Citation Nr: 21064101 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 17-38 828 DATE: October 19, 2021 ORDER Entitlement to service connection for allergic rhinitis is granted. Entitlement to service connection for sinusitis is granted. REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a left foot disability is remanded. Entitlement to service connection for a rash is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include depression and a sleep disorder, is remanded. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty for training in the U.S. Air Force from March 2003 to June 2003, and on active duty from June 2012 to January 2013 with service in Southwest Asia. These matters come before the Board of Veteran's Appeals (Board) on appeal from a March 2015 rating decision by the Regional Office (RO). The Veteran testified at a hearing before a member of the Board in April 2021; a transcript has been associated with the claims file. FINDINGS OF FACT 1. The Veteran is shown to have had qualifying service in the Southwest Asia theater of operations during the Persian Gulf War for 38 C.F.R. § 3.320 purposes. 2. The Veteran is shown to have allergic rhinitis that manifested within 10 years of the date of separation from her active service. 3. The Veteran is shown to have sinusitis that manifested within 10 years of the date of separation from her active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for allergic rhinitis on a presumptive basis under 38 C.F.R. § 3.320 have been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.320 (86 Fed. Reg. 42732 (Aug. 5, 2021)). 2. The criteria for entitlement to service connection for sinusitis on a presumptive basis under 38 C.F.R. § 3.320 have been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.320 (86 Fed. Reg. 42732 (Aug. 5, 2021)). Service Connection 1. Entitlement to service connection for allergic rhinitis 2. Entitlement to service connection for sinusitis The Veteran claims she has allergic rhinitis and sinusitis due to her active service in Kuwait. She testified at the Board hearing that she has experienced sinus trouble and a runny nose since she served in Kuwait. She testified that she walked by burn pits daily in Kuwait. Under 38 C.F.R. § 3.320, for veterans with qualifying service in the Southwest Asia theater of operations during the Persian Gulf War, service connection may be presumed for certain listed chronic diseases associated with exposure to fine, particulate matter, which listed diseases include: asthma, rhinitis, and sinusitis (to include rhinosinusitis). Service connection may be presumed under 38 C.F.R. § 3.320 even though there is no evidence of a listed disease during the period of service if it becomes manifest to any degree (including non-compensable) within 10 years from the date of separation. Exposure to fine, particulate matter shall be presumed under 38 C.F.R. § 3.320 for veterans with qualifying service in the Southwest Asia theater of operations during the Persian Gulf War. In this case, the available service treatment records in the claims file include records of treatment at Ali Al Salem Air Base in Kuwait dated in 2012. See Records, received May 2017 at p.33 and 39 of 43. Therefore, service in the Southwest Asia theater of operations for 38 C.F.R. § 3.320 purposes is clearly shown. Post-service, the Veteran's VA treatment records show she has been followed for diagnosed allergic rhinitis and sinusitis since November 2013. See CAPRI, received February 2015 at p.22 and 65; CAPRI, received May 2017 at p.2 and 12; CAPRI, received January 2018 at p.4; Records, received November 2019 at p.34 (January 2018). A December 2013 VA treatment record notes that her allergic rhinitis was environmental, and not seasonal. See CAPRI, received February 2015 at p.50. An October 2014 VA treatment record shows she reported nose bleeds and difficulty breathing when she was deployed to Kuwait, and was told she was merely adjusting to the atmosphere. She also reported problems with allergies when she returned from Kuwait. See CAPRI, received February 2015 at p.34. Allergic rhinitis and chronic sinusitis with acute exacerbation were diagnosed. As shown above, the Veteran is shown to have qualifying service in Kuwait for 38 C.F.R. § 3.320 purposes, and she currently has diagnosed rhinitis and sinusitis that became manifest within the 10-year presumptive period for presumptive service connection purposes, with no intercurrent cause shown. Therefore, the Board finds that service connection for allergic rhinitis and sinusitis should be presumed under 38 C.F.R. § 3.320, and the claims are granted. REASONS FOR REMAND 1. Entitlement to service connection for a left knee disability The Veteran testified at the Board hearing that after a Reserve drill at Keesler AFB, her left knee became swollen, and she was given crutches. She testified she has experienced left knee pain since service. A January 2013 service treatment record (noting she was on active duty, apparently transposed in February 2013) shows the Veteran complained of left knee pain and swelling for one year. Examination revealed positive patellar compression, mild edema, and tenderness. It was noted that her symptoms were suggestive of patellofemoral syndrome. See Records, received May 2017 at p.22 of 43. Post-service, an October 2014 VA treatment record shows the Veteran reported intermittent pain and swelling of the left knee. She reported her left knee was examined at Keesler AFB clinic, she was told it may be arthritis, and that it was also examined after her deployment in Kuwait. Left knee arthralgia was diagnosed. See CAPRI, received February 2015 at p.34-35. Because the records show treatment for left knee pain in service, suggestive of patellofemoral syndrome, and continued left knee arthralgia post-service, the Board finds that the claim should be remanded so that the Veteran may be afforded a VA examination to address the nature and etiology of the claimed left knee disability. In addition, there is no record of the RO having requested the Veteran's service treatment records from the National Personnel Records Center (NPRC). The Board does acknowledge a request for service treatment records was sent to the Keesler AFB Medical Center, and 43 pages of records were received. Therefore, on remand, all of the Veteran's service treatment records from her period of active duty for training in 2003, and from her active duty from June 2012 to January 2013, should be requested from the NPRC. Also, her DD Form 214 for her period of active duty from June 2012 to January 2013 indicates the Veteran had one year and 16 days of prior active service. It is unclear, however, if this notation was in error, as only record in the file of prior active service was her period of active duty for training from March 2003 to June 2003. Furthermore, the DD Form 214 (for 2012 to 2013) shows the Veteran was not available to sign, and a DD Form 215 would be issued for any needed corrections. Therefore, on remand, all of the Veteran's service personnel records should be obtained. If an additional period of active service is found in these service personnel records (other than March 2003 to June 2003, and June 2012 to January 2013), the service treatment records for that period should be associated with the claims file. 2. Entitlement to service connection for a left foot disability The Veteran contends she incurred a left foot injury during her active service. She testified at the Board hearing that she was running on a track, apparently during her service in Kuwait, and fell off the track and into a hole. She testified that she was treated in service with an Ace bandage and was told to keep the foot elevated for one day. An August 2012 service treatment record shows pain in the right foot, but not the left. See Records, received May 2017 at p.40 of 43. Post-service, an October 2014 VA treatment record shows the Veteran reported intermittent left foot pain, and examination revealed tenderness in the plantar area. An x-ray was negative for any abnormality. See CAPRI, received February 2015 at p.30, 35, 37. As noted above, it appears several of her service treatment records are missing from the claims file. Therefore, the claim should be remanded so that all of her available service treatment records may be obtained. If any service treatment records are obtained that show complaint or treatment in service for her left foot during a period of active service, a VA examination should be performed to address the nature and etiology of the claimed left foot disability. 3. Entitlement to service connection for a rash The Veteran testified at the Board hearing that she started experiencing itchy spots and sores after returning from Kuwait. Again, many of her service treatment records are not associated with the claims file. Post-service, November 2013 VA treatment records show she reported a persistent papular or nodular rash on her hands and arms. See CAPRI, received February 2015 at p.70-72. A November 2014 VA treatment record shows she reported an itchy rash that started after a two-day stay at a hotel, and she was diagnosed with scabies and prescribed permethrin. See CAPRI, received May 2017 at p.6 and 9. A December 2014 record shows a diagnosed chronic rash, differential diagnosis eczema versus tinea. See Records, received February 2015 at p.13 A January 2015 VA dermatology record shows the Veteran reported a rash, although it was not present at the time of the appointment. She reported lice treatment was not helpful. Examination revealed scattered post inflammatory pigmentary changes, mainly on her lower legs and feet, and atopic dermatitis was diagnosed. See CAPRI, received February 2015 at p.2. Before a decision can be made on the claim, the claim should be remanded so that all of her outstanding service treatment records may be obtained. Because the Veteran is competent to report experiencing an intermittent rash since service, she should also be afforded a VA examination to address whether she has a skin rash due to her active service. 4. Entitlement to service connection for an acquired psychiatric disorder, to include depression and a sleep disorder The Veteran testified at the Board hearing that she has felt down or depressed since she returned from her deployment to Kuwait. She testified that she was moved to a building by herself at the end of her active service rather than the gym. She also testified that her separation was delayed two weeks by a hurricane, which was particularly stressful because her father was in ill health and her mother was asking when she would be home. She also testified that she was supposed to be promoted to Master Sergeant, but was not promoted due to missing a class. As noted above, it appears many of the Veteran's service treatment records are missing from the claims file. She submitted a copy of one record, no date is shown, showing she reported difficulty sleeping. It is not certain whether this record was from a period of active service, although this record includes a notation that she had 172 days of "military duty" that year, excluding inactive duty for training. See Records, received December 2019 at p.9. A November 2013 VA treatment record shows she reported trouble sleeping when she returned from service. See CAPRI, received February 2015 at p.63. An October 2014 VA treatment record shows she reported "so many stressors" during service, including arguments with her supervisor and another service person. She also reported stress during service because her son was getting into trouble while under her parents' care, including using drugs and stealing, as well as a DUI charge, fighting with her father, who cried to her via Skype, and hearing voices and diagnosed with schizophrenia. She reported she requested to go home to check on her son and her father, but was told she could not leave unless her son overdosed or her father died. She reported that the extension of her service by two weeks seemed like a "death sentence," and that her father had a stroke and died shortly after service. She also reported she had not slept well since Kuwait. See CAPRI, received February 2015 at p.31-33. She was diagnosed with a chronic adjustment disorder with depressed mood, marital discord, situational stressors, as well as insomnia, rule-out sleep disorder. November 2014 VA treatment records show a sleep study did not find sleep apnea, and depression/insomnia was diagnosed. See CAPRI, received February 2015 at p.13, 16, and 21; see also CAPRI, received May 2017 at p.32. Similarly, a July 2018 private treatment record shows a sleep study was performed and "other hypersomnia" was diagnosed. See Records, received November 2019 at p.1. A July 2015 record shows a diagnosed insomnia and a major depressive disorder. See CAPRI, received May 2017 at p.113. As noted above, the Veteran's complete service treatment records have not been associated with the claims file. Therefore, the claim will be remanded so that all of the Veteran's service treatment records may be obtained. In addition, because the Veteran reported a history in service or trouble with her supervisor, her service personnel records should also be obtained. The Veteran has not been provided a VA examination relating to the claim. On remand, a VA examination should be performed to address the nature and etiology of her claimed acquired psychiatric disorder and sleep difficulty. The matters are REMANDED for the following action: 1. Associate with the claims file all of the Veteran's service personnel records from her active service from 2012 to 2013, as well as her subsequent Reserve service. 2. Request the Veteran's service treatment records from the NPRC, and any other reasonable source, for her period of active duty for training from March 2003 to June 2003, her period of active duty from June 2012 to January 2013, and any subsequent Reserve service. In addition, if the service personnel records obtained pursuant to paragraph (1) above show additional periods of active service, obtain the service treatment records for that period of active service. 3. After all of the development in paragraphs (1) and (2) has been completed, if any of the service treatment records obtained show any left foot complaint in service, afford the Veteran a VA examination to address the nature and etiology of her claimed left foot disability. The complete claims folder must be provided to the examiner for review in conjunction with the examination, and the examiner must note that the claims folder has been reviewed. The examiner should opine as to whether it is "at least as likely as not" that any left foot disability identified on examination was caused by the Veteran's active service. Any opinion must be accompanied by a complete rationale. Direct the VA examiner's attention to a post-service October 2014 VA treatment record showing complaint of left foot pain in the plantar area. See CAPRI, received February 2015 at p.30, 35, 37. Also direct the VA examiner's attention to any newly received service treatment records that may be relevant. 4. After all of the development in paragraph (2) has been completed, afford the Veteran a VA examination to address the nature and etiology of her claimed left knee disability. The complete claims folder must be provided to the examiner for review in conjunction with the examination, and the examiner must note that the claims folder has been reviewed. The examiner should opine as to whether it is "at least as likely as not" that any left knee disability identified on examination was caused by the Veteran's active service. Any opinion must be accompanied by a complete rationale. Direct the VA examiner's attention to a January 2013 service treatment record (transposed in February 2013) and an October 2014 VA treatment record showing left knee complaints. See Records, received May 2017 at p.22 of 43; CAPRI, received February 2015 at p.34-35. Also direct the VA examiner's attention to any newly received service treatment records that may be relevant. 5. Afford the Veteran a VA examination to address the nature and etiology of her claimed rash condition. The complete claims folder must be provided to the examiner for review in conjunction with the examination, and the examiner must note that the claims folder has been reviewed. The examiner should opine as to whether it is "at least as likely as not" that any rash condition identified on examination was caused by the Veteran's active service to include as due to conceded burn pit exposure in Kuwait. Any opinion must be accompanied by a complete rationale. Direct the VA examiner's attention to her reports of a rash to VA clinicians in November 2013, November 2014, December 2014, and January 2015. See CAPRI, received February 2015 at p.5, 13, and 70-72; CAPRI, received May 2017 at p.6 and 9. Also direct the VA examiner's attention to any newly received service treatment records that may be relevant. 6. Afford the Veteran a VA examination to address the nature and etiology of her claimed acquired psychiatric disorder, to include depression, and primary sleep disorder. The complete claims folder must be provided to the examiner for review in conjunction with the examination, and the examiner must note that the claims folder has been reviewed. The examiner should opine as to whether it is "at least as likely as not" that any acquired psychiatric disorder, to include depression, or primary sleep disorder identified on examination was caused by the Veteran's active service. Please ask the Veteran to explain whether any sleep difficulty constitutes a symptom of an acquired psychiatric disorder (i.e., a symptom of a mood disorder) versus a symptom of a primary sleep disorder. Any opinion must be accompanied by a complete rationale. (continued next page) Direct the VA examiner's attention to the Veteran's detailed social history and service history noted in an October 2014 VA treatment record, and to the sleep study results from November 2014 and July 2018 (showing diagnosed insomnia or hypersomnia). See CAPRI, received February 2015 at p.13, 16, 21, and 31-33; CAPRI, received May 2017 at p.32 and 113; Records, received November 2019 at p.1. Also direct the VA examiner's attention to any newly received service treatment records that may be relevant. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Juliano, 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.