Citation Nr: 21002382 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 16-33 377 DATE: January 13, 2021 REMANDED Entitlement to service connection for a nasal disorder is remanded. Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to a nasal disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from November 1981 to March 1985. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The case was remanded for further development in August 2019. It has since been returned to the Board for review. Upon review, the Board finds that further development is needed prior to adjudication of the claims. 1. Entitlement to service connection for a nasal disorder is remanded. Service treatment records from August 1984 show that the Veteran was seen for a possible broken nose. A January 1985 separation examination noted a positive history for an old fracture of the nose which healed without complication. The Veteran’s December 2014 private treatment records show a diagnosis of a nasal septum that is minimally deviated to the right that is likely chronic. No fracture was identified. A January 2016 VA treatment record notes septal deviation. However, other VA treatment records show no septal deviation. See e.g. May 2015 and September 2017 VA treatment records. The Veteran was afforded VA examinations in December 2014 and December 2019 in connection with his claim. An addendum medical opinion was obtained in October 2020. The December 2014 VA examiner documented that the Veteran was diagnosed with a nose fracture in service in 1983 that was reduced manually in 1985. He, however, opined that the Veteran did not have a current diagnosis of sinusitis, rhinitis, a larynx or pharynx disorder, a deviated septum, a tumor or neoplasm, or any other nasal disorder. The December 2019 VA examiner diagnosed the Veteran with a deviated septum and chronic sinusitis. Additionally, the December 2019 VA examiner diagnosed the Veteran with a minor abnormality and noted that 2019 x-rays showed that the Veteran had gentle levoconvex curvature of the nasal septum. Further, the December 2019 VA examiner indicated that the “degree of deviation is commonly constitutional.” An October 2020 addendum medical opinion noted no diagnosis of a deviated septum causing deformity and found a gentle levoconvex curvature of the nasal septum to a degree that is “commonly constitutional.” However, the VA examiners did not opine as to whether the Veteran’s minor abnormality, gentle levoconvex curvature of the nasal septum, or chronic sinusitis were related to his military service. Therefore, an additional VA medical opinion is needed to determine the nature and etiology of any nasal disorder that may be present now or was present at any time during the pendency of the appeal. 2. Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to a nasal disorder, is remanded. The Veteran has been diagnosed with OSA. He has contended that his OSA is caused by a nasal disorder. During service, the Veteran was seen for an inability to stay awake in September 1983 and October 1983. He was diagnosed with narcolepsy, although no evidence of narcolepsy was found during a period of hospitalization. A December 2019 VA examiner opined that the Veteran’s current OSA is less likely related to his military service as the sleep disorder symptoms described in service are not related to OSA. The VA examiner also opined that his OSA is less likely related to residuals of a nose fracture. However, the VA examiner did not discuss whether his OSA was aggravated beyond its natural progression by residuals of a nose fracture, nor did he provide a rationale for this portion of the opinion. An October 2020 VA examiner opined that the Veteran’s OSA is not related to his military service, but did not provide an opinion as to whether the Veteran’s OSA is caused or aggravated by any diagnosed nasal disorder. Therefore, an additional VA medical opinion is needed. The matters are REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for a nasal disorder or sleep apnea. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also obtain any outstanding VA medical records. 2. After completing the foregoing development, the AOJ should refer the Veteran’s claims file to the October 2020 VA examiner or to another suitably qualified VA examiner for a clarifying opinion as to the nature and etiology of any nasal disorder. An examination of the Veteran should be performed if deemed necessary by the individual providing the opinion. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s statements, service records, and post-service medical records. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. 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 nasal disorders and any previously diagnosed nasal disorders. Specifically, the examiner should address a December 2014 private treatment record and a September 2016 VA treatment record that document a deviated septum. The examiner should also address the December 2019 VA examination report that shows a diagnosis of chronic sinusitis, a minor abnormality, and a gentle levoconvex curvature of the nasal septum. For each nasal disorder identified, the examiner should state whether it is at least as likely as not that that it manifested in or is otherwise related to the Veteran’s military service, including any symptomatology therein. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. After completing the foregoing development, the AOJ should refer the Veteran’s claims file to the October 2020 VA examiner or to another suitably qualified VA examiner for a clarifying opinion as to the nature and etiology of his OSA. An examination of the Veteran should be performed if deemed necessary by the individual providing the opinion. 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 should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should opine as to whether it is at least as likely as not that the Veteran’s OSA is causally or etiologically related to his military service, to include any symptomatology therein. The examiner should also opine whether it is as least as likely as not that the Veteran’s OSA is either caused or aggravated by any nasal disorder. A clear rationale for all opinions would be helpful, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 4. After completing the above actions, the AOJ should conduct any other development as may be indicated. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. J. Williams, Associate Counsel 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.