Citation Nr: 21067842 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 13-31 452A DATE: November 5, 2021 REMANDED Entitlement to service connection for a right hand disability is remanded. Entitlement to service connection for allergic rhinitis is reamnded. REASONS FOR REMAND The Veteran had active service from August 1989 to August 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2012 rating decision of the Waco, Texas, Regional Office of the Department of Veterans Affairs (VA). The Veteran appeared at a June 2016 hearing before the undersigned Veterans Law Judge. A hearing transcript is of record. 1. Entitlement to service connection for a right hand disability is remanded. The Veteran contends that he is entitled to service connection for a right hand disability because the claimed disability is the result of an injury sustained following a physical altercation during service. A March 2011 right hand X-ray study from Falls Community Hospital notes findings consistent with a "remote boxer's fracture." A January 2012 written statement from Dr. Crockett indicates that the Veteran had reported that he had "right hand degenerative arthritis status post a fracture while he was in the service" and "within the realm of reasonable medical probability and this medical examiner's opinion, I believe these diagnoses to be true and accurate." In May 2020, the Board remanded the claim to have an examiner address the March 2011 finding of a remote boxer's fracture, the January 2012 private treatment records, and any relationship to the Veteran's reports of a hand injury during service. In a June 2021 VA medical opinion, the examiner opined that the claimed disability was not related to service. the rationale provided was that the March 2011 X-ray did not indicate and acute fracture or dislocation. The January 2012 private treatment records were unable to be located, and there was no diagnosis on examination. Unfortunately, there has not been substantial compliance with the Board's previous remand requests regarding the claim for service connection for a right hand disability. Another remand is required. Stegall v. West, 11 Vet. App. 268 (1998). The June 2021 VA examiner did not specifically address the May 2011 finding of a remote boxer's fractures and how that finding does or does not support the Veteran's assertion that a right hand disability is the result of an altercation in service. The examiner noted that the January 2012 private treatment records, beyond what was documented by the VA, were not made available prior to the opinion. The remand request instructed the RO to obtain a medical opinion from a physician, but the provided opinion was given by a nurse practitioner. Therefore, an opinion that satisfies the previous request is necessary. 2. Entitlement to service connection for allergic rhinitis is remanded. Unfortunately, there has not been substantial compliance with the Board's previous remand requests regarding the claim for service connection for allergic rhinitis. Another remand is required. Stegall v. West, 11 Vet. App. 268 (1998). In May 2020, the Board remanded the claim after finding that the VA examiner erroneously relied on the silence of the service medical records for treatment or a diagnosis. On remand, the RO was instructed to obtain a medical opinion from a physician. The March 2021 VA examination and medical opinion was provided by a nurse practitioner. Therefore, a medical opinion that complies with the previous request is necessary. In addition, VA has enacted provisions to presumed service connection for certain Gulf War Veterans, which include service connection for rhinitis. On remand, the Agency of Original Jurisdiction should consider those provisions and determine whether the Veteran meets those criteria. The matters are REMANDED for the following action: 1. Obtain an addendum opinion conducted by a medical doctor who has not previously examined the Veteran to determine the nature and etiology of any identified right hand disabilities and any relationship to active service. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a.) Diagnose all right hand disabilities found on examination. The examiner must specifically discuss the record which found a remote boxer's fracture. (b.) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified right hand disability that has been diagnosed at any time during this appeal, including the September 2019 right hand strain and X-ray findings of remote boxer's fracture, had its onset during active service or is related to any incident of service, including the reported trauma during an altercation. (c.) The examiner should specifically discuss the March 2011 right hand X-ray study from Falls Community Hospital, to include the finding of a "remote boxer's fracture" and Dr. Crockett's January 2012 opinion. The January 2012 private treatment records should be made available to the examiner. (d.) The examiner should address the Veteran's lay statements and reports of continuity of symptomatology. 2. Obtain an addendum opinion conducted by a medical doctor who has not previously examined the Veteran to assist in determining the nature and etiology of diagnosed allergic rhinitis and any relationship to active service. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a.) Diagnose all respiratory disabilities found and specifically state whether or not rhinitis is found or has been present during the pendency of the appeal. (b.) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified respiratory disability that has been diagnosed at any time during this appeal, to specifically include rhinitis, had its onset during active service or is related to any incident of service, including the documented allergic rhinitis and hay fever during service. 3. Then, readjudicate the issues on appeal, with specific consideration of whether presumptive service connection for rhinitis is warranted. If any decision is adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Cross, 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.