Citation Nr: 21025402 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 15-44 680 DATE: April 28, 2021 REMANDED Entitlement to service connection for a nasal disability is remanded. Entitlement to service connection for a right ankle disability is remanded. REASONS FOR REMAND The Veteran served on active duty from July 2005 to December 2011. He testified at a hearing with the undersigned in September 2019. These matters were most recently remanded in November 2020. Unfortunately, there has not been substantial compliance with the prior remand directives and another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Nasal disability The claim must be remanded again because the February 2021 VA opinion is inadequate. The Board remanded the claim in November 2020 because a January 2020 VA opinion was inadequate. That examiner diagnosed deviated nasal septum and allergic rhinitis and gave a positive nexus opinion. However, the examiner did not identify which of the diagnoses represented residual disability of a possible fracture, especially given x-ray imaging which showed no evidence of a displaced nasal bone fracture. The February 2021 examiner offered a negative opinion because x-ray evidence showed no evidence of a fracture of the nasal bones. The examiner did not discuss the likely etiology of the diagnosed deviated septum. As noted in prior remands, the Veteran testified that he fractured his nose during service while participating on the unit’s boxing team. The Board found that testimony competent and credible to the extent that the Veteran was a boxer and was likely hit in the nose. The Veteran is not competent to diagnose a nasal fracture, but he is competent to say he was hit in the nose and face. The examiner must consider the Veteran’s history and lay statements in providing the opinion. 2. Right Ankle Disability The claim must be remanded again because the January 2021 medical opinion is inadequate. A January 2020 VA examination included a diagnosis of bilateral lateral collateral ligament sprain. The examiner offered a negative nexus opinion for the right ankle based entirely on the absence of treatment records during service showing evidence of an acute or chronic condition. The basis of the January 2021 opinion was also based solely on lack of treatment records. As noted in previous remands, the Veteran testified that he suffered multiple injuries in the documented in-service motor vehicle accident and self-treated several of those disabilities. The opinions on remand must consider the Veteran’s competent lay statements. Dalton v. Nicholson, 21 Vet. App. 23 (2007). The matters are REMANDED for the following action: 1. Forward copies of all pertinent records to an appropriate examiner to determine the likely etiology of diagnosed deviated nasal septum. Based on a review of the record, the examiner must answer the following: Is it at least as likely as not that the deviated nasal septum is related to the Veteran’s service, to include his experience on the boxing team and the and the motorcycle accident? In offering the opinion, the examiner must consider, and discuss as necessary, the following: (i) the Veteran’s participation on the boxing team in service, which included taking hits to the face; (ii) his competent statements that since taking a punch to the face in 2009, has had trouble breathing and pressure on the bridge of his nose, and; (iii) the documented in-service motorcycle accident. The absence of treatment records during service cannot be the sole basis for a negative opinion. The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as adjudicators are precluded from making any medical findings. 2. Forward copies of all pertinent records to an appropriate examiner to obtain an opinion on the likely etiology of the diagnosed right ankle disability. Based on a review of the record, the examiner must answer the following: Is it at least as likely as not that the diagnosed right ankle collateral ligament sprain is related to the Veteran’s service, to include two documented snowboarding accidents and two motorcycle accidents? In answering this question, the examiner must specifically consider the Veteran’s competent statements that he had multiple injuries in the documented in-service motor vehicle accident and self-treated several of those disabilities. The absence of treatment records during service cannot be the sole basis for a negative opinion. The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as adjudicators are precluded from making any medical findings. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Jarman, 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.