Citation Nr: 21062882 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 15-27 561A DATE: October 12, 2021 ORDER Service connection for orbital fracture residuals of the right eye is granted. REMANDED Service connection for corneal foreign body in the right eye is remanded. Service connection for a sinus disability is remanded. FINDING OF FACT The current right eye orbital fracture residuals are related to the in-service grenade explosion during service. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran's favor, the criteria for right eye orbital fracture residuals have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran, who is the appellant, had active service from July 1967 to February 1971. This matter is on appeal from a March 2014 rating decision. Service Connection Legal Authority 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; 38 C.F.R. § 3.303(a). Service connection may 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 established on a direct basis when there is competent, credible evidence of: (1) a current disability; (2) a disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. 38 C.F.R. § 3.303(a), (d). Service connection may be established on a presumptive basis for chronic diseases listed under 38 C.F.R. § 3.309(a) if chronic symptoms of the disease were shown in service; the disease was manifested to a compensable degree with a presumptive period, usually one year after service separation; or continuous symptoms of the disease were manifested since service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.33(b), 3.307, 3.309(a); see also Walker v. Shinseki, 708 F. 3d 1131 (Fed. Cir. 2013). Because the current diagnosis of right orbital fracture residuals is not listed as a chronic disease under 38 C.F.R. § 3.303(b), the presumptive service connection provisions are not applicable. 1. Service connection for right eye orbital fracture residuals is granted. The Veteran contends that the current right eye orbital fracture residuals are related to the in-service grenade blast that caused multiple bodily injuries. He asserts that, while no eye injury is documented in the service treatment records, the only trauma that could have caused the right eye orbital fracture was the in-service grenade blast because he has not had any other injury that could have affected the right eye. After review of all the lay and medical evidence of record, the Board finds that the evidence is in equipoise on the question of whether the current right eye orbital fracture residuals is related to service. There is both unfavorable and favorable evidence of record regarding the question of whether the current right eye orbital fracture residuals are related to service. On the one hand, service treatment records document the Veteran's treatment for multiple fragment wounds to the left arm, buttocks, and both legs due to a grenade explosion in June 1970; however, there is no reference to a right eye injury. The December 1970 service Medical Board report notes that the Veteran's hospital admission included an ophthalmology consultation, among other consultations, and the ophthalmologic consultation did not indicate significant pathology. After review of the record and interview and examination of the Veteran, the October 2013 VA examiner opined that it was less likely than not that the right eye orbital fracture was related to the traumatic brain injury in service. In support of the medical opinion, the October 2013 VA examiner explained that the Veteran had no impairment of ocular motility, pupil abnormality, or diplopia due to the old orbital fractures, and records indicated no obvious facial injury from the 1970 fragging incident. The October 2013 VA examiner added that visual fields were constricted due to facial features, and there was no ocular or neurologic reason for the vertical compression other than the lids obstructing the field. In an October 2013 addendum, the October 2013 VA examiner wrote that the right orbital floor and medial orbital wall fractures were secondary to blunt trauma to the right orbit and would result in facial swelling and ecchymosis, which the Veteran did not experience. The October 2013 VA examiner noted that the concussion from the explosion of a hand grenade would not be sufficient to cause the orbital fractures and noted that blunt trauma usually results from a blow to the eye from an altercation or sports such as being struck in the eye with a baseball. On the other hand, the Center for Disease Control (CDC) Primer for Physicians on Explosions and Blast Injuries submitted by the Veteran includes eye, orbit, and/or face fractures on the list of potential explosive-related injuries. A May 2012 private radiology report includes an impression of small right orbital floor and medial orbital wall blowout fractures from prior trauma. At the Board hearing, the Veteran credibly testified that he had no prior traumas other than the in-service grenade explosion resulting in multiple bodily injuries that could have caused the right eye orbital fracture. Resolving reasonable doubt in the Veteran's favor, the Board finds that the current right eye orbital fracture residuals are related to the in-service grenade explosion that resulted in multiple injuries to the Veteran. For these reasons, direct service connection for right eye orbital fracture residuals under 38 C.F.R. § 3.303(d) is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND 2. Service connection for corneal foreign body in the right eye is remanded. The issue of service connection for corneal foreign body in the right eye is remanded for a supplemental VA medical opinion. The October 2013 VA examination report is inadequate because the examiner diagnosed corneal foreign body in the right eye that had been diagnosed in 1993 and noted that an old foreign body stain was demonstrated on examination but did not opine on whether the diagnosis was related to service, to include the in-service grenade explosion, or was either caused or worsened beyond the natural progression (aggravated) by the now service-connected right eye disability and/or TBI residuals. See 38 C.F.R. § 3.310 (providing for secondary service connection). 3. Service connection for a sinus disability is remanded. The issue of service connection for a sinus disability is remanded for a supplemental VA medical opinion. The Veteran contends that he has a current sinus disability related to an injury to the sinus region that occurred during the in-service grenade explosion. He alternatively contends that the current sinus disability was either caused or worsened beyond the natural progression (aggravated) by the now service-connected right eye disability and/or TBI residuals, raising a secondary service connection theory. See 38 C.F.R. § 3.310. The evidence currently of record is insufficient to decide the appeal because there is no adequate medical opinion of record addressing whether the current sinusitis is causally related to service or is otherwise secondary to (38 C.F.R. § 3.310) the now service-connected right orbital fracture residuals and/or service-connected TBI residuals. The October 2013 VA medical opinion is inadequate because the VA examiner opined that the Veteran did not have and had not been diagnosed with a sinus condition; however, a May 2012 radiology report notes an impression of likely chronic minor right frontal and minor bilateral maxillary sinus disease, in addition to an impression of small right orbital floor and medial orbital wall blowout fractures from prior trauma. The October 2013 VA examiner noted review of the May 2012 radiology report but wrote that it showed no evidence of chronic sinus disease, without providing any further explanation when the noted impression on the radiology report was likely chronic minor sinus disease. The October 2013 VA examiner also made no comment on the significance of a deviated septum shown on the October 2013 nasal endoscopy. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate examiner regarding whether the corneal foreign body in the right eye is at least as likely as not: (1) causally related to the in-service grenade explosion and/or the right eye orbital fracture; (2) caused by the service-connected right orbital fracture residuals and/or service-connected TBI residuals; and (3) worsened beyond its natural progression by (aggravated by) the service-connected right orbital fracture residuals and/or service-connected TBI residuals. The examiner should review the record and provide rationale for the medical opinion. An examination should be scheduled if needed to provide the medical opinion. 2. Obtain an addendum opinion from an appropriate examiner regarding whether the Veteran's chronic sinus disability is at least as likely as not: 1) causally related to the in-service grenade explosion and/or right eye orbital fracture; 2) caused by the service-connected right orbital fracture residuals and/or service-connected TBI residuals; and (3) worsened beyond its natural progression by (aggravated by) the service-connected right orbital fracture residuals and/or service-connected TBI residuals. The examiner should review the record and provide rationale for the medical opinion, to include consideration of the significance of the May 2012 radiology report for the sinuses reflecting an impression of likely chronic sinus disease, as well as the October 2013 nasal endoscopy reflecting a deviated septum. An examination should be scheduled if needed to provide the medical opinion. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Palmer, 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.