Citation Nr: 21027711 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 12-19 836 DATE: May 6, 2021 ORDER Service connection for asthma is granted. REMANDED Entitlement to more than a 10 percent rating for service-connected follicular cervicitis with pelvic inflammatory disease (PID) is remanded. FINDING OF FACT The Veteran's asthma is proximately due to the Veteran's service-connected allergies. CONCLUSION OF LAW The criteria for service connection for asthma have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from March 1983 to July 1987. These matters are before the Board of Veterans' Appeals (Board) on appeal from a September 2010 rating decision. In October 2016 the Veteran presented testimony at a Central Office hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that proceeding has been associated with the claims file. The issue of an increased rating for service-connected follicular cervicitis with PID is addressed in the REMAND portion of the decision below and is REMANDED to the Agency of Original Jurisdiction (AOJ). Duties to Notify and Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), the VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.326(a) (2019). In light of the Board's favorable decision, however, any deficiencies in VA's duties to notify and assist the Veteran with her claim decided herein are moot. Service connection Legal Criteria Establishing secondary service connection requires evidence: (1) of a current disability (for which secondary service connection is sought); (2) of a service-connected disability; and (3) that the current disability was either caused or aggravated by the service-connected disability. 38 C.F.R. § 3.310(a); see also Allen v. Brown, 7 Vet. App. 439 (1995). Factual Background A March 2019 Board decision granted service connection for allergies. The Veteran has alleged, including at her October 2016 hearing, that her respiratory problems (claimed as asthma or bronchitis) were exacerbated by her service-connected allergies. Analysis First, the Board finds there is a current disability. A January 2020 private treatment record diagnosed mild intermittent asthma. The September 2020 VA examination also diagnosed asthma. However, the examiner provided a December 2020 addendum that stated the diagnosis of asthma should be removed because the pulmonary functioning test (PFT) do not support the current diagnosis of asthma or bronchitis. However, the November 2020 PFT diagnosed asthma/ bronchitis. The Board affords no probative weight to the December 2020 addendum opinion because it is based on an inaccurate factual premise. A medical opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Additionally, the examiner did not address the prior diagnoses of asthma. Second, there is a service-connected disability. A June 2020 rating decision implemented the March 2019 Board decision that granted service connection for seasonal allergies. Lastly, the Board finds the Veteran's service-connected allergies have caused her asthma. The March 2019 Board decision remanded for an aggravation opinion. The Veteran received a September 2020 examination and opinion. The examiner opined that asthma was less likely than not incurred in or caused by service. The examiner stated the Veteran was empirically treated for asthma since 1999 and no diagnostics to support are found. The examiner stated the Veteran has persistent nasal and allergy symptoms that often are irritants to underlying obstructive or reactive airway disease if diagnosed but can also typically result in symptoms similar if chronic irritation is present, such as mold. The examiner also provided an aggravation opinion and added overall the condition of allergies can irritate and cause asthma exacerbation if there is underlying asthma, otherwise it generally causes episodic symptoms of reactive airway due to the histamine and mast cell response associated with allergic reactions. The Board affords significant weight to the portion of the rationale that explains the association between asthma and allergies. The examiner's rationale clearly states the Veteran's allergies can cause symptoms of a reactive airway. The examiner disagreed that a diagnosis was present in this case. As noted above, a diagnosis is confirmed. Accordingly, service connection is granted. REASONS FOR REMAND Increased Rating Although the Board sincerely regrets the additional delay, a remand is necessary to ensure that there is a complete and accurate record upon which to decide the Veteran's claim so that every possible consideration is afforded. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Id. The Board remanded the issue in March 2019. The remand directives instructed the examiner to describe all pathology, symptoms (frequency and severity). The Veteran received a September 2020 VA examination. The examiner indicated no current symptoms and no current treatment. The examiner noted the Veteran experienced natural menopause. An October 2012 private treatment record noted post-menopausal bleeding and endometrium biopsy. The Board notes there are gaps in gynecological treatment for the period on appeal. As a VA examination that adequately addresses the frequency and severity of the Veteran's symptoms is crucial to assigning an accurate disability rating, the Board finds a remand appropriate. The matters are REMANDED for the following action: 1. Obtain all updated records (i.e., those not already of record) of VA and adequately identified private treatment the Veteran has received for the service-connected follicular cervicitis with pelvic inflammatory disease. 2. Then, arrange for the Veteran to be examined by a gynecologist to determine the current severity of her service-connected follicular cervicitis with pelvic inflammatory disease. Based on an examination, review of the record, and any tests or studies deemed necessary, the examiner should describe all pathology, symptoms (frequency and severity), and functional impairment associated with such disabilities in sufficient detail to allow for application of the pertinent rating criteria. The examiner should elicit a more detailed subjective reporting history describing the course and progression of the relevant symptoms, including pre-menopausal symptoms. 3. All opinions must include a detailed explanation (rationale). (By law, the Board may not rely on any conclusion that is unsupported by a thorough explanation. Providing such an opinion or conclusion will delay processing of the claim and may also require further clarification). VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Bruton, 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.