Citation Nr: 21014286 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 08-20 651 DATE: March 11, 2021 REMANDED Entitlement to service connection for chronic sinus disorder, to include as due to undiagnosed illness, is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Air Force from June 1992 to December 1996. This matter come before the Board of Veterans’ Appeals (Board) on appeal from an October 2007 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) that denied service connection for chronic sinusitis. The matter has been remanded several times, most recently in February 2019, to afford the Veteran a new VA examination with an addendum opinion on aggravation of a pre-existing injury. The Board notes there is also a certified issue before the Board regarding the timeliness of the Veteran’s substantive appeal in relation to an August 2017 statement of the case (SOC). The Veteran has requested a hearing which has not yet been held. As the requested hearing for that issue remains pending, the Board will not address the issue at this time. For the reasons set forth below, the Board finds a remand is necessary in the Veteran’s claim for chronic sinus disorder. The Board regrets the delay as the Veteran has been waiting a long time for a decision on his appeal. Entitlement to service connection for chronic sinus disorder The Veteran contends that his chronic sinus condition is due to environmental hazards exposure while stationed in Southwest Asia during the Gulf War. The Board notes that the Veteran was deployed to the Persian Gulf region in June 1992. See DD-214. The Veteran’s service treatment records show he referenced a pollen allergy (“hay fever”) along with being on allergy medication on his medical examination for entry into service. See February 1992 Report of Medical History. Additionally, the Veteran was assessed with allergic sinusitis/rhinitis in service. See Osan AB Emergency Care Note, June 1995. After service, the Veteran underwent one of several VA examinations in May 2016. The examiner diagnosed the Veteran as having allergic rhinitis and found the Veteran’s chronic sinus disorder preexisted his military service based on a review of his service treatment records. The examiner found that the Veteran’s sinus disorder had a clear and specific etiology that is less likely caused by environmental hazards exposure during service in Southwest Asia. In a February 2019 Board decision, the Board found the May 2016 VA examination was inadequate because it did not render an opinion on whether the Veteran’s sinus disorder (if a pre-existing condition) was aggravated by his military service. The Board remanded the matter for a new VA examination to be conducted and to get an opinion on aggravation. The Veteran next underwent a VA examination in January 2020 for his sinus condition where the examiner diagnosed the Veteran as having allergic rhinitis and added a diagnosis of recurrent epistasis, reporting both had onset in service. The January 2020 examiner opined that the Veteran’s sinus condition is less likely than not connected to his military service. In support, the examiner cited to a single radiologic record performed in 2016 that revealed no evidence to support a chronic sinus infection. No rationale linking the evidence to the opinion was provided. Likewise, the examiner opined that the Veteran’s sinus condition was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. In support the examiner cited to the same single radiological report from 2016. Further, the examiner did not confirm whether the Veteran’s sinus condition preexisted service. The Board finds the January 2020 VA opinions to be inadequate. Specifically, the examiner did not inform the Board as to whether the Veteran’s report of “hay fever” and him being on allergy medication is a preexisting condition. Additionally, the examiner did not opine on whether the Veteran’s report of allergies upon entering service is etiologically related to the Veteran’s current diagnoses of allergic rhinitis and/or recurrent epistasis. Moreover, the examiner did not provide a rationale as to how she arrived at the conclusion that his current disability is not an aggravated disposition of his preexisting illness. Put simply, the examiner merely restated data and made conclusions without providing a supporting rationale connecting the two. VA has a duty to assist Veterans in developing their claims for benefits. 38 C.F.R. § 3.159. The duty to assist including providing a medical examination when necessary to decide a claim. 38 C.F.R. § 3.159(c)(4). When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the January 2020 VA examination is inadequate based on the examiner’s failure to render an adequate opinion on aggravation and direct service connection. Overall, the Board must be clear if the Veteran has a preexisting injury or disease that is a continuation of his current sinus condition or not. If so, the Board must be clear if the preexisting injury was aggravated beyond its natural progression due to his service. If not, the Board must be clear if the current condition is otherwise etiologically related to the Veteran’s service. Thus far, the record is not clear as to any of these questions and a remand is necessary to obtain an addendum medical opinion. The matter is REMANDED for the following actions: 1. Obtain updated VA and/or private treatment records to the extent possible. If any such records are unavailable, the Veteran’s claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. Obtain an addendum VA medical opinion for the Veteran’s chronic sinus disorder from a different medical professional with appropriate expertise. The reviewer should review the Veteran’s claims file, including a copy of this remand. Based on a review of the record, including all relevant medical and lay evidence, and a new examination if necessary, the reviewer must address the following: (a.) Does the evidence of record clearly and unmistakably (i.e., it is undebatable) show that the Veteran has a chronic sinus disorder which preexisted service? The examiner should specifically address the Veteran’s February 1992 report of having allergies upon entering service and being on allergy medication. The examiner should provide a full description of the preexisting condition, if any is found, and report any signs and symptoms that are continued in evaluating the Veteran’s current sinus disability. (b.) If a preexisting illness, injury or disease is found, is it at least as likely as not (50 percent or greater likelihood) that the preexisting chronic sinus disorder underwent worsening (i.e., permanent increase in severity) during service? The examiner should discuss relevant lay statements made by the Veteran about exposures to bun pits and having nosebleeds in service, if these relate to his preexisting illness, injury or disease, if any, and any worsening; and also, to the June 1995 service treatment record showing a diagnosis of allergic sinusitis/rhinitis. (c.) If the pre-existing chronic sinus disorder underwent worsening, is there clear and unmistakable evidence (undebatable) that such worsening of the preexisting chronic sinus disorder during service was due to the natural progress of the disease? (d.) If there is not clear and unmistakable evidence that the chronic sinus disorder preexisted service, then the Veteran must be considered to have been sound at entry without a diagnosis of a chronic sinus disorder. Based upon that premise, the examiner is asked to opine on whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran has a chronic sinus disorder which had its onset in service or is otherwise etiologically related to service. The examiner is asked to specifically address whether: (i.) The diagnosis began during active duty service. (ii.) The diagnosis is related to some incident of active duty service, to include incident to Gulf War service. The examiner should address the Veteran’s June 1995 in service diagnosis of allergic sinusitis/rhinitis, any relevant lay statements made by the Veteran reported during and after service, as well as any other relevant evidence of treatment or symptoms of a chronic sinus condition contained in the Veteran’s medical file, in rendering any opinion. The examiner should also discuss relevant lay statements made by the Veteran about exposures to bun pits and having nosebleeds during service in the Southwest Asia Theater of Operations during the Persian Gulf War and whether they relate to his current diagnoses of allergic rhinitis and recurrent epistasis. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. A complete rationale must be provided for all opinions presented. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. After the requested development has been completed, together with any additional development as may become necessary, readjudicate the Veteran’s claim. If the benefit sought on appeal remains denied, issue to the Veteran and the Veteran’s representative a supplemental statement of the case and give an opportunity to respond thereto. John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Christopher M. Davidson 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.