Citation Nr: 21076312 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 14-39 252 DATE: December 23, 2021 REMANDED Entitlement to service connection for sinusitis, to include allergic rhinitis, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1989 to January 1994. In December 2018, the Board denied entitlement to service connection for sinusitis. The Veteran appealed the December 2018 Board decision to the Court of Appeals for Veterans Claims (Court). The Court entered a December 2019 joint motion for partial remand (JMPR) for development of these issues. On return to the Board, this issue was remanded by the Board in April 2020 for further development. In April 2021, the Board again remanded this matter for further development. As will be detailed below, further clarification is warranted. In the April 2021 remand, the Board noted that in a May 2012 VA treatment record, the Veteran complained of "sinus problems." On examination, the medical provider observed the Veteran to have sinus tenderness. The medical provider's impression was that the Veteran had sinus problems. The Board further observed that at the time of the June 2012 VA sinusitis examination, the examiner indicated the Veteran had a diagnosis of chronic sinusitis. It noted that the June 2012 VA examiner opined that the Veteran's sinusitis was less likely than not caused by service. The examiner reasoned that the Veteran had a history of pre-existing "hay fever" or allergic rhinitis, which was documented on her enlistment examination as well as on subsequent periodic physicals. The examiner stated there was no STR evidence suggesting aggravation of this condition beyond its normal progression in-service. The examiner found that this condition was not incurred in or caused by military service and there was no evidence within the claims file to suggest permanent aggravation of this condition resulting from military service. The Board further observed that at the time of a September 2020 VA sinusitis examination, the examiner indicated the Veteran had a diagnosis of allergic rhinitis. The examiner opined that the Veteran's sinusitis was less likely than not caused by service. The examiner reasoned that although the Veteran was diagnosed with acute sinusitis in October 1990 and January 1993, there were no signs or symptoms of chronic sinusitis at the time of the examination and therefore the Veteran was not diagnosed with sinusitis. The examiner indicated that the Veteran was diagnosed instead with allergic rhinitis. The examiner further opined that the Veteran's allergic rhinitis was noted on the Veteran's enlistment examination, with an indication that she had hay fever and was allergic to dust and animals. The examiner stated that these complaints continued through the Veteran's STRs. The examiner noted that on the Veteran's separation examination, she marked no past or current sinusitis and instead marked that she had hay fever. The examiner observed the Veteran did not seek treatment for rhinitis during service and therefore, there was no increase in symptoms and no aggravation. The examiner further stated the Veteran did not have a current diagnosis of sinusitis and therefore it was less likely than not due to service. Finally, the examiner stated that the Veteran had allergic rhinitis which unmistakably existed prior to service and did not seek treatment for it in service or immediately after; therefore, it was not aggravated beyond natural progression. In its April 2021 remand, the Board noted that the VA examinations presented conflicting diagnoses. The June 2012 VA examiner indicated the Veteran had a diagnosis of chronic sinusitis, and the September 2020 VA examiner indicated the Veteran did not have a diagnosis of sinusitis. The Board further observed that the March 2012 VA treatment records showed that the Veteran complained of and was assessed to have "sinus problems." It noted that as the record indicated the Veteran had a sinus disorder or symptoms of "sinus problems" the September 2020 VA examination and opinion did not offer sufficient consideration of the entire record or sufficient detail for the Board to make an informed decision regarding the etiology of the Veteran's chronic sinus disorder or sinus complaints. As a result, the Board requested that an addendum opinion be obtained as to whether it was at least as likely as not that any diagnosed chronic sinusitis was related to service, to include in-service treatment for sinus complaints. The examiner had to address the March 2012 VA treatment for "sinus problems," the June 2012 VA examination diagnosis of chronic sinusitis, and the October 2012 VA treatment provider's positive medical opinion. The Veteran was afforded a VA examination in October 2021 and an opinion was obtained at that time. The examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner provided the following: STR 3/25/11, *10/25/93 ETS physical and report of medical history - Only documented condition was "allergic rhinitis.", 9/28/12, all show allergic rhinitis and no sinusitis. On separation exam dated 10/25/1993, vet marked "no" to sinusitis and "yes" to hay fever. There was no treatment sought for rhinitis and therefore, there was no increase in symptoms and no aggravation. Vet does not have current diagnosis of sinusitis and therefore it is less likely than not due to in service event, illness or injury. Vet has allergic rhinitis which unmistakably existed prior to service and did not seek treatment for it in service or immediately after, therefore it was not aggravated beyond natural progression. I can find no imaging for sinusitis and no treatment. As to the question of whether it was at least as likely as not that any diagnosed chronic sinusitis was related to service, to include inservice treatment for sinus complaints, the examiner stated less than secondary to inservice injury as there are no imaging techniques that show sinusitis. As to addressing the March 2012 VA treatment for sinus problems, the June 2012 VA examination diagnosis of chronic sinusitis, and the October 2012 VA treatment providers positive opinion the examiner stated the following: she has allergic rhinitis which was treated in service, STR's 1/25/92, 10/7/90, 10/25/93, 1/5/93. On separation exam dated 10/25/1993, vet marked "no" to sinusitis and "yes" to hay fever. There was no treatment sought for rhinitis and therefore, there was no increase in symptoms and no aggravation. Vet does not have current diagnosis of sinusitis, only allergic rhinitis, and therefore it is less likely than not due to in service event, illness or injury. Vet has allergic rhinitis which unmistakably existed prior to service and did not seek treatment for it in service or immediately after service as I cannot find records to support her claims. I can find no imaging for sinusitis and no treatment. While the examiner provided the requested opinion, she did not address the June 2012 VA examination diagnosis of chronic sinusitis or the October 2012 VA treatment providers positive opinion. Moreover, the service treatment records contain a specific diagnosis of sinusitis in January 1993 as opposed to rhinitis and the June 2012 VA examiner's indicated findings of chronic sinusitis. This in direct opposition to the examiner's notation that the only documented condition was "allergic rhinitis.", 9/28/12, all show allergic rhinitis and no sinusitis. Given the above, additional clarification is warranted. The matters are REMANDED for the following action: If available, return the claims folder to the examiner who provided the October 2021 opinion: Following a review of the entire file, the examiner is requested to provide the following opinion: Is it at least as likely as not that any diagnosed sinusitis disorder, to include allergic rhinitis, had its onset or is otherwise related to service? When rendering this opinion, the examiner must consider and address the following: the March 2012 VA treatment for "sinus problems," the June 2012 VA examination diagnosis of chronic sinusitis, and the October 2012 VA treatment provider's positive medical opinion. The examiner must also address and discuss the January 1993 inservice diagnosis of sinusitis. Complete detailed rationale is requested for each rendered opinion. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. S. Kelly, 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.