Citation Nr: 21068686 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 18-32 352 DATE: November 12, 2021 REMANDED Entitlement to service connection for a sinus disability, to include allergic rhinitis is remanded. REASONS FOR REMAND The Veteran had active air service from September 1949 to February 1953. This matter comes before the Board of Veterans Appeals (Board) on appeal from an August 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, FL. In February 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the electronic claims file. The Board previously considered this appeal in May 2020, December 2020 and April 2021 and remanded this issue for further development each time. The case has returned to the Board for further appellate review. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding the issue on appeal. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for a sinus disability, to include allergic rhinitis is remanded. Although the Board regrets the additional delay, the Board finds that further development is required before the claim on appeal can be decided. Unfortunately, as noted above, there has not been substantial compliance with the Board's previous remand directives resulting in inadequate medical opinions on the issue of entitlement to service connection for a sinus condition, to include allergic rhinitis. In April 2018, the Veteran underwent a VA examination to determine the etiology of any sinus disabilities. The VA examiner diagnosed the Veteran with allergic rhinitis. The VA examiner opined the Veteran's allergic rhinitis was less likely than not incurred in service. The rationale provided was that there was no diagnosis of allergic rhinitis while on active duty and no evidence of chronicity of sinusitis or allergic rhinitis since service separation. The mere absence of evidence does not equate to unfavorable evidence. See Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (en banc) (cautioning that negative evidence, meaning actual evidence weighing against a party, must not be equated with the absence of substantive evidence). In the May 2020, December 2020, and April 2021 Board remands, the RO was directed to obtain addendum medical opinions from "an appropriately qualified physician on the etiology of the Veteran's current sinus or allergy disabilities." Additionally, the examiner was directed to specifically discuss: a) the Veteran's reports of exposure to environmental hazards in service, b) symptoms that began in service and have continued since, c) his in-service tooth removal, and d) the Veteran's February 1953 service exit examination where it is noted, "Examinee believes he has sinusitis, no treatment received." Additionally, examiners were asked to provide rationales for all opinions and conclusions rendered. In the July 2020 first addendum opinion, the examiner only mentioned the reported exposure to environmental hazards, saying, "In regard to reported exposure to environmental hazards there is no evidence of continuity and chronicity of care," and did not opine as to the nexus of the claimed condition with this exposure. The July 2020 examiner failed to address the Veteran's report of symptoms that began in service and continued since or his in-service tooth removal. The Veteran's statements should be accepted as truthful unless otherwise shown by the record; a full explanation is required for any history rejected. Pursuant to the Board's December 2020 remand, a second addendum VA medical opinion was provided in December 2020; however, upon review, the Board also found this addendum VA opinion to be inadequate for adjudicative purposes as the examiner provided an unfavorable opinion based entirely on the lack of evidence in the Service treatment records (STRs). STR note no sinus disabilities or allergic rhinitis nor exposure to environmental hazards such as coal, gun powder, or fumes corroborating the Veteran's statements. This second opinion is inadequate, as lack of evidence in the STRs is insufficient rationale to support a negative nexus opinion. See Forshey v. Principi. Pursuant to the Board's April 2021 remand, a third addendum medical opinion was provided in July and August 2021 by a third VA examiner. Upon review, the Board finds this opinion inadequate for adjudicative purposes as well. This examiner opined: "It is less likely as not that the currently diagnosed respiratory disabilities, to include any sinus disabilities or allergic rhinitis were incurred during active military service or are due to exposure of environmental hazards in service," without any rationale as to why exposure to environment hazards in service did not cause or is otherwise unrelated to the Veteran's sinus condition. As for the Veteran's contention that his sinus condition was caused by a tooth extraction in service, the examiner said, "Tooth removal is not relevant to the allergic rhinitis. There is no pathology between them." And as for the Veteran's service exit exam, where he says he believes he has sinusitis while in service in 1953, this examiner mentions that there was an exit exam, but does not report the Veteran's statement or address the fact that while in service, the Veteran contended he had sinusitis back in 1953. An August 2021 addendum indicated that the Veteran reported exposure to environmental hazards, like coals, gun powder and fumes and reported symptoms began in service. Allergies occur when the immune system reacts to a foreign substance such as pollen, environmental hazards, like coals, gun powder, fumes. Thus, the August 2021 addendum suggests a connection even though the examiner used this rationale to indicate the condition was less likely related to service. In light of this inconsistency, further opinion is necessary. The matter is REMANDED for the following action: 1. Obtain an addendum medical opinion from an E.N.T or another appropriately qualified physician on the etiology of the Veteran's current sinus or allergy disabilities. The examiner must indicate review of the claims file in the examination report to include this remand order. If the VA examiner determines that an additional examination of the Veteran is necessary to provide reliable opinions as to causation, such examination should be scheduled; however, the Veteran should not be required to report for another examination as a matter of course, if it is not found to be necessary. (a.) Is it as likely as not that the currently diagnosed respiratory disabilities, to include any sinus disabilities or allergic rhinitis were incurred during active military service or are due to exposure to environmental hazards in service? The examiner must discuss the following: (i.) the Veteran's reports of exposure to in-service environmental hazards, like coal dust, gun powder, fumes, etc., which he believes caused his sinus disability. (ii.) sinus disability symptoms that the Veteran testified began in service and have continued since service, (iii.) his in-service tooth removal, that the Veteran believes caused his sinus disability, (iv.) and the February 1953 service exit examination report which contains a note, "Examinee believes he has sinusitis, no treatment received." (v.) the August 2021 addendum which suggests allergies occur when the immune system reacts to a foreign substance, such as pollen, environmental hazards, coal, gun powder, fumes. A rationale should be given for all opinions and conclusions rendered. The examiner is advised that a lack of evidence in the STRs is insufficient rationale to support a negative nexus opinion. The mere absence of evidence does not equate to unfavorable evidence. The Veteran's statements should be accepted as truthful unless otherwise shown by the record; a full explanation is required for any history rejected. The examiner may not reject a Veteran's lay testimony merely because it is not corroborated by contemporaneous medical records. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Black, Jeffrey W. 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.