Citation Nr: 21067413 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 16-22 098 DATE: November 4, 2021 REMANDED A rating in excess of 30 percent for psychiatric disorder, to include anxiety disorder is remanded. Service connection for allergic rhinitis is remanded. Service connection for asthma is remanded. Service connection for migraines is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 1980 to August 1994, including service in the Persian Gulf from September 7, 1990, to April 2, 1991. This case was previously before the Board in November 2018 and remanded for additional development. REASONS FOR REMAND Psychiatric disorder, asthma, allergic rhinitis and migraines The Veteran seeks service connection for his asthma, allergic rhinitis and migraines conditions. In support, he reported that his asthma, allergic rhinitis and migraines conditions incurred in service and are related to service, to include exposure to environmental hazards while serving in Kuwait. Indeed, the Veteran's medical treatment record shows that he suffers from headaches since 1986 and they worsen due to his anxiety. See VA medical treatment record (March 2001). Additionally, his service treatment record (STR) shows a probable diagnosis of allergic rhinitis. See STR (June 1982). In November 2018, the Board remanded these issues, for medical examinations to determine the etiology and relation of his conditions to service and service-connected disabilities. Subsequently, in January 2020, the Veteran was afforded medical examinations for these conditions. As to all conditions, the examiner provided negative nexus opinions. However, the Board finds that these examinations are inadequate. As to his rhinitis, asthma and headaches the examiner was not clear if the Veteran currently suffers from these conditions, or any symptoms or functional impairment. Further, the examiner did not offer a complete rationale supporting the statements provided regarding the nature, cause and etiology of these conditions. Also, a complete rationale must be provided regarding any relation to the Veteran's remanded conditions with service, to include the environmental hazards in his deployment to Kuwait, and if these conditions are caused, proximately due, related or aggravated by his service-connected disabilities. Thus, the Board finds these examinations inadequate since they failed to adequately consider the nature, cause and etiology of his conditions. Therefore, on remand the examiner should determine the nature, cause, and etiology of his asthma, allergic rhinitis and migraines conditions, as well, if his conditions are related caused or proximately due to his service-connected conditions. In addition, the Veteran seeks a rating in excess of 30 percent for his psychiatric disorder. The Board remanded this issue on November 2018 and the Veteran was afforded a VA examination in January 2020. The examiner noted that the Veteran's had occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, al-though generally functioning satisfactorily, with normal routine behavior, self-care and conversation. However, the Board finds that the latest VA examination does not reflect the current severity and impact of the Veteran's current condition. See VA medical examination (July 2021). Thus, the Board finds that another medical examination is needed to determine the current severity of the Veteran's psychiatric condition, to include the impact of his service-connected disabilities on his psychiatric disorder. Further, as to all conditions, the examiner must consider and discuss the competent medical and lay evidence in record. As there is no adequate examination to determine if during the course of this appeal the Veteran has had rhinitis, headaches and asthma condition. In addition, the Veteran served in the Persian Gulf from September 7, 1990 to April 2, 1991. Effective August 5, 2021, service connection for asthma, rhinitis and sinusitis on a presumptive basis is available based on presumed particulate matter exposures during military service in Southwest Asia. See 86 Fed. Regulation. 42724 (Aug. 5, 2021). As such, a remand of these service connection is warranted. As to the current severity of his psychiatric disorder, a remand is necessary to have the Veteran examined and for an examiner to review his claims folder and provide opinions necessary to adjudicate this appeal. The matters are REMANDED for the following action: 1. Obtain complete VA and Non-VA treatment records of the Veteran's asthma, allergic rhinitis, migraines and psychiatric conditions. 2. Notify the Veteran that he may submit additional lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service asthma, allergic rhinitis, migraines. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the current severity of the Veteran's psychiatric disorder. The examiner must include all symptoms reported and noted in the examination. 4. Schedule a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible). Whether an in-person examination is necessary should be determined by the examiner. The examiner must clarify if the Veteran currently suffers from asthma, allergic rhinitis and migraines. Additionally, the examiner must note all symptoms and functional impairment related to these condition that the Veteran currently suffers from. If the Veteran currently suffers from these conditions, the examiner must opine as to whether it is at least as likely as not that the Veteran's asthma, allergic rhinitis, migraines are related to or had their onset in service. Moreover, the examiner must review all the credible and competent medical and lay evidence, about the Veteran's asthma, allergic rhinitis, migraines onset, etiology, nature and symptoms in and after service. Additionally, the examiner must opine if his asthma, allergic rhinitis and migraines conditions are aggravated or proximately due to service or his service-connected conditions. The examiner is asked to review the pertinent evidence, including the Veteran's lay assertions regarding his symptomatology, and undertake any indicated studies. Then, based on the results of the examination, the examiner is asked to address each of the following questions: (a) Please state whether the symptoms of each claimed condition are attributable to a known clinical diagnosis. If the Veteran does not now have, but previously had any such condition, when did that condition resolve? (b) Is the Veteran's disability pattern consistent with: (1) a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology, (2) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (3) a disease with a clear and specific etiology and diagnosis. (c) If, after examining the Veteran and reviewing the claims file, you determine that the Veteran's disability pattern is either (2) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (3) a disease with a clear and specific etiology and diagnosis, then please provide an expert opinion as to whether it is related to a presumed environmental exposure experienced by the Veteran during service in Southwest Asia. (d) Is it at least as likely as not that any diagnosed disorder had its onset directly during the Veteran's service or is otherwise causally related to any event or circumstance of his service, including environmental exposures during service in Southwest Asia during the Persian Gulf War? (e) If not directly related to service on the basis of questions (b)-(d), is any medical condition proximately due to, the result of, or caused by any service-connected disability(ies)? (f) If not caused by another medical condition, has any disorder been aggravated by any service-connected disability(ies)? If yes, was that increase in severity due to the natural progress of the disease? In offering these opinions, the examiner must acknowledge and discuss the Veteran's competent lay statements of his conditions and any lay evidence regarding the onset of his conditions. In answering these questions for the whole appeal period, the examiner must acknowledge and discuss that effective August 5, 2021, service connection for asthma, rhinitis and sinusitis on a presumptive basis is available based on presumed particulate matter exposures during military service in Southwest Asia. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Alvarado- 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.