Citation Nr: 21008382 Decision Date: 02/16/21 Archive Date: 02/16/21 DOCKET NO. 17-29 149 DATE: February 16, 2021 REMANDED Entitlement to an initial compensable rating for allergic rhinitis is remanded. REASONS FOR REMAND The Veteran served on active duty from July 2007 to June 2008 with additional service in the Army Reserves. This matter was previously remanded in August 2018 and most recently in July 2020. It now returns for further appellate review. The Board of Veterans Appeals (Board) notes that the Veteran was granted service connection for obstructive sleep apnea in a November 2020 rating decision. Thus, the service connection claim for obstructive sleep apnea is no longer before the Board because a grant of service connection constitutes a full grant of benefits on appeal. Grantham v. Brown, 111 F.3d 1156 (Fed. Cir. 1997). 1. Allergic Rhinitis Although, further delay is regrettable, the Board finds another remand is necessary in order to schedule the Veteran’s for an in-person examination. The Board remanded the claim in July 2020 in order to obtain a VA examination for the Veteran’s service-connected allergic rhinitis. Pursuant to the remand, the VA obtained an examination in September 2020. See September 2020 VA Sinusitis, Rhinitis, and Other Conditions Disability Benefits Questionnaire (DBQ). The VA examiner noted that the report was based on record review, and that no physical examination was performed because face to face examinations were suspended due to COVID-19 pandemic emergency. In the February 2021 appellate brief the Veteran’s representative stated “[w]e applaud VA’s efforts to continue the claims process under the burdens of the COVID-19 shutdown, however, we have to question the effectiveness for a telephone examination in this case, such as with allergic rhinitis, when so much of the rating criteria implies that an in-person assessment is necessary.” See February 2021 Appellate Brief. The Board agrees with the Veteran’s representative, although VA’s efforts to process the Veteran’s claim under the constraints caused by the COVID-19 pandemic are commendable, an in-person examination is necessary to address the current nature and severity of the Veteran’s allergic rhinitis. The Veteran’s representative also argued that the Veteran reports flare-ups of his allergic rhinitis which results in greater than 50 percent obstruction of nasal passages or complete obstruction on one side. See February 2021 Appellate Brief. The Board requires a physical examination and medical opinion to determine whether the Veteran’s flare-up results in or approximates greater than 50 percent obstruction of nasal passages or complete obstruction on one side. Additionally, the Board notes that the September 2020 VA examiner relied on the findings of the August 2016 VA examination. However, the August 2016 VA examiner did not obtain any imaging studies including x-rays or CT scans, to determine whether the Veteran is currently experiencing any nasal obstruction. Therefore, for the foregoing reasons the Board finds a new VA examination is warranted. Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board notes the claims file reflects that the Veteran has been receiving treatment from the San Juan VA Medical Center (VAMC), and that records dated through August 2020 are associated with the file; however, more recent records may exist. The Board emphasizes that records generated by VA facilities that may have an impact on the adjudication of a claim are considered constructively in the possession of VA adjudicators during the consideration of a claim, regardless of whether those records are physically on file. See Sullivan v. McDonald, 815 F.3d 786, 793 (Fed. Cir. 2016). The matters are REMANDED for the following action: 1. Obtain the Veteran’s comprehensive VA treatment records for the period from August 2020 to the present, to include from VA medical centers, clinics, counseling centers, hospitals, and outpatient treatment centers.  See 38 C.F.R. § 3.159(c)(3) (2020).   The Board observes that the Veteran has been treated at the San Juan VAMC.   2. Schedule the Veteran for AN IN-PERSON VA EXAMINATION to determine the severity of his service-connected allergic rhinitis. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. All indicated tests and studies should be performed, such as X-rays and/or CT scan. The claims file, including a copy of this remand, must be made available to the examiner for review who shall indicate that the claims file was reviewed in her/his examination report. • If at all practicable, an in-person examination should be scheduled. • The Board recognizes the potential practical difficulties in scheduling an examination in light of the COVID-19 epidemic and requests flexibility and understanding in affording the Veteran any warranted examination. (a.) The examiner is asked to fully describe all symptomatology and functional deficits associated with this disability pursuant to the diagnostic criteria described in 38 C.F.R. § 4.97, including Diagnostic Code 6522. (b.) The examiner is directed to ensure IMAGING TESTS, SUCH AS X-RAYS OR A CT SCAN, ARE CONDUCTED so as to determine whether there is presently any obstruction in the nasal passage. (c.) THE EXAMINER SHOULD SPECIFICALLY OPINE AS TO WHETHER THE VETERAN’S REPORTS OF RHINITIS EXACERBATION (FLAREUPS) AT LEAST 2 TIMES PER WEEK ARE CONSISTENT WITH OBSTRUCTION OF NASAL PASSAGES ON BOTH SIDES OR COMPLETE OBSTRUCTION ON ONE SIDE. SEE SEPTEMBER 2020 VA EXAMINATION. • Any opinion expressed by the VA examiner should be accompanied by a complete rationale. If medical literature is relied upon in rendering this determination, the VA examiner should identify and specifically cite each reference material utilized. • If the VA examiner is unable to offer an opinion without resorting to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. 3. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Lilly, Associate Attorney 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.