Citation Nr: 21004856 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 10-98 939A DATE: January 28, 2021 REMANDED Service connection for a sinus condition, to include as secondary to service-connected residuals of a traumatic brain injury (TBI), is remanded. REASONS FOR REMAND The Veteran had active duty military service from June 1952 to September 1965. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2008 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) which, among other things, denied service connection for a sinus condition as secondary to service-connected residuals of a traumatic brain injury. The Veteran died in November 2016 and the Appellant is his surviving spouse. The Appellant is the substituted claimant for this appeal. In September 2020, the matter was remanded for further development, to include obtaining a medical opinion on direct service connection. In November 2020, an opinion was provided. In June 2020 and November 2020, the AOJ obtained VA etiology opinions for direct and secondary service connection for the Veteran’s sinus condition claim; however, upon review of these opinions, the Board finds that they are insufficient. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). First, with respect to the etiology opinion on direct service connection, the November 2020 examiner opined: “[r]eview of the medical record and STR shows no evidence of the diagnosis, treatment or symptoms suggestive of any sinus condition while on active duty or within one year of separation from military service. Review of the medical record shows the veteran was diagnosed with chronic sinusitis many years after service. Chronic rhinosinusitis (CRS) may be broadly defined as an inflammatory disorder of the paranasal sinuses and linings of the nasal passages that lasts 12 weeks or longer. Signs and symptoms – there are four cardinal signs/symptoms of CRS in adults: anterior and/or posterior nasal mucopurulent drainage; nasal obstruction/nasal blockage/congestion; facial pain, pressure, and/or fullness; and reduction or loss of sense of smell.” The Board finds this direct service connection opinion insufficient because the examiner failed to provide adequate reasons and explanations as to why the Veteran’s sinus condition was not related to service. Indeed, the lack of adequate reasons and explanations in this opinion makes it impossible for the Board to use to make an informed determination as to whether or not service connection for a sinus condition is warranted. An adequate medical examination “must support its conclusions with an analysis that the Board can consider and weigh against contrary opinions” and must “provide sufficient detail for the Board to make a fully informed evaluation of whether direct service connection is warranted.” See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Second, regarding the June 2020 etiology opinion on secondary service connection for a sinus condition, the examiner opined that the Veteran’s Vasomotor Rhinitis was less likely than not caused by his service-connected residuals of a TBI. In support, he noted that the Veteran’s diagnosed Vasomotor Rhinitis occurs when the blood vessels inside the nose dilate. A review of medical literature does not reference a “cause and effect” association between head injury/trauma and the development of Vasomotor Rhinitis. Therefore, the examiner addressed secondary service connection and causation, without assessing the issue of aggravation. The Court of Appeals for Veterans Claims has indicated that in circumstances such as this case, a medical opinion addressing that question should be sought. El-Amin v. Shinseki, 26 Vet. App. 136 (2013) (indicating that findings of “not due to,” “not caused by,” and “not related to” a service-connected disability are insufficient to address the question of aggravation under 38 C.F.R. § 3.310(b)). To review, secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. Here, “aggravation” means the worsening beyond its natural progression by a service-connected disability. The Board notes that a permanent worsening of a non-service-connected disability is not required to establish secondary service connection on the basis of aggravation. Further, this opinion was insufficient because it failed to consider the Veteran’s prior medical history on additional sinus conditions. The Veteran’s medical records indicate that he sought treatment for, and was diagnosed with, sinusitis as early as January 1997. See La Grange Medical Hospital records, January 1997; Rating Decision, January 2008. The examiner only discussed that the May 2015 ENT showed no diagnosis of sinusitis and therefore based his analysis on his rhinitis diagnosis. As medical treatment records suggest the Veteran had additional sinus conditions not considered by the examiner, it is imperative the VA examiner consider the Veteran’s complete relevant medical history when rendering an opinion. As a result, an addendum VA medical opinion is necessary to ensure a complete review of the Veteran’s relevant medical history. For the reasons listed above, the Board finds the November 2020 and June 2020 medical opinions to be insufficient for decision-making purposes. The matter is REMANDED for the following actions: 1. Forward the Veteran’s claims file to an appropriate examiner to provide addendum opinions regarding service connection for a sinus condition, to include as secondary to a service-connected disability. After reviewing the claims folder, the examiner is asked to address the following: (a.) Whether it is at least as likely as not that the Veteran’s sinus condition(s) had its onset in service or are otherwise related to an in-service event, injury or disease. (b.) Whether it is at least as likely as not that the Veteran’s sinus condition(s) is either due to OR aggravated by the Veteran’s service-connected residuals of a TBI. The examiner is asked to provide an opinion as to both causation and aggravation. The examiner is asked to provide a rationale and explain the reasons behind any opinions expressed and conclusions reached. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Krista Johnson, 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.