Citation Nr: 21002937 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 13-11 639 DATE: January 19, 2021 ISSUE 1. Entitlement to service connection for a bilateral sensorineural hearing loss disability, to include as secondary to an upper respiratory disorder. 2. Entitlement to service connection for tinnitus, to include as secondary to an upper respiratory disorder. 3. Entitlement to service connection for an upper respiratory disorder, (other than vasomotor rhinitis) to include as secondary to a bilateral hearing loss disability and/or tinnitus. 4. Entitlement to service connection for a low back disability. 5. Entitlement to service connection for a right hip disability, to include as secondary to a low back disability. ORDER Entitlement to service connection for a low back disability is denied. Entitlement to service connection for a right hip disability, to include as secondary to a low back disability is denied. REMANDED Entitlement to service connection for a bilateral sensorineural hearing loss disability, to include as secondary to an upper respiratory disorder is remanded. Entitlement to service connection for tinnitus, to include as secondary to an upper respiratory disorder is remanded. Entitlement to service connection for an upper respiratory disorder (other than vasomotor rhinitis) to include as secondary to a bilateral sensorineural hearing loss disability and/ or tinnitus is remanded. FINDINGS OF FACT 1. The Veteran's low back disability is not etiologically related to service and did not manifest within one year of separation from active service. 2. A right hip disability was not manifest in service, is not caused or aggravated by a service-connected disease or injury and is not otherwise attributable to service. CONCLUSIONS OF LAW 1. The criteria for the establishment of service connection for a low back disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303, 3.310. 2. A right hip disability was not incurred in or aggravated by service, and is not proximately due to, the result of, or aggravated by service-connected disease or injury. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from July 1969 to March 1971, with service in the Republic of Vietnam from January 1970 to March 1971. The Veteran was awarded the Combat Infantry Badge and Bronze Star Medal with 1 Oak Leaf Cluster, among other decorations. This case comes before the Board of Veterans’ Appeals (the Board) from August 2010 and October 2010 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. In March 2017, the Veteran was afforded a hearing before the undersigned Veteran’s Law Judge. A transcript of that hearing is of record. This case was previously before the Board in October 2017. In that decision, the Board remanded the Veteran’s claims for further development, particularly for the purpose of obtaining outstanding VA treatment records from 1971 through 1972 and any outstanding medical treatment records pertinent to the Veteran’s claim, including chiropractic care received after a 1984 motor vehicle accident. The Veteran was also afforded VA examinations to determine the etiology of his claimed disabilities. The Board notes that March 2018 Correspondence from the VA indicated that VA treatment records from 1971 through 1972 records were not available. See March 12, 2018 Correspondence. Additionally, although, as directed, the AOJ requested that the Veteran provide, or provide appropriate authorization to obtain any outstanding, pertinent private (non-VA) records, including chiropractic care received after a 1984 motor vehicle accident, there is no identified evidence for which appropriate authorization to obtain has been provided, and neither the Veteran nor his representative has alleged any error or omission in the assistance provided. Id. Hence, the Veteran is not prejudiced by the Board proceeding to a decision on the claims on appeal, at this juncture. Regarding the Veteran’s claims of entitlement to service connection for an upper respiratory disorder, to include as secondary to a bilateral hearing loss and tinnitus disability, it is important to note that in an August 2019 rating decision, the Veteran was granted service connection for vasomotor rhinitis. See August 21, 2019 rating decision. Hence, the Veteran’s claim of entitlement to service connection for an upper respiratory disorder has been re-characterized as reflected on the title page. With respect to the Veteran’s claims of entitlement to service connection for a bilateral sensorineural hearing loss and/or tinnitus disability, to include as secondary to an upper respiratory disorder, and entitlement to service connection for an upper respiratory disorder (other than vasomotor rhinitis), for reasons that will be explained below, the Board finds that Addendum Medical Opinions are required. See Stegall v. West, 11 Vet. App. 268, 271 (1998). These claims will be addressed in the Remand section of this decision. This case has been advanced on the docket pursuant to 38 C.F.R. § 20.900 (c) (2018). The Board begins its discussion and analysis with the Veteran’s entitlement to service connection claim for a low back disability, followed by discussion and analysis of the Veteran’s service connection claim for a right hip disability, to include as secondary to a low back disability. Service Connection Applicable law provides that service connection will be granted if it is shown that the Veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also 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 may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2018). Service connection may also 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). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303 (a). Further, service connection may be warranted for disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310 (a). Secondary service connection requires (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). A disability deemed proximately due to or the result of a service-connected disease or injury shall be service connected ("secondary service connection"). 38 C.F.R. § 3.310 (a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310 (b). For certain chronic diseases, such as arthritis, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). When a chronic disease is not shown to have manifested to a compensable degree within one year after service, under 38 C.F.R. § 3.303(b) for the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support a claim for such diseases; however, such continuity of symptomatology may only support a claim for those chronic diseases listed under 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Board has reviewed the entire record, with an emphasis on the evidence relevant to this appeal. Although the Board must provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Hence, the Board will summarize the relevant evidence as appropriate and the analysis below will focus specifically on what the evidence shows, or fails to show, in the present claim. Entitlement to service connection for a low back disability. The Veteran contends that he is entitled to service connection for his low back disability. See April 26, 2010, VA Form 21-4138, Statement in Support of Claim; See also December 15, 2020 Appellate Brief, pg. 3. There is no dispute in this case that the Veteran has a current disability. See April 2018 VA examination, pg. 1 re: diagnosis of spinal fusion; June 25, 2008 treatment records regarding diagnosis of lumbar disc disease, probable spinal stenosis; See also August 2008 treatment records re: decompressive laminectomy and inferior facetectomy, L3 4 and S1, L3-4 and L4-5 bilateral lateral effusion L3 L4 L5 and S1. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). With regards to an inservice injury: The Veteran’s service treatment records are silent for a low back condition, and at separation the Veteran denied any history of back problems. See July 1969 Report of Medical Examination; March 1971 Report of Medical Examination; see also, March 1971, Report of Medical History. The Veteran contend that his current back disability stems from an injury he sustained during service while performing what the Veteran has described as a 150-yard man carry. The Veteran testified at his March 2017 Board hearing that he experienced pain after this drill, but he did not report it at the time. See March 2017 Board Hearing transcript, pgs. 14-15. As such, the Board finds that the second prong of service connection has arguably been met. With regards to a “nexus” to service, post service treatment records report that the Veteran was evaluated in April 1972 to rule out a lumbar disc syndrome. On examination, anterior-posterior and lateral views demonstrated a normal appearance of the vertebrae and disc spaces. The alignment was reported as normal and the paraspinous soft tissues, normal. See April 4, 1972 treatment record. In June 1972, post service treatment records show that the Veteran was evaluated for a back condition. During this evaluation, the Veteran reported that in September 1969 while taking his final physical training test, during the 150-yard man carry, he fell with another person on the ground and hurt his back. The Veteran reported that the symptoms have not been severe since his last his report to a VA Hospital. See June 12, 1972, Report of Medial Examination for Disability Evaluation and June 27, 1972 treatment records. September 2004 post service treatment records report that the has been experiencing back pain for twenty years. On history, it was reported that the Veteran’s back pain started in a motor vehicle accident some time in 1984. On history, it was reported that the Veteran had seen a chiropractor for years and actually had some nice resolution. See September 18, 2004 treatment record. April 2007 and November 2007 treatment records show that the Veteran was treated for back pain and lumbar radiculopathy. See April 7, 2007 and November 12, 2007 treatment records. June 2008 treatment records show diagnosis of lumbar disc disease, probable spinal canal stenosis. See June 25, 2008 treatment records. August 2008 treatment records report the Veteran had a decompressive laminectomy and inferior facetectomy, L3 4 and S1, L3-4 and L4-5 bilateral lateral effusion L3 L4 L5 and S1. See August 25, 2008 treatment records (Lake Hospital System, Operative Report). Pursuant to the Board’s October 2017 Remand directives, the Veteran was afforded a VA Back conditions examination to determine the nature and etiology of his low back disability. As referenced above in this decision, the Veteran was diagnosed with a thoracolumbar spine condition, e.g., spinal fusion (status post decompressive laminectomy L3-Si with fixation and bilateral/lateral fusion). See April 2018 VA Back Conditions examination, pg. 1; see also, August 25, 2008, treatment records (Lake Hospital Operative report). The examiner noted the Veteran’s medical history as follows: “During basic training at Fort Campbell, Ky and during final test of physical fitness, he did a 150 yard man carry and he fell forward and picked up the other trainee and he felt a warmth to his back and he got nauseated. He did not seek medical attention for this. He changed duty stations three days and he did not seek medical attention even went he went to the new station in New Orleans. On June 27, 1972, he was evaluated at the Cleveland VA and noted his purported history of injury while in basic training and noted normal ROM, normal gait, normal reflexes, no leg atrophy, negative straight leg raise and noted "back condition - not found". He sought medical attention at the Wade Park VA for his lumbar spine in 1972. He was given exercises. He did not return for treatment. He reports that he has had right hip pain since about 1972. He tried to stay active and strong and he played basketball. There is documentation of a car accident in 1984 and after which he has several years of chiropractic therapy for low back pain. He reports that it "all fell apart when he turned 60". His gait changed. In 2001, he had an operation on his left great toe - Euclid Hospital Mr. Z.V. provided care. The Veteran was provided injection to his right shoulder on October 31, 2007, a lumbar MRI showed the impression of: disc space narrowing at the L3-4 and L5 SI levels with degenerative changes and degeneration of the lumbar discs at L2-3 to L5 S1 3 Mild disc bulge of the L2-3 disc with mild canal narrowing. Mild approximately 3 mm disc bulge/protrusion of the L3-4 disc with moderate to marked spinal stenosis and mild foraminal narrowing on the left with possible impingement on the left L3 nerve root in the foramen. Mild facet arthrosis at the L4 5 level with a mild 3 mm central disc protrusion with mild canal narrowing. There is mild foraminal narrowing bilaterally without nerve root impingement in the foramina Mild retrolisthesis of L5 on SI with a mild 2 mm broad based disc bulge and mild canal narrowing. There is mild foraminal narrowing on the right with probable impingement on the right L5 nerve root in the foramen, which should be correlated clinically. There is mild facet arthrosis at this level. Dr. K. provided epidural steroid injections. On August 25, 2008, Dr. I. performed decompressive laminectomy and inferior facetectomy L3 4 and 5, fixation L3 L4 L5 and Si using screws and rods navigational system discectomy L3-4 and L4-5 bilateral lateral effusion L3 L4 L5 and Si. On October 27, 2009, Dr. M. noted that he had a long history of pain to his right hip. He noted a weight of 270 lbs. and height of 6'1". X-rays showed evidence of severe degenerative arthritis. He recommended arthroplasty. On March 31, 2010, Dr. F.M. performed right total hip arthroplasty. This helped his right hip pain. Dr. D.P. prescribes opiate analgesics. medications: Percocet every 6 hours, Vicodin every 6 hours. He has no strength. He cannot stand on his toes. He walks with a cane. His has a girlfriend that does his shopping and cleaning for him. He does not take the garbage out. He does not cut the grass. He was putting in a linoleum floor for a church member in about 2004 and he was unable to finish the job.” See April VA 2018 Back Conditions examination, (Medical History), pgs. 2-3. After reviewing all available medical records, taking into consideration, the Veteran’s medical history and reported injury in service, the April 2018 VA examiner rendered a negative nexus opinion to service. The examiner opined that it is less likely than not that a low back disability was incurred in during service. See April VA 2018 Back Conditions examination, (Medical History), pg.10. The examiner reasoned that “there is no documentation of a back injury in proximity to the purported occurrence during basic training. A separation examination in 3-1971 noted no back problems and normal back examination. An examination at the VA in 6-1972 revealed "back condition - not found". It is pathophysiologically implausible that an isolated back injury in 1969 would result in age-related multilevel lumbar degenerative disc disease four decades later. The weight of the evidence is such that it is less likely than not that low back was incurred in during service. Id. at 10. Analysis In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). The Board finds the April 2018 VA examiner's opinion highly probative because it first takes into consideration the Veteran’s medical history (including review of his June 12 and June 27, 1972 post service treatment records). Additionally, the examiner considers the Veteran’s lay assertions with regards to his in-service injury. Moreover, the VA examiners’ review of the available evidence of record is followed by a reasoned explanation for the conclusion reached. A medical opinion is most probative if it is factually accurate, fully articulated, and based on sound reasoning. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The examiner opined against a “nexus” between the Veteran's low back disability and service. It is clear that the Veteran believes that a nexus exists between his in-service injury and his current low back disability. Such a lay belief sometimes is sufficient. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). It indeed is error to suggest that lay evidence can never be enough to establish that there is a nexus between a claimed condition and service. See Colantonio v. Shinseki, 606 F.3d 1378 (Fed. Cir. 2010); Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010). However, the causal relationship between the Veteran’s current low back disability and active duty service is a complex medical issue for which the Veteran is not qualified to offer an opinion. The Veteran has not been shown to have the necessary training or expertise to competently provide a medical nexus opinion as to the etiology of his low back disability. The Board reiterates that after reviewing all available medical records, the April 2018 VA examiner opined that it is pathophysiologically implausible that an isolated back injury in 1969 would result in age-related multilevel lumbar degenerative disc disease four decades later. Thus, while the Board has considered the Veteran's lay statements about his in-service injury, it finds the April 2018 VA examination opinion as to the etiology of this Veteran’s low back disability to outweigh them. More to this point: The Board has considered the Veteran’s March 2017 Board Hearing testimony regarding not making any complaints about any low back condition during his separation examination. The Veteran testified that he did not make any complaints at separation because he was in a hurry to get back home from the Republic of Vietnam. See March 2017 Board Hearing transcript, pgs. 7-8 & 14-15. The Board observes, however that the Veteran did report other conditions on his March 1971 Separation Examination, e.g., hay fever, shortness of breath. See March 1971 Report of Medical Examination; see also, March 1971, Report of Medical History. With regards to the Veteran’s June 1972 post service treatment records regarding a low back condition, it was reported that no back condition was found. See June 12, 1972, Report of Medial Examination for Disability Evaluation and June 27, 1972 treatment records. The Board further finds that presumptive service connection is not warranted because the evidence does not show that he has a diagnosis of arthritis becoming manifest to a degree of 10 percent of more within one year from the date of separation. In this case, the Veteran was not diagnosed with degenerative disc disease for many years post service. The Board observes that although the Veteran has complained of continuous chronic back pain, he denied any back pain at separation and medical evidence does not corroborate back pain beginning until 1984, 13 years after service. See September 18, 2004 treatment record; See also April 2018 VA Back Conditions examination, pg. 2. Hence, the Board finds that the Veteran's low back disability is not etiologically related to service and did not manifest within one year of separation from active service. There is no contrary medical opinion of record with regards to the etiology of this Veteran’s low back disability. For the reasons stated above, the Board finds that the preponderance of the evidence is against the Veteran's low back disability service connection claim; therefore, the benefit of the doubt provision does not apply. Entitlement to service connection for a right hip disability, to include as secondary to a back disability. The Veteran seeks service connection for a right hip disability, to include as secondary his back disability. See December 15, 2020 Appellate Brief, pg. 3. The Veteran specifically alleges that his right hip disability has been caused by his low back disability. The evidence of record shows that the Veteran has a diagnosis of degenerative joint disease of the right hip. See March 2010, treatment record (Erieside Medical Group, Inc.). To the extent that the Veteran has alleged that his right hip disability is directly related to service, the Board finds that there is no evidence linking this condition to his military service. Service treatment records are negative for any documentation of complaint, relevant findings, treatment for, or diagnosis of a right hip disability. See July 1969 Entrance Examination; March 1971 Separation Examination; see also, March 1971 Report of Medical History. A review of the Veteran's VA and private medical treatment records indicates that on March 31, 2010, Dr. F.M. performed right total hip arthroplasty. See April 2010 treatment record (Lake Health Discharge Summary); See also, March 2017 Board Hearing transcript, pg. 16. The probative medical evidence of record does not contain a VA or private medical opinion indicating that the Veteran's right hip disability was incurred during or caused by his period of active service. The Board further finds that presumptive service connection is not warranted because the evidence does not show that he has a diagnosis of degenerative arthritis becoming manifest to a degree of 10 percent of more within one year from the date of separation. The Veteran was not diagnosed with degenerative disc disease for many years post service. Here, the Board finds that the record is negative for any link between the Veteran's right hip condition and his time in service. Therefore, the claim must be denied on a direct basis. Accordingly, entitlement to service connection on a direct basis is not warranted. See 38 C.F.R. § 3.303. The Board notes that the Veteran specifically raised a theory of entitlement to service connection for a right hip disability, as secondary to his low back disability. See April 27, 2010, VA 21-4138, Statement in Support of Claim; See also December 15, 2020 Appellate Brief, pg. 3. However, as discussed above in this decision, the Veteran is not currently service connected for a low back disability, which could be the basis for a finding of secondary service connection. Hence, that Board finds that the Veteran’s right hip disability was not manifest in service, is not caused or aggravated by a service-connected disease or injury and is not otherwise attributable to service. Therefore, the Veteran’s claim of entitlement to service connection for a right hip disability, to include as secondary to a low back disability must be denied. REASONS FOR REMAND Entitlement to service connection for a bilateral sensorineural hearing loss disability and tinnitus, to include as secondary to upper respiratory The Veteran contends that he is entitled to service connection for a bilateral hearing loss disability and tinnitus due to his in-service noise exposure as a mortarman, to include as secondary to an upper respiratory condition. See March 2017 Board Hearing transcript, pgs. 11-12; See also DD-214. The Veteran was afforded a VA examination in April 2018 to determine the nature and etiology of his bilateral hearing loss and tinnitus disability. The examiner opined that it was less likely as not that the Veteran's bilateral sensorineural hearing loss and tinnitus disability was related to service. See April 2018 Hearing Loss and Tinnitus examination. Pursuant to the Board’s October 2017 remand, the examiner was also to address whether the Veteran’s upper respiratory disorders caused or aggravated the Veteran’s bilateral sensorineural hearing loss. The April 2018 examiner reported that respiratory disorders and whether they are related or aggravated by hearing loss or tinnitus are not within the scope of an audiologists’ practice. See April 2018 Hearing Loss and Tinnitus examination, pgs. 4-5. The Board notes that these remand directives were also not addressed in the Sinusitis, Rhinitis and Other Conditions of the Nose, Throat Larynx and Pharynx examinations. See April 2018 and March 2019 Sinusitis, Rhinitis and Other Conditions of the Nose, Throat Larynx and Pharynx examinations. Thus, it is not clear whether the Veteran’s bilateral sensorineural hearing loss and tinnitus disabilities were caused or aggravated by the Veteran’s upper respiratory disorders. The Board observes that this is one of the Veteran’s contention. See also December 15, 2020 Appellate Brief re: upper respiratory condition causing bilateral hearing loss. The Board is obligated to ensure that the questions are addressed before adjudication of the Veteran's appeal may proceed. See Stegall v. West, supra. Therefore, a remand is necessary to obtain an addendum medical opinion to address these questions. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (the Board is prohibited from exercising its own independent judgment to resolve medical questions). Entitlement to service connection for an upper respiratory disorder (other than vasomotor rhinitis) to include as secondary to a bilateral sensorineural hearing loss disability and/or tinnitus. As referenced above in the introduction of this decision, the Veteran is now service connected for vasomotor rhinitis. See August 2019 Rating decision. A March 2019 VA examiner concluded however that there was no objective evidence that the Veteran had chronic sinusitis. See March 6, 2019 Sinusitis, Rhinitis and Other Conditions of the Nose, Throat Larynx and Pharynx examinations, pg. 5. Treatment records in February 2010 and June of 2010 report that the Veteran has a diagnosis of chronic sinusitis. The Veteran has been treated with fluticasone, as recommended by the VA. See February 10, 2010 and June 9, 2010 VA treatment records. August 2014 treatment records show that the Veteran was instructed to continue Nasonex nasal spray for sinusitis and ipratropium. This treatment record also reports that the Veteran continues to undergo immunotherapy. See August 13, 2014 treatment record. Thus, it is not clear to the Board whether the Veteran has had at any time proximate to or during the course of this appeal, sinusitis. A compensable rating for sinusitis for VA compensation purposes requires one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. The Veteran and his representative contend that his chronic sinusitis is getting worse. See December 15, 2020 Appellate Brief, pg. 2. Because of the multiple treatment records indicating a diagnosis of chronic sinusitis, the Board finds that a clarifying addendum opinion is required prior to adjudications of this Veteran’s claim as it pertains to an upper respiratory disorder (other than vasomotor rhinitis). See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (the Board is prohibited from exercising its own independent judgment to resolve medical questions). Accordingly, these matters are REMANDED for the following action: 1. Take appropriate action to obtain VA treatment records not already of record relating to the Veteran’s claimed disabilities. 2. With appropriate authorization from the Veteran, obtain and associate with the record any outstanding private treatment records identified by him as pertinent to his claims. 3. Thereafter, forward the Veteran’s claim’s file, including a copy of this remand, to a physician with the appropriate expertise necessary to render an addendum opinion medical opinion regarding the etiology of the Veteran’s bilateral sensorineural hearing loss and tinnitus. The record to include a copy of this Remand must be made available to the examiner. The examiner should review the entire claims file, including a copy of this remand, and respond to the following: Whether it is at least as likely as not (50 percent or greater probability) that any current bilateral hearing loss disability was caused by the Veteran’s upper respiratory disorders. Whether it is at least as likely as not (50 percent or greater probability) that any current bilateral hearing loss disability was aggravated by the Veteran’s upper respiratory disorder. Whether it is at least as likely as not (50 percent or greater probability) that tinnitus was caused by the Veteran’s upper respiratory disorders. Whether it is at least as likely as not (50 percent or greater probability) that any diagnosed tinnitus was aggravated by the Veteran’s upper respiratory disorders. The examiner is informed that the Veteran is currently service connected for vasomotor rhinitis. Note: The examiner is invited to review the Veteran’s December 15, 2020 Appellate Brief, pg. 2 re: upper respiratory conditions and impact on bilateral hearing and tinnitus. Please note review of this December 15, 2020 Appellate Brief. A full and complete rationale for any opinion expressed is required. If the examiner feels that the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). Jones v. Shinseki, 23 Vet. App. 382 (2010). 4. Next, forward the Veteran’s claim’s file, including a copy of this remand, to a physician with the appropriate expertise necessary to render an addendum medical opinion to determine whether the Veteran has any current or previously diagnosed sinus disorder other than vasomotor rhinitis (including chronic sinusitis). The examiner should review the entire claims file, to include this remand, and respond to the following: Whether it is as least as likely as not that any current or previously diagnosed sinus disorder other than vasomotor rhinitis (including chronic sinusitis) manifested during active duty service or is otherwise related to an event, injury or disease incurred during active duty service? For purposes of this examination, the examiner is requested to review and address conflicting information regarding the Veteran’s sinus disorder diagnosis. If appropriate, the examiner is requested to reconcile any conflicting medical evidence of record. For example, the examiner’s attention is directed to VA treatment records dated June 9, 2010, February 10, 2010 and August 13, 2014. The examiner should provide a complete rationale for any opinions offered. If the examiner is unable to provide any requested opinion without resort to speculation, he or she should explain why this is so. 5. Review the examination reports for compliance with the Board’s directives. Any corrective action should be undertaken prior to recertification to the Board. Thereafter, readjudicate the issues on appeal. 6. If any determination remains unfavorable to the Veteran, he and his representative should be furnished a supplemental statement of the case which addresses all evidence associated with the claims file since the last statement of the case. The Veteran should be afforded the applicable time period in which to respond. Michael A. Pappas Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Little, 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.