Citation Nr: 21074024 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 18-34 627 DATE: December 14, 2021 ORDER Entitlement to service connection for sinusitis is granted. REMANDED Entitlement to service connection for residuals of traumatic brain injuries is remanded. Entitlement to service connection for a right wrist condition is remanded. Entitlement to service connection for a right hand condition is remanded. FINDING OF FACT The evidence is at least nearly equal that the Veteran's currently diagnosed sinusitis originally was incurred in service. CONCLUSION OF LAW The criteria for service connection for sinusitis have been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(d). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1973 to August 1993. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in July 2021, and a transcript of that hearing is of record. The Veteran seeks service connection for sinusitis, for residuals of traumatic brain injuries, and for conditions of his right wrist and hand. The former claim will be adjudicated now, while the latter three claims will be remanded. Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires evidence of (1) a current disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the claimed in-service event, injury, or disease and the present injury or disease. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Turning to the evidence regarding service connection for sinusitis, VA treatment entries from February 2017, December 2017, and January 2020 reflect that the Veteran was diagnosed with sinusitis. The Veteran testified at the July 2021 Board hearing that he did not have problems with his sinuses until he was stationed in Hawaii during service, as well as that he has had reoccurring nasal congestion and sinus headaches since the problems began. The Veteran's service treatment records reflect several instances of symptoms that were assessed as upper respiratory infections. Moreover, on multiple in-service reports of medical history, the Veteran answered "Yes" to whether he at that time or ever before had hay fever, including on his February 1993 report of medical history on which he added that he had taken Benadryl for his symptoms. In accord with the Veteran's hearing testimony of his problems beginning in service, his March 1973 enlistment examination and report of medical history noted no problems with his sinuses. In August 2021, the Veteran's treating clinician, D.P., noted the Veteran's in-service symptoms and reports of "hay fever" treated with Benadryl, and opined that the Veteran's "currently diagnosed sinusitis is a continuation of [the] sinus condition noted during his military career." Based on the service treatment records evidencing a recurring in-service history of upper respiratory infections and associated symptomatology, and the Veteran's current diagnoses of sinusitis which were interpreted by the August 2021 clinician as a continuing process of the condition originally incurred in service, the Board finds that the evidence is at least nearly equal that the Veteran's current sinusitis was incurred in service. 38 C.F.R. § 3.303(d). Where the evidence is nearly equal, the claimant prevails. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 999 F.3d 1391, 1395 (Fed. Cir. 2021); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, with evidence that the Veteran's current condition was incurred in service, entitlement to service connection for sinusitis is granted. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(d). REASONS FOR REMAND The Board finds that remand is required for the remaining claims. Regarding the claim for residuals of a traumatic brain injury, a C&P examination was provided in October 2015. Based on the examination at that time, the examiner found the Veteran was not experiencing any symptoms diagnosable as residuals of the in-service head injuries, to include an injury at boot camp when the Veteran hit his head while doing sit-ups, as well as when the Veteran hit an overhead while exiting a ship, lacerating his head and requiring stitches. Though the Veteran related to the October 2015 examiner that he was experiencing headaches and emotional symptoms that he contended were due to those injuries, the examiner opined that the Veteran's headaches are not associated with the claimed head injuries, and at a mental health examination one month later the Veteran denied any emotional symptomatology and was found not to have any diagnosable mental health condition. Since that time, however, the Veteran has received mental health treatment at VA and has been diagnosed by his psychiatrist with intermittent explosive disorder. At the July 2021 Board hearing the Veteran explained that his contention is that following service he noticed "a real short fuse" that "has gotten worse since [he]'s gotten older," and he believes that this is due to his in-service traumatic head injuries. Given these reports of symptomology and an associated psychiatric diagnosis during the appeal period, which the Veteran has asserted is a residual of his in-service head injuries, remand is required in order to obtain an opinion addressing this theory of service connection. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (holding that the requirement for a current disability is satisfied where the evidence shows the Veteran had a disability at any time during the pendency of his claim). Regarding the Veteran's claims for right wrist and right hand conditions, examinations were provided in October 2015, with diagnoses of arthritis in the bilateral wrists and bilateral hands. The Veteran related that in boot camp a spinning rifle hit his wrist and hand, injuring them, and the examiner noted an August 1973 service treatment record with an impression of a "possible bone contusion w/ some myo damage." The Veteran also reported general use throughout the rest of his service, including "grabbing towing lines, getting it hit on stuff, hanging onto firehoses, . . . [t]ypically everyday collateral duties." Ultimately, the examiner concluded that "[g]iven the bilateral involvement" of his arthritis, "this is most likely secondary aging. There is no evidence of residuals of an injury to the right hand/wrist." At the July 2021 Board hearing, the Veteran added his contention that in his military occupational specialty as a radioman, his "20 years of using [his] hand for Morse code" and typing, as well as chipping paint on ships in the course of normal Coast Guard duties, caused his current wrist and hand conditions. Moreover, he related that there were nights in service, particularly after performing his radioman duties and chipping paint, where he would come home with an aching wrist and hand and would need to apply Bengay to find relief. Given these additional in-service injuries and the Veteran's competent testimony regarding his symptoms during service, the Board finds that an addendum opinion should be provided that considers this relevant information. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Accordingly, the matter is REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of the Veteran's claimed residuals of traumatic brain injuries. The clinician is asked to opine on all of the following: (a) Is the Veteran's reported symptom of irritability, which he reported began after service and has worsened since he got older, and/or his diagnosed condition of intermittent explosive disorder, at least as likely as not due to his claimed traumatic brain injuries, to include an injury at boot camp when the Veteran hit his head doing sit-ups as well as when the Veteran hit his head on a ship overhead, lacerating his skull and requiring stitches? (b) Are the Veteran's headaches, including light and noise sensitivity, at least as likely as not due to his claimed traumatic brain injuries, to include an injury at boot camp when the Veteran hit his head doing sit-ups as well as when the Veteran hit his head on a ship overhead, lacerating his skull and requiring stitches? 2. Obtain an addendum opinion regarding the etiology of the Veteran's diagnosed right-wrist arthritis and right-hand arthritis. The clinician is asked to opine whether the Veteran's conditions at least as likely as not are related to his service, to include as due to the injury in 1973 in which a spinning rifle hit his wrist and hand, and/or as due to the cumulative use of his wrist and hand during his 20 years active-duty service as a Morse code radioman, typing, chipping paint off ships, opening and closing hatches, grabbing towing lines, and holding fire hoses. In rendering this opinion, the clinician must consider and discuss the Veteran's testimony that during service there were evenings after the day's work when he needed to apply Bengay to relieve the pain in his wrist and hand. 3. After the above development and any other development deemed necessary is completed, readjudicate the Veteran's claims. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Davis, 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.