Citation Nr: 21022452 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 13-33 585 DATE: April 15, 2021 REMANDED Entitlement to service connection for sinusitis, to include allergic rhinitis, is remanded. Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. Entitlement to service connection for fibroids with a resulting hysterectomy as secondary to service-connected endometriosis is remanded. Entitlement to a temporary total evaluation of 100 percent for hysterectomy surgery is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1985 to April 1986 and from July 1987 to May 1997. These matters initially came before the Board of Veterans’ Appeals (Board) on appeal from January 2011 (fibroids) and April 2012 (sinus disability and OSA) rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In May 2014 and April 2016, the Board remanded the case for additional development. In August 2018, the Board denied the Veteran’s claims. The Veteran appealed the August 2018 decision to the Unites States Court of Appeals for Veterans Claims (Court). In March 2019, the Court granted a Joint Motion for Partial Remand (JMPR), vacating the Board’s decision as it related to the issues listed on the title page and remanded the matters for compliance with the instructions in the JMPR. The Board denied the Veteran’s claims on November 25, 2020. The Veteran submitted a Motion to Vacate the Board’s November 2020 decision. In order to afford due process, the Board vacated its November 25, 2020 decision denying the Veteran’s claims on March 22, 2021. 1. Entitlement to service connection for sinusitis, to include allergic rhinitis, is remanded. In her January 2021 Appellate Brief, the Veteran argued that the January 2020 VA examiner failed to discuss relevant literature submitted to VA, nor did the examiner identify current diagnoses and provide a nexus opinion as required by the 2016 Board Remand or the 2019 JMPR. Initially, Board notes that the Veteran does not identify which evidence overlooked by the January 2020 VA examiner. The examination report indicates that the examiner reviewed the Veteran’s electronic claims file, including lay statements, examination reports, and VA and private medical records. Unless the Veteran can specifically identify evidence not discussed by the VA examiner, the Board finds this vague and overbroad argument unpersuasive. Turning to the Veteran’s second and third arguments, the Board finds that a remand is proper. The evidence of the record shows that a July 2014 VA examiner provided a negative nexus opinion between the Veteran’s rhinitis and active service. No opinion was provided discussing the relationship, if any, between the Veteran sinusitis disability and active service. Since the July 2014 VA examination report, additional medical and treatment records were associated with the claims file, thereby prompting the Board to remand these matters in an April 2016 decision. A February 2018 VA examiner provided an addendum opinion where she stated that the Veteran’s sinus disability was less likely than not related to active service. The Court found this examination report inadequate for adjudication purposes and remanded the case back to the Board for additional development in accordance with the JMPR. VA obtained an addendum opinion in January 2020. There, the examiner properly addressed the lack of a nexus between the Veteran’s current sinusitis and her documented in-service sinusitis treatment. However, the examiner failed to discuss whether rhinitis was caused by or aggravated by the Veteran’s active service. As such, this case must be remanded back to the RO in order to obtain an addendum opinion from an appropriate clinician as to whether the Veteran’s allergic rhinitis and sinusitis were caused by or aggravated by her period of active service, even if the conditions have fully resolved at the time the examiner renders his or her opinion. 2. Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. The Veteran contends that sinusitis, including allergic rhinitis caused or aggravated OSA. Therefore, the issues are inextricably intertwined. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a significant impact upon another, and that impact in turn could render any appellate review meaningless and a waste of judicial resources, the two claims are inextricably intertwined). The Board additionally notes that if sinusitis or rhinitis are service-connected, an opinion regarding any relationship should be obtained. 3. Entitlement to service connection for fibroids with a resulting hysterectomy as secondary to service-connected endometriosis is remanded. On January 25, 2021, the Veteran submitted an article entitled “Do symptomatic endometriosis and uterine fibroids appear together?” published in the Journal of Human Reproductive Sciences which discusses the potential connection between the two disorders. See J Hum Reprod Sci. 2011 Jan-Apr; 4(1): 34-38. In it, the authors conclude that symptomatic endometriosis appears together with symptomatic uterine fibroids. The January 2020 VA examiner did not have an opportunity to review this newly received relevant evidence. As such, a remand is required in order to allow a VA examiner to review the new evidence and provide an opinion on the relationship, if any, between the Veteran’s service-connected endometriosis and her claimed uterine fibroids. 4. Entitlement to a temporary total evaluation of 100 percent for hysterectomy surgery is remanded. The Veteran’s claim for a temporary total evaluation for hysterectomy surgery depends on the outcome of her claim for service connection for fibroids. Therefore, the issues are inextricably intertwined. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a significant impact upon another, and that impact in turn could render any appellate review meaningless and a waste of judicial resources, the two claims are inextricably intertwined). The matters are REMANDED for the following action: 1. The Veteran should be asked to submit or provide information regarding any private or VA treatment. 2. Then, provide the Veteran with a reasonable amount of time to submit additional evidence in support of her claims on appeal. 3. Obtain an addendum opinion from an appropriate clinician discussing the following: (a.) Whether the Veteran’s allergic rhinitis is at least as likely as not related to active service. (b.) Whether the Veteran’s sinusitis is at least as likely as not related to active service. (c.) Specifically, the examiner should discuss whether there is a relationship between the Veteran’s sinusitis and rhinitis during the period on appeal and in-service treatment for sinus disabilities. The examiner should provide adequate rationale, including a detailed discussion addressing why the examiner believes the Veteran’s allergic rhinitis and/or sinusitis are related to service or are not related to service. (d.) The Board is aware that allergic rhinitis and sinusitis usually resolve within 10 days of appearing, however, as there is evidence of these disabilities occurring and resolving during the period on appeal, the examiner must discuss whether allergic rhinitis and sinusitis are related to service. 4. ONLY IF the VA examiner finds that the Veteran’s allergic rhinitis and/or sinusitis are related to active service, then obtain an addendum opinion from an appropriate clinician discussing: (a.) Whether it is more likely than not that obstructive sleep apnea caused by a service-connected sinus disability. (b.) Whether it is more likely than not that the Veteran’s obstructive sleep apnea is aggravated by a service-connected sinus disability. 5. Obtain an addendum opinion from an appropriate clinician discussing the following: (a.) Whether it is more likely than not that the Veteran’s fibroids with resulting hysterectomy are related to active service. (b.) Whether it is more likely than not that the Veteran’s fibroids with resulting hysterectomy are caused by service-connected endometriosis. (c.) Whether it is more likely than not that the Veteran’s fibroids with resulting hysterectomy are aggravated by service-connected endometriosis. The examiner must discuss the article submitted by the Veteran titled, “Do symptomatic endometriosis and uterine fibroids appear together?” published in the Journal of Human Reproductive Sciences. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mohammad Mahmoudi, 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.