Citation Nr: 21061750 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 16-05 713A DATE: October 5, 2021 REMANDED Entitlement to service connection for sinusitis is remanded. REASONS FOR REMAND The Veteran had active duty military service from March 2007 to September 2012, including service in Southwest Asia. This matter was previously before the Board in April 2020 and in March 2021. Both times it was remanded for new VA examinations to address inadequacies in previous VA examinations. Unfortunately, the VA examination and opinion obtained in April 2021 remained inadequate. The Agency of Original Jurisdiction (AOJ) requested an addendum to remedy these inadequacies but the addendum opinion in May 2021 was still deficient. Therefore, this matter must once again be remanded for a VA examination and opinion to address the Board's specific questions. Stegall v. West,11 Vet. App. 268 (1998). The Board regrets the additional delay in obtaining a final answer for the Veteran. Entitlement to service connection for sinusitis The Veteran seeks service connection for sinusitis, which she asserts had its onset in service and may be related to her exposure to noxious chemicals and sandstorms in Iraq. The Board notes that service connection is in effect for allergic rhinitis, which complicates the Board's understanding of the disability picture at issue and hinders the ability to render a decision on the sinusitis claim without clear medical opinions. Notably, the Board is forbidden by law from drawing in medical conclusions or diagnoses but must rely upon the medical information and opinions furnished by qualified professionals. See Colvin v. Derwinski, 1 Vet. App. 171 (1991) (holding that the rating board cannot substitute its own medical judgment for that of medical professionals). The medical evidence in this case is somewhat confused. Examinations conducted of the Veteran in September 2011, October 2011, and May 2017 all concluded that the Veteran did not have sinusitis and therefore did not provide any opinion on service connection. However, the Medical Evaluation Board in service in December 2011 specifically listed sinusitis as a contributing diagnosis at the time of the Veteran's medical discharge, despite acknowledging the negative opinions of September and October 2011. In addition, the Veteran had a sinus CT scan in 2015 which appeared to show evidence of sinusitis, followed by a septoplasty, but an Xray of the sinus in September 2020 was read as normal. The Board's remand in March 2021 included very specific requests regarding possible pre-existing conditions, causation or aggravation due to noxious exposures and sandstorms, differentiation between allergic rhinitis and sinusitis, specific discussion of the Veteran's history and symptoms, and an opinion on aggravation of sinusitis by rhinitis. The examination and opinion obtained in April 2021, even with the addendum opinion of May 2021, did not fully resolve the questions posed by the Board. The Board will endeavor to provide sufficient specificity to the questions on remand to ensure a clear medical opinion in response, but requests that a different VA examiner be utilized in order to improve the likelihood that the remand directives are followed. Please note that mere completion of a standard C&P Examination questionnaire form will not constitute compliance with the Board's remand directives. The matters are REMANDED for the following action: 1. Obtain a new VA examination and opinion on sinusitis from a provider other than the one who performed the April 2021 examination. The examiner is asked to render an opinion as to whether the Veteran has or at any time since service separation has had sinusitis which is at least as likely as not (probability 50 percent or greater) the result of or otherwise due to her military service. In rendering this opinion, the examiner must address each of the following points: a) The Veteran reported exposure to noxious chemicals and sandstorms during her service in Iraq (see Hearing Transcript, 12/12/2019). Please address any impact such exposure may have had on claimed sinusitis and the likely long-term effects of such exposure. b) The Medical Evaluation Board in December 2011 listed sinusitis as a contributing diagnosis for the medical discharge from service. Please address any medical basis for including this diagnosis if shown in the evidence or state why it should not have been included. c) The Veteran has described symptoms she attributes to sinusitis, including stuffy nose, post-nasal drip, sinus pressure, congestion, runny nose, and sneezing. Please indicate whether these symptoms are consistent with a diagnosis of sinusitis or if they are more properly attributed to service-connected rhinitis. d) Please address the imaging studies including the CT scan in 2017 and the Xray in 2020 and the findings of these studies and whether they are indicative of sinusitis, either acute or chronic, and their significance with respect to the Veteran's claim. e) If the examiner concludes that the Veteran does not have any pathological findings suggesting sinusitis, the examiner should account for the symptoms identified by the Veteran and explain why a diagnosis of sinusitis is not appropriate. f) If no current pathology of sinusitis is found, the examiner should still address whether the Veteran's medical records or reports of symptoms indicate that sinusitis was present in service and at any time during the life of this claim (from September 2012), and if there is any relationship between any symptoms in service and any manifestations since service. g) Please explain as clearly as possible in plain language why the conclusions and opinions were arrived at, with citations to any specific evidence of record and to any informative medical research or literature on the subject. 2. After the opinion is obtained, the AOJ should review the document for compliance with the Board's directives. If the AOJ should find deficiencies, another opinion from a more responsive provider should be requested. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Cheryl E. Handy 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.