Citation Nr: 21026031 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 16-03 087 DATE: April 29, 2021 ORDER Entitlement to service connection for vasomotor rhinitis is granted. REMANDED The issue of entitlement to service connection for gastric condition (stomach disability), to include residuals from gastric cancer, gastritis, and gastroesophageal reflux disease (GERD), is remanded. FINDING OF FACT Resolving reasonable doubt in favor of the Veteran, his vasomotor rhinitis had its onset during his active service. CONCLUSION OF LAW The criteria for entitlement to service connection for vasomotor rhinitis have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from December 1971 to May 1993. This appeal arose from a January 2014 rating decision. In November 2018 and September 2020, the Board remanded these issues for further evidentiary development to be conducted by the Agency of Original Jurisdiction (AOJ). Entitlement to service connection for vasomotor rhinitis. The Veteran contends that the onset of his nasal condition began during his active service. A Veteran is granted service connection where evidence shows that an injury or disease that results in a current disability was incurred during service or was aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §3.303(a). To be entitled to service connection, the evidence must support (1) a current disability; (2) an in-service injury or event; and (3) a nexus between the current disability and the in-service injury or event. 38 C.F.R. §3.303(a). The evidence of record establishes that the Veteran has a current diagnosis of vasomotor rhinitis. See October 2013 and October 2019 VA Examination Reports. Regarding an in-service injury or event, the service treatment records document multiple complaints concerning the Veteran’s nasal condition. In September 1976, it was noted that the Veteran experienced an infection on the left side of the nose. The Veteran reported having pain in his nose. It was documented that his nasal passage was swollen. In January 1979, the Veteran reported sharp and throbbing pain radiating from the frontal sinus area. In June 1984, the Veteran complained of a head cold lasting for 24 hours. It was documented that the Veteran’s nose was swollen and had boggy turbinates. The assessment provided was upper respiratory infection. On the April 1993 Report of Medical History, the Veteran reported experiencing sinusitis. Regarding whether there is nexus between the Veteran’s current condition and his in-service symptoms, the VA examiner in October 2013 concluded that it could not be stated without mere speculation that the Veteran’s non-allergic vasomotor rhinitis was a continuation of his symptoms experienced during his service. The examiner did state that the Veteran’s recurring nasal congestion was secondary to his non-allergic vasomotor rhinitis. The examiner stated that the Veteran demonstrated an unusual reaction to cold temperature and wind, causing immediate nasal congestion. The examiner explained that it was a recognized clinical problem in which the cold caused autonomic nerve stimulation resulting in sympathetic or parasympathetic alterations, causing nasal congestion. The Board remanded the claim to obtain further clarification. In October 2019, the VA examiner provided a negative nexus opinion. The examiner indicated that there was no documentation of a diagnosis of chronic vasomotor rhinitis while the Veteran was in service or in the year following his separation for active service. This opinion was solely based on the absence of medical documentation, which is inadequate in this matter. See Dalton v. Nicholson, 21 Vet. App. 23 (2007); see also Dalton v. Peake, 21 Vet. App. 23 (2007). Therefore, the Board again remanded the claim to obtain another medical opinion. In January 2021, the VA examiner opined that it was less likely than not that the Veteran’s condition was incurred in or caused by his service. The examiner stated that the in-service reports of medical history and examinations in April 1978, October 1984 and April 1993 did not reveal a history or physical examination findings for ongoing acute or chronic treatment of allergic rhinitis condition. The examiner continued that the medical record review did not reveal continuous ongoing medical treatment or aggravation of acute or chronic allergic rhinitis condition during the time of discharge to present day. This opinion does not adequate address the evidence of the record. The opinion fails to consider and discuss the in-service symptoms noted and explain its relation to the Veteran’s condition. Additionally, the Veteran was diagnosed with vasomotor rhinitis, not allergic rhinitis. This examiner based the opinion solely on the absence of documentation and an inaccurate factual premise. Therefore, the Board gives this opinion low probative weight in this matter. At the October 2013 VA Examination, the Veteran reported experiencing nasal congestion, explaining as his sinuses running. He stated it was worse whenever he got any wind or draft and would experience nasal congestion within 10 to 15 minutes. At the October 2019 VA Examination, the Veteran reported experiencing sinus problems back to the 1970s. The Veteran expressed that his symptoms periodically worsened, and he used Zyrtec daily. In this matter, the Board finds that the Veteran is competent to report symptoms of nasal congestion. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board also finds his statements to be credible. After a thorough consideration of the medical and lay evidence of the record, the Board finds that a reasonable doubt has arisen regarding the initial onset of the Veteran's rhinitis. The Board finds the Veteran’s statements of continuing symptoms since his service to be competent and credible. The Veteran’s in-service symptoms are similar to the symptoms noted in the October 2013 VA examination, such as abnormal turbinates, swollen nasal passages, and nasal congestion. When thoroughly considering the Veteran’s credible accounts of his symptoms during and after service, the service treatment records, and that he was diagnosed with vasomotor rhinitis based on similar symptoms, the evidence raises a reasonable doubt as to the initial onset of the Veteran's vasomotor rhinitis. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Resolving all reasonable doubt in favor of the Veteran, the Board finds that the Veteran's vasomotor rhinitis is related to his service. 38 C.F.R. § 3.303(d). The Board determines that the criteria for service connection have been met, and entitlement to service connection for vasomotor rhinitis is warranted. REASONS FOR REMAND The issue of entitlement to service connection for gastric condition (stomach disability), to include residuals from gastric cancer, gastritis, and gastroesophageal reflux disease (GERD), is remanded. After a thorough review of the Veteran's claims file, the Board has determined that additional evidentiary development is necessary prior to the adjudication of the Veteran’s claim of entitlement to service connection for a gastric condition. Post-service treatment records show that in 2015, the Veteran developed gastric adenoma. The diagnoses provided was tubular adenoma and mild inactive chronic gastritis. The Veteran underwent a gastrectomy due to his gastric cancer in 2015. Records also noted that the Veteran is being treated for gastroesophageal reflux disease (GERD). See November 2015 VA Medical Treatment Records (CAPRI). The service treatment records document multiple complaints regarding abdominal pain. The Veteran was assessed to have gastroenteritis and viral gastritis multiple times. See June 2013 Service Treatment Records (STR). In January 2021, the VA examiner opined that it was less likely than not that the Veteran’s gastric adenoma or current stomach symptoms was incurred in or caused by his service. The examiner stated that the in-service reports and examinations did not reveal a history or physical examination findings for ongoing acute or chronic treatment of a gastric adenoma condition. The examiner also stated that the medical record review did not reveal continuous ongoing medical treatment or aggravation of acute or chronic gastric adenoma condition from the time of separation to the present day. Again, in this opinion, the examiner fails to adequately address the relevant medical evidence of the record and resolve the medical questions. The examiner does not address the in-service complaints and diagnoses of gastroenteritis and gastritis and determine if those diagnoses were early manifestations of the Veteran’s current gastric condition. Additionally, it is unclear as to the exact diagnosis or diagnoses of the Veteran’s current gastric condition. The medical evidence shows that he is being treated for GERD. Furthermore, the medical evidence discusses issues with the Veteran’s colon in conjunction with his gastric condition and abdominal. Therefore, there needs to be clarification regarding the assessment of the Veteran’s specific gastric condition. On remand, the AOJ should obtain another VA medical examination and opinion that fully addresses and resolves the medical questions in order to determine the nature and etiology of the Veteran’s gastric condition. The matter is REMANDED for the following action: 1. Provide the Veteran an opportunity to identify any pertinent treatment records for his gastric condition. The Agency of Original Jurisdiction (AOJ) should secure any necessary authorizations. If the records cannot be obtained, inform the Veteran of the records that could not be obtained, including what efforts were made to obtain them. The Veteran should also be notified that he may submit any such records. All efforts should be recorded in the claims folder. Additionally, all updated VA treatment records should be obtained. If any requested outstanding records cannot be obtained, the Veteran should be notified of such. 2. Once all available, relevant medical records have been received, and associated with the claims file, schedule the Veteran for a VA examination to determine the nature and etiology of his gastric condition. Any and all indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The claims file and a copy of this REMAND should be made available to the examiner for review. After record review and examination, the VA examiner should offer his or her opinion with supporting rationale as to the following inquiries, as clearly and precisely as possible: (a) Please provide the diagnosis or diagnoses of a gastric condition found to be present during the pendency of this appeal. If there are different diagnoses than those currently of record, the examiner should attempt to reconcile the diagnoses with the evidence of record. (b) For any gastric condition found to be present during the appeal period, is it at least as likely as not (50 percent or greater probability) that the Veteran's gastric condition was incurred in, caused by, or etiologically related to the Veteran's service? The examiner must consider and address the in-service complaints of abdominal pain, nausea, and the diagnoses of gastroenteritis and gastritis when rendering the opinion. In rendering these opinions, the examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If the Veteran’s reports are discounted, the examiner should provide a reason for doing so. A fully articulated medical rationale for each opinion expressed must be set forth in the medical report. The examiner should discuss the particulars of this Veteran's medical history, pertinent lay evidence, and the relevant medical literature or studies as applicable to this case, which may reasonably explain the medical analysis in the study of this case. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. 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. 3. Then, review the record, conduct any additional development deemed necessary, and readjudicate the claim. If any benefit sought remains denied, furnish to the Veteran (and, if applicable at the time, his representative) an appropriate supplemental statement of the case (SSOC). The Veteran should be afforded the appropriate time period to respond. Thereafter, if indicated, the case should be returned to the Board for the purpose of appellate disposition. R. Costello Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Middleton, 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.