due to herbicide exposure. The Veteran has asserted that symptoms for allergic rhinitis (claimed as chronic sinusitis) began in service and have continued since that time. A review of post-service treatment records documented a history of seasonal allergies, vasomotor symptoms, sinusitis, and allergic rhinitis. Additionally, the Veteran has raised the issue of in-service exposure to herbicide. The Veteran served in Vietnam from October 1967 to October 1968 and his exposure to herbicides is presumed. Although allergic rhinitis or chronic sinusitis are not listed as diseases associated with herbicide exposure under 38 C.F.R. § 3.309(e), the regulations governing presumptive service connection for herbicide exposure do not preclude the Veteran from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039 (1994). Accordingly, the Board finds that remand is warranted to determine the nature and etiology of the Veteran’s allergic rhinitis or chronic sinusitis, to include as due to herbicide agent exposure. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Then, schedule the Veteran for a VA examination to determine the nature and etiology of any currently present thoracic spine disability. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present thoracic spine disability is etiologically related to the Veteran’s active service. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present thoracic spine disability was caused or chronically worsened by the Veteran’s service-connected lumbar spine disability. The examiner must specifically comment on the Veteran’s mid-back pain in 2002 and diagnosis for severe thoracic arthritis in 2004. The rationale for all opinions expressed must be provided. 3. Then, schedule the Veteran for a VA examination to determine the nature and etiology of any currently present allergic rhinitis or chronic sinusitis. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present allergic rhinitis or chronic sinusitis is etiologically related to the Veteran’s active service, to include as due to herbicide agent exposure. The examiner should consider all lay statements of record and presume that the Veteran is a reliable historian with regard to his report of onset and continuity of his sinus symptoms. The rationale for all opinions expressed must be provided. 4. Confirm that the VA examination reports and all medical opinions provided comport with this remand and undertake any other development determined to be warranted. 5. Then, readjudicate the appeal. If the decision remains adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Ware, Associate Counsel