Citation Nr: 21003726 Decision Date: 01/22/21 Archive Date: 01/22/21 DOCKET NO. 16-31 795 DATE: January 22, 2021 REMANDED Entitlement to service connection for nasal disorders, to include residuals of a fractured nose, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from March 1980 to December 1987. The claim was previously remanded for further development in April 2019. Unfortunately, an additional remand is needed. The previous Board remand expanded the claim to include any diagnosed nose disorder. An opinion was requested as to whether any diagnosed nose disorder was related to the Veteran’s trauma to his nose during an altercation in active service. In an October 2019 opinion, it was reported that the Veteran’s claimed condition was not related to service. The rationale reported that the Veteran’s EMR (entire medical record) had been reviewed without diagnosis or treatment of allergic rhinitis. While military service does expose “SMs” (service members) to new environments and allergens, it does not cause the allergic reactions found in the “SM’s” as this is mediated by their individual immune system and hypersensitivity. Additionally, the Veteran is not being actively treated for allergic rhinitis. Thus, given these facts, a medical nexus is not able to be established and his allergic rhinitis is less likely than not incurred or caused by an inservice injury, event, or illness. In November 2019, a VA opinion reported, that the Veteran’s nasal condition is related to rhinitis with nasal condition and it was confirmed by physical examination and review of the medical records confirm a diagnosis of allergic rhinitis March 2001. Later, also in November 2019, a VA examiner opined that the Veteran’s nasal injury was not aggravated beyond its natural progression. The examiner opined that the Veteran did not appear to have had a nasal injury in service since medical records were insufficient to establish a claim, and there was no imaging of the injury. He reasoned based on the earliest medical record in March 2001, the Veteran had been diagnosed with deviated nasal septum; but it had not been documented in earlier medical records. Thus, aggravation could not be established. Also, the imaging of the Veteran’s nasal bones did not reveal any fractures or deviated septum upon examination in November 2019. Instead his left nostril was clogged. This was due to his allergic rhinitis. Read in conjunction, these opinions still do not address whether the Veteran’s current nasal condition of allergic rhinitis was incurred during active duty to include as due to the Veteran’s inservice altercation. The Board must ensure compliance with the previous remand, so a remand for an addendum opinion is needed. The matters are REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. 2. Obtain updated medical records, VA and private, and associate them with the record. The Board in particularly interested in any records associated with the Veteran’s endoscopy surgeries. 3. Obtain an addendum opinion from a VA examiner to determine the nature and etiology of the Veteran's allergic rhinitis condition. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The addendum opinion must include a notation that this record review took place. It is up to the discretion of the examiner as to whether a new examination of the Veteran is necessary to provide an adequate opinion. After the record review and examination of the Veteran, if deemed necessary by the examiner, the VA examiner is asked to respond to the following inquiry: (a.) Is at least as likely as not (a 50 percent probability or greater) that the Veteran’s allergic rhinitis is related to active duty to include trauma to his nose during service? (Continued on the next page)   For the requested opinion above, a comprehensive rationale for all opinions must be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be provided without resorting to speculation, the examiner must explain why this is so and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Wade 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.