Citation Nr: 21073575 Decision Date: 12/09/21 Archive Date: 12/09/21 DOCKET NO. 16-51 447 DATE: December 9, 2021 REMANDED Entitlement to service connection for a sinus disorder, to include allergic rhinitis and/or sinusitis, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1969 to July 1990. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2019, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A hearing transcript is associated with the record. This appeal was remanded in October 2019, July 2020, and May 2021. Entitlement to service connection for a sinus disorder, to include allergic rhinitis and/or sinusitis, is remanded. The Veteran contends that his sinus disability had onset during service, including severe sinus headaches. See Hearing Transcript (July 2019). The Veteran's representative asserted that the sinus disability is due to flying in high altitudes during service in unpressurized AC-130 cabins. See Hearing Transcript (July 2019). The Board finds that remand is once again required to obtain compliance with its prior remand directives. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. In October 2019, the Board remanded the appeal so that the VA could obtain an examination, based on evidence of respiratory infections, sinus drainage, and chest congestion in the service treatment records (STRs) and a 1991 VA examination report that noted a history of previous upper respiratory infections. See BVA Decision (October 2019). In July 2020, the Board found the resulting February 2020 VA examination and opinion inadequate and remanded for an addendum opinion. See BVA Decision (July 2020). The Board noted that the 2020 examiner did not provide a supporting explanation that addressed the Veteran's lay statements and did not provide an explanation for why the lack of inservice diagnostic findings was supported a negative opinion. See BVA Decision (July 2020). Thereafter, in May 2021, the Board remanded the appeal after finding a November 2020 VA examination, a February 2021 addendum, and a March 2021 addendum inadequate. See BVA Decision (May 2021). The Board noted that the opinions found that there was no sinus disability but failed to address a diagnosis of allergic rhinitis at the February 2020 VA examination. The Board also noted that the March 2021 opinion contained the same inadequacy as the February 2020 opinion it did not provide an explanation linking the lack of in-service diagnostic findings to the negative nexus opinion and did not reflect the consideration of the Veteran's lay statements. See BVA Decision (May 2021). Accordingly, a July 2021 VA examination was obtained. See BVA Decision (July 2021). The examiner provided a negative nexus opinion, reasoning that there was no objective evidence of complaints or treatment during service, normal sinus findings in the STRs, that the Veteran stated his symptoms began in 2017 at the 2020 VA examination, and that medical literature did not suggest a connection between high altitude flying to sinus disability. See C&P Exam (July 2021). However, once again, the examiner did not address the Veteran's statements that the symptoms began during active duty and were recurrent since that time and did not address the STRs that showed multiple instances of upper respiratory infections and sinus drainage. See C&P Exam (July 2021). Accordingly, remand is required to obtain compliance with prior remand directives. See Stegall, supra. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran's sinus disability. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. Based on review of the record, detail the Veteran's reported symptoms, including the nature, onset, progression and severity of any symptoms consistent with any sinus disorder. The opinion should, among other things, include a discussion of the Veteran's documented history and assertions. The opinion should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). The clinician should provide the following opinions: (a) Whether there has been a sinus disability, including allergic rhinitis or sinusitis at any point during the appeal period beginning in 2016 or functional impairment in earning capacity due to sinus symptoms during that same period. (b) Whether it is at least as likely as not that any sinus disability, including allergic rhinitis and/or sinusitis, had its onset in service. Consider whether in-service symptoms described by the Veteran, such as sinus headaches, at least as likely as not represent the onset of a sinus disorder in service and indicate whether such symptoms are more likely than not due to other causesexplain. (c) Whether it is at least as likely as not that any sinus disability, including allergic rhinitis and/or sinusitis, is otherwise related to an in-service injury, event, or disease, including (i) the instances of upper respiratory infections and sinus drainage in the STRs dated in 19071, 1972, 1974, 1980, 1983, 1984, 1987, and 1989; or (ii) was caused by flying in high altitudes during service in unpressurized AC-130 cabins. NOTE (1): An adequate medical opinion may not be predicated solely on the absence of an in-service diagnosis or documented complaints. NOTE (2): If any medical history is rejected, a complete explanation is required. NOTE (3): An adequate medical opinion may not be predicated solely on medical literature without discussing facts specific to the Veteran vis-à-vis the literature and/or medical research. 2. Ensure that the medical opinion obtained includes a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.M., 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.