Citation Nr: 21067553 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 17-43 607 DATE: November 4, 2021 REMANDED Entitlement to service connection for angular cheilitis is remanded. Entitlement to service connection for geographic tongue is remanded. Entitlement to an initial compensable rating for sinusitis and status post cystectomy, left maxillary is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1983 to May 2013. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision. 1. Entitlement to service connection for angular cheilitis is remanded. 2. Entitlement to service connection for geographic tongue is remanded. The Veteran seeks service connection for angular cheilitis and geographic tongue, asserting that such conditions began in service and have continued until the present. The Veteran's service treatment records note a geographic tongue diagnosis with treatment in 1995 and 1996 and an angular chilitis diagnosis with treatment in 2011. The Veteran filed his claim for service connection in March 2013. The July 2013 VA examiner noted a diagnosis of geographic tongue with a diagnosis date of December 1995. The VA examiner noted the Veteran's reports of lesions on his tongue which clear up but always return and can be painful. The Veteran reported the condition is intermittent but has remained constant since onset. The VA examiner noted no current symptoms. A July 2013 VA examiner evaluated the Veteran's skin conditions. The VA examiner noted the Veteran's reports of angular cheilitis symptoms since the 1990s which has been intermittent but recurrent and which responds to Mupirocin and/or Bactroban ointment. However, the VA examiner noted no pathology at the time of examination to render a diagnosis. In an August 2017 statement, the Veteran reported that his geographic tongue and angular cheilitis skin symptoms have persisted since service. While the July 2013 VA examiner noted a diagnosis of geographic tongue, no current symptoms were identified. As to angular cheilitis, the July 2013 VA examiner noted the Veteran's reports of recurrent symptoms which responded to prescription medication but no current pathology. The Veteran is competent to report his symptoms. In light of the Veteran's reports of a recurring problem since separation from service in May 2013, additional VA medical opinion is warranted to determine whether the Veteran has had an actual disability (claimed as geographic tongue or angular cheilitis) at any time during the claims period. McClain v. Nicholson, 21 Vet.App. 319, 321 (2007) (holding that the current disability requirement is satisfied if a "claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim."). 3. Entitlement to an initial compensable rating for sinusitis and status post cystectomy, left maxillary is remanded. The Veteran seeks a compensable rating for his service-connected sinusitis disability, asserting that he has multiple non-incapacitating episodes per year. The July 2013 VA examiner noted no non-incapacitating episodes of sinusitis characterized by headaches, pain, and purulent discharge or crusting in the prior year as well as no incapacitating episodes of sinusitis. However, the VA examiner noted the Veteran experiences sinus infections three times a year which require time off of work. A February 2015 radiology report notes asymmetric thickening of the left maxillary sinus, significantly progressed compared to the last examination. A March 2015 treatment record notes occasional drainage, large crusts, and pain. Given the indications of potential worsening since the July 2013 VA examination, remand is warranted to obtain a new VA examination to address the current severity of the Veteran's sinusitis disability. In addition, as clarification regarding the July 2013 VA examiner's notations would be helpful, the VA examiner should comment on whether the sinus infections three times a year which require time off of work noted by the July 2013 VA examiner constitute non-incapacitating or incapacitating episodes of sinusitis. In addition, the Veteran submitted some 2014 and 2015 records from Walter Reed National Military Medical Center for treatment of his sinusitis disability. While this matter is on remand, any additional outstanding, relevant treatment records should be obtained from Walter Reed. The matters are REMANDED for the following action: 1. Take any appropriate actions to obtain any relevant outstanding treatment records from Walter Reed National Military Medical Center. 2. After outstanding records are obtained to the extent possible, ask an appropriate examiner to review the Veteran's file. The necessity of an in-person examination is left to the discretion of the examiner. The examiner should opine as to whether the Veteran has had an actual disability (claimed as geographic tongue) at any time during the claims period, even if resolved. For any such disability, the examiner should opine regarding whether it is at least as likely as not that the disability: (a) had an onset in service; or (b) is otherwise related to service. The examiner should consider all medical and lay evidence of record. The examiner should specifically address the Veteran's in-service treatment for geographic tongue in 1995 and 1996, his reports that symptoms have continued to the present, and the July 2013 VA examiner's geographic tongue diagnosis. If the Veteran's reports are discounted, the examiner should provide a rationale for doing so (e.g., whether there is any medical reason to accept or reject his contentions). The examiner is asked to explain the reasons behind any opinions expressed. 3. After outstanding records are obtained to the extent possible, ask an appropriate examiner to review the Veteran's file. The necessity of an in-person examination is left to the discretion of the examiner. The examiner should opine as to whether the Veteran has had an actual disability (claimed as angular cheilitis) at any time during the claims period, even if resolved. For any such disability, the examiner should opine regarding whether it is at least as likely as not that the disability: (a) had an onset in service; or (b) is otherwise related to service. If there is no diagnosed disability that the Veteran's symptoms can be attributed to, the examiner should opine whether it is at least as likely as not that the symptoms represent an objective indication of chronic disability resulting from an undiagnosed illness or a diagnosed, but medically unexplained chronic multi-symptom illness (MUCMI) related to the Veteran's Persian Gulf War service. The examiner should consider all medical and lay evidence of record. The examiner should specifically address the Veteran's in-service treatment in 2011 and his reports that symptoms have continued to the present. The examiner should specifically address whether the Veteran's disability is related to his Gulf War exposures. If the Veteran's reports are discounted, the examiner should provide a rationale for doing so (e.g., whether there is any medical reason to accept or reject his contentions). The examiner is asked to explain the reasons behind any opinions expressed. 4. Schedule the Veteran for an appropriate VA examination to determine the current severity of his service-connected sinusitis disability. The entire claims file should be reviewed by the examiner and any appropriate tests conducted. The Veteran's symptomatology should be described, including those used in the rating criteria. The examiner should specifically address the July 2013 VA examiner's notation of sinus infections three times a year which require time off of work. 5. After the above development, and any other development deemed necessary, readjudicate the claims. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Purcell, Amy 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.