Citation Nr: 21025120 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 18-30 580 DATE: April 27, 2021 REMANDED Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for residuals of a nasal fracture is remanded. Entitlement to service connection for a headache disorder, including as secondary to residuals of a nasal fracture is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from January 1962 to April 1966. This appeal arises from a January 2014 rating decision, denying the Veteran’s service-connection claims for a nose disorder, migraine headaches and a right knee disorder. These denials were continued in a September 2014 rating decision. The Veteran and his spouse testified at a Board videoconference hearing in June 2020, before the undersigned Veterans Law Judge (VLJ). A transcript is of record. In October 2020, the Board remanded the case to the AOJ for additional development and consideration. The file is again before the Board for further appellate review. 1. Entitlement to service connection for a right knee disorder. The Veteran testified that when he was stationed with the U.S. Navy in Guam, during 1964 and 1965, he played on the football team. He sustained an in-service knee injury and nose fracture playing football, and then had migraine headaches as a result of the nose fracture. He testified he had a total knee replacement on that knee a couple years ago as a result of the in-service knee injury. Moreover, the Veteran has submitted lay statements in support of his claims, such as an April 1966 letter (coincident with time of separation) from the football coach for his assigned ship, the U.S.S. Proteus, who confirmed he played football while stationed in Guam in 1965. He also included a copy of his ship’s August 1965 newsletter, with a photo of the ship’s football team, with a hand-written notation that purportedly identifies the Veteran as amongst the team. His brother, C.F., also provided a February 2014 statement that states he was told by the Veteran about a “screwed up knee” and breaking his nose a couple times from playing semi-pro football for the USS Proteus. Importantly, following the Veteran’s personal hearing, he submitted a June 2020 positive nexus opinion from a private treating physician, Dr. J.D., that indicated a relation between “long standing” deviated septum, knee pain and migraines and service. Dr. J.D. stated that he has been treating the Veteran for these conditions since 2014, but did not provide a rationale in support of the positive opinion. The October 2020 Board remand directed the AOJ to provide a VA examination and medical opinion to ascertain the nature and etiology of the Veteran’s claimed right knee, nasal and headaches disabilities. A remand by the Board confers on a Veteran the right to substantial compliance with the remand orders. Stegall v. West, 11 Vet. App. 268 (1998); D’Aries v. Peake, 22 Vet. App. 97 (2008). On remand, a December 2020 VA examiner diagnosed right knee osteoarthritis, but found it was less likely than not (less than 50 percent probability) related to service. However, the Board finds the July 2019 examiner’s negative nexus opinion was inadequate because it did not consider lay statements on a history of chronic bilateral knee pain since an in-service right knee football injury. When VA undertakes to examine a Veteran, VA is obligated to ensure that that examination is adequate. See Barr v. Nicholson, 21. Vet. App. 303 (2007). Inadequate medical examinations include examinations that contain only data and conclusions, do not provide an etiological opinion, are not based upon a review of medical records, or provide unsupported conclusions. Nieves- Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Thus, an addendum VA medical opinion is warranted. 2. Entitlement to service connection for residuals of a nasal fracture. On remand, the December 2020 VA examiner indicated the Veteran had no current evidence of nasal fracture or deviated septum disability to relate to service. The requirement that a current disability be present is satisfied when a claimant has a disability: 1) at the time a claim for VA disability compensation is filed, or 2) during the pendency of that claim, even though the disability resolves prior to adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319 (2007); but see Romanowsky v. Shinseki, 26 Vet. App. 289, 293-94 (2013) (holding that “when the record contains a recent diagnosis of a disability prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.”). However, the VA examiner did not appear to reconcile whether a deviated septum disability may have existed during at least a portion of the pendency of the appeal or recent to the filing of the March 2013 claim. See Barr, 21. Vet. App. at 303; and Nieves- Rodriguez, 22 Vet. App. at 304; and Stefl, 21 Vet. App. at 124. During the pendency of the claim, a June 2020 letter from a private treating physician, Dr. J.D., indicated a relationship between activities in service and a “long standing” deviated septum disability that he has treated the Veteran for since 2014. The Board also notes that the examiner did not clarify if the Veteran may have had a deviated septum disability recent to the March 2013 claim, given that a February 2010 sinus CT scan assessed chronic sinusitis. Thus, an addendum VA medical opinion is warranted. 3. Entitlement to service connection for a headache disorder, including as secondary to residuals of a nasal fracture. On remand, the December 2020 VA examiner diagnosed a current migraine headaches disability. The examiner provided a negative opinion against the possibility that his current headaches disability was related to service, stating, “I cannot find a nexus to support a in service injury or an event caused his [headaches] as there multiple records noting different etiologies or triggers for the headaches. The [headaches] are less likely than not due to any event in service.” Regrettably, the opinion is inadequate because it noted his current headaches disability could have many different etiologies but did not state why this precluded the possibility of his migraine headaches being etiologically related to service. See Barr, 21. Vet. App. at 303; and Nieves- Rodriguez, 22 Vet. App. at 304; and Stefl, 21 Vet. App. at 124. Thus, an addendum VA medical opinion is warranted. The matters are REMANDED for the following action: 1. Arrange for an addendum medical opinion from a qualified VA clinician (different from the December 2020 VA examiner) to determine the etiology of the Veteran’s right knee disability. If the examiner determines that another in-person examination of the Veteran is required to provide the below-requested information, then such an examination should be scheduled. The examiner should provide the following: After examination and review of the claims file, the examiner should express an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any diagnosed right knee disability (e.g., right knee osteoarthritis) is caused by or otherwise etiologically related to his active service. Rationale must be provided for the opinion proffered. The examiner must consider any competent lay statements by the Veteran on the history of his claimed disability during service and symptoms (e.g., knee pain) following service. 2. Arrange for an addendum medical opinion from a qualified VA clinician (different from the December 2020 VA examiner) to determine the nature and etiology of the Veteran’s claimed nasal/sinus disability. If the examiner determines that another in-person examination of the Veteran is required to provide the below-requested information, then such an examination should be scheduled. The examiner should provide the following: (a) The examiner should identify all current diagnoses for the claimed nasal/sinus disability, since the pendency of or recent to the filing of the March 2013 claim. Specifically confirm if the Veteran has been diagnosed with a deviated septum, chronic sinusitis, or residuals of a nasal fracture, at any time since or recent to the March 2013 claim; and if so, clarify the diagnosis. (b) After review of the claims file, the examiner should express an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any diagnosed nasal/sinus disability is caused by or otherwise etiologically related to his active service. Rationale must be provided for the opinion proffered. The examiner must consider any competent lay statements by the Veteran on the history of his claimed disability during service and symptoms (e.g., nasal pain and sinus problems) following service. 3. Then, arrange for an addendum medical opinion from a qualified VA clinician (different from the December 2020 VA examiner) to determine the etiology of the Veteran’s headaches disability. If the examiner determines that another in-person examination of the Veteran is required to provide the below-requested information, then such an examination should be scheduled. The examiner should provide the following: (a) After examination and review of the claims file, the examiner should express an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any diagnosed headaches disability (e.g., migraines) is caused by or otherwise etiologically related to his active service. (c) The examiner should also opine as to whether it is at least as likely as not (50 percent probability or greater) that any diagnosed headaches disability (e.g., migraines) was caused by, proximately due to, and/or aggravated by any diagnosed nasal/sinus disability. (Continued on the next page)   Rationale must be provided for the opinion proffered. The examiner must consider any competent lay statements by the Veteran on the history of his claimed disability during service and symptoms (e.g., headaches) following service. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Biswajit Chatterjee, 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.