Citation Nr: 21029401 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 12-26 651 DATE: May 13, 2021 REMANDED Entitlement to service connection for a deviated nasal septum is remanded. REASONS FOR REMAND The Veteran had active service from June 1972 to October 1972, January 1988 to April 1988, and August 2002 to August 2003, with additional service in the National Guard. This case originally came before the Board of Veterans' Appeals (Board) on appeal from a January 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). A hearing was conducted in June 2014 by the undersigned Veterans Law Judge. A transcript is associated with the claims file. The Board previously remanded this claim in January 2015, June 2017, May 2019, and October 2020 for further development. Entitlement to service connection for a deviated nasal septum is remanded. While the Board sincerely regrets further delay, a fully-informed decision on the issue of entitlement to service connection for a deviated nasal septum can not be made because the January 2021 VA examination is inadequate. Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007). The Veteran was afforded a VA examination in January 2021. The examiner opined it was less likely than not that the Veteran's deviated nasal septum is due to or aggravated by his service-connected sleep apnea. However, the examiner based this opinion on incorrect facts. The examiner said, "deviated nasal septum was noted as a pre-operative diagnosis and was not found as a post-operative diagnosis. This would suggest that the Veteran had the condition prior to the surgery and it was treated during the surgery." However, the operative report for the Veteran's surgery in March 2007 listed "deviated nasal septum" as both preoperative and postoperative diagnoses. See Tulsa Spine and Specialty Hospital records submitted July 2011. The Veteran contends he still has a deviated nasal septum. Therefore, an addendum opinion based on an accurate review of the file is required. The matters are REMANDED for the following action: 1. Obtain all VA treatment records not currently associated with the claims file. 2. Obtain an addendum opinion for the Veteran's deviated nasal septum. The entire file should be made available to the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's deviated septum had an onset during service OR is proximately due to or aggravated (beyond a natural progression) by his service-connected obstructive sleep apnea and/or rhinitis with turbinate hyperplasia, to include the March 2007 septoplasty with partial turbinectomy, uvulopalatopharyngoplasty with tonsillectomy. The examiner is directed to specifically discuss the significance, if any, of the March 2007 surgery on the Veteran's deviated nasal septum, while considering the Veteran's preoperative and postoperative diagnoses of deviated nasal septum. The examiner must also consider and address the June 2014 hearing testimony regarding the March 2007 surgery. The examiner is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. (continued on next page) TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Papacalos, 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.