Citation Nr: 21013760 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 14-21 051 DATE: March 10, 2021 REMANDED Entitlement to service connection for a sinus disorder is remanded. REASONS FOR REMAND The Veteran served honorably in the Army from June 1964 to May 1967. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2012 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO) in Portland, Oregon. In October 2018 the Veteran presented testimony at a Board hearing before the undersigned Veterans Law Judge (VLJ) Sinus disorder Remand is required for an adequate VA examination. The Board regrets additional delay; however, 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. The decision was remanded in August 2020 to address the Veteran’s lay statements regarding ongoing sinus infections and relevant VA examination and private medical records. A September 2020 addendum opinion was provided. The examiner opined the sinus condition was less likely than not incurred in or caused by service. The examiner stated all records referenced in the August 2020 remand directives were reviewed. First, the remand directives stated the “examiner must address” the records not simply review them. The examiner reiterated their December 2019 opinion. The examiner stated the Veteran sustained blunt nasal trauma in 1964 and was seen twice in 1965 for upper respiratory infection and sinus congestion. The examiner stated that it was common, and usually denotes trapping of air in the sinus cavities and is not a diagnosis of sinusitis. The Board finds this characterization inaccurate and based on an inaccurate factual premise. A medical opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Notably, the same examiner noted frontal headaches in the December 2019 VA examination. The second November 1965 service treatment record (STR) stated “still has frontal headaches and sinus congestion with tenderness over frontal sinuses.” The November 1965 STR gave an impression of acute sinusitis with bronchitis. The Veteran was given a prescription. The opinion provided does not address the February 1979 private treatment record, or June 1979 VA examination. The examiner discusses the 2003 course of treatment and concludes the Veteran’s sinus problems were adequately treated. The examiner indicated occasional nasal congestion was due to allergic rhinitis. The examiner concludes by opining there was no clear evidence that any injury or illness during active duty contributed to the development of allergic rhinitis, septal deviation, or sinusitis in the years following separation. Because the examiner again failed to address the Veteran’s lay statements, relevant records, and accurate report of the Veteran’s STRs, remand is required for an addendum opinion. The matters are REMANDED for the following action: Obtain an addendum opinion regarding the etiology of the sinus disorder from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the sinus condition had onset in, or is otherwise related to, active service. The examiner must address the following: 1) the December 1964 nasal injury noted in the Veteran’s STRs 2) November 1965 upper respiratory infection and impression of acute sinusitis noted in the Veteran’s STRs; 3) the Veteran’s assertion of frequent sinus infections and nasal discharge after service that have continued since that time; 4) a February 1979 private treatment record that addressed medication and decongestant for upper respiratory infection; and 4) the June 1979 VA examination that showed obstruction of the left nostril. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Bruton, 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.