Citation Nr: 21074642 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 15-04 059A DATE: December 15, 2021 ORDER Service connection for chronic sinusitis with allergic rhinitis is granted. FINDING OF FACT The Veteran's current chronic sinusitis with allergic rhinitis was incurred in service. CONCLUSION OF LAW The criteria for service connection for chronic sinusitis with allergic rhinitis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1977 to September 1980. This appeal is before the Board of Veterans' Appeals (Board) from an August 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office. The Board remanded the matter on appeal in May 2018, April 2020, and March 2021. In March 2021, the Board also remanded the issue of service connection for a dental condition for treatment purposes, instructing the agency of original jurisdiction (AOJ) to refer the matter to the appropriate VA medical center for consideration, to include promulgation of a Form 10-7131 if applicable, and to associate an indication of this with the record. A September 2021 memorandum indicates that the AOJ referred the matter to the Memphis VA Medical Center, in accordance with the Board's remand. Therefore, the matter of service connection for a dental condition for treatment purposes is not currently before the Board and will not be addressed in this decision. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. Service connection for chronic sinusitis with allergic rhinitis is granted. In his most recent March 2021 VA examination, the Veteran was diagnosed with chronic sinusitis and allergic rhinitis. VA treatment records, including those dated in August and December 2013 and January 2018, confirm these diagnoses. In its May 2018 remand, the Board noted that, while the Veteran's service treatment records did not appear to contain any entries showing a diagnosis of or treatment for a chronic sinus disorder, in his July 2012 application, the Veteran reported his sinus problems were due to breathing in dust and pollen from field duty, and inhaling certain gases. Noting that such exposure appeared consistent with the fact that his assigned military duties included that of a short-range missile crewman and personnel carrier driver, the Board instructed the AOJ to obtain a medical opinion to determine whether the Veteran's current allergic rhinitis was due to service. In April 2020, the Board, finding a July 2019 VA examiner's opinion inadequate, remanded for another medical opinion. The examiner was instructed to consider all relevant medical and lay evidence, including the Veteran's reports on July 2019 VA examination of problems breathing and runny nose in service and treatment with Zyrtec and Singulair shortly after service. The AOJ obtained another VA medical opinion, dated in May 2020. In its March 2021 remand, the Board determined that the opinion offered a negative nexus finding, but merely stated as a rationale that the Veteran's service treatment records did not contain a diagnosis for allergic rhinitis during service. The Board noted that lack of evidence cannot be treated as substantive negative evidence, and that reliance on the lack of medical evidence, especially without consideration of lay statements, is an inadequate rationale. It therefore determined that the April 2020 remand directives were not substantially complied with, and that the matter must again be remanded for an addendum VA medical opinion that addressed all the evidence of record, including the Veteran's lay statements. The AOJ obtained another VA addendum opinion in July 2021, in which the VA examiner diagnosed chronic sinusitis with allergic rhinitis, but determined that such disability was not related to service. The examiner's rationale was as follows: "Despite the veterans [sic] verbal reports of sinus problems during and shortly after service that are no medical records to supports [sic] the claim. The veteran serviced [sic] from 1977 to 1988 however records only support sinus etc complaints sometime later (years)." The VA examiner's rationale, in short, was again solely the lack of medical documentation until years after service. While noting the Veteran's reports of sinus problems during and shortly after service, the examiner simply dismissed them by citing the lack of documented medical evidence, without explaining whether this was because the lack of documentation contradicted the Veteran's assertionsand if so, why this wasor whether, even if the Veteran's assertions were credible, the lack of documentation weighed against a finding of nexusand, if so, why this was. The rationale did not explain why a lack of medical documentation persuasively showed that the Veteran's sinus condition was not related to service. Moreover, the opinion did not address the question of whether the Veteran's sinus problems might be related to breathing in dust and pollen from field duty or inhaling certain gases, which the Board previously found consistent with his assigned military duties, and which was the original basis of the Board's opinion request in its May 2018 remand. Under these circumstances, the Board finds that a fourth remand of the issue on appeal for yet another addendum opinion is unlikely to aid in deciding the appeal and is not warranted. The Board has previously noted the Veteran's reports of inhalation exposure in service and subsequent in-service sinus problems continuing after service. Given this, the Board finds that the evidence as to whether the Veteran's current chronic sinusitis with allergic rhinitis was incurred in service to be in relative equipoise. Resolving reasonable doubt in his favor, the Board finds that it was. Accordingly, service connection for chronic sinusitis with allergic rhinitis must be granted. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mack, Andrew 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.