Citation Nr: 21039713 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 16-22 308 DATE: July 1, 2021 REMANDED Entitlement to service connection for sinusitis is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1974 to December 1978. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision of the Department of Veterans Affairs (RO). In May 2019, the Board denied the Veteran's claim for service connection for chronic sinusitis. The Veteran appealed the denial to the United States Court of Appeals for Veterans Claims (Court) which in a June 2020 Order and pursuant to a Joint Motion for Partial Remand (JMPR), vacated and remanded the May 2019 Board denial. In December 2020, the Board remanded the case for further development in compliance with the JMPR. On review however, another remand is necessary to obtain an adequate medical opinion regarding the likely etiology of the Veteran's sinus disorder. In the December 2020 remand, the Board asked the examiner (a physician or "preferably an otolaryngologist") to provide an opinion regarding the nature, severity, and etiology of the Veteran's claimed chronic sinusitis for the period on appeal. In April 2021, a VA family nurse practitioner opined that the claimed condition was less likely than not (50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness, reasoning that the Veteran denied sinus trouble on a June 1976 dental questionnaire and lacked repeated visits for sinus issues since service. The nurse practitioner also noted the private medical records mentioned sinus issues as possibly secondary to dental procedures and to an abcess. Lastly, the nurse practitioner noted the Veteran stated he had surgery for deviated septum in 2019 and continued to have sinus issues, but that the septum surgery was not documented in the record. However, the Board notes that the nurse practitioner did not address the Board's questions regarding the etiology of the sinus disorder or acknowledge the private treatment records and the possible impact of any root canals, dental implants or allergic rhinitis as mentioned in the private doctor statements as requested by the Board. Therefore, this examination report is inadequate and does not substantially comply with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Lastly, as noted by the nurse practitioner, the records regarding deviated septum surgery in 2019 are not associated with the claims file and an attempt to obtain these records should be made. Accordingly, this case is REMANDED for the following action: 1. Contact the Veteran and ask him to identify any information regarding his report of a 2019 deviated septum surgical repair. Then provide him with VA Forms 21-4142, Authorization and Consent to Release Information to the VA, for the identified outstanding and relevant private treatment records. Advise him that he may submit such records if he so chooses. 2. Thereafter, obtain another medical opinion from a physician (or preferably an otolaryngologist) regarding the likely etiology of the Veteran's claimed chronic sinus disorder. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. After review of the record, the examiner is asked to respond to the following: (a) Provide an opinion as to whether it is at least as likely as not (a 50 percent or higher probability) that the Veteran's claimed chronic sinusitis is due to, related to, or otherwise etiologically associated with an in-service event, injury or disease, specifically removal of tooth #14. (b) The examiner must consider and discuss as necessary any etiological relationship between the Veteran's in-service dental surgery on tooth #14 (which involved removal of a broken root canal file) and the claimed chronic sinusitis as well as any other possible dental issues or medical disorders and their possible relationship to sinusitis. **In doing so, please consider and address all pertinent lay and medical evidence of record including, but not limited to: (a) the August 2015 medical opinion by Dr. M.P.S. (including reference to diagnosis of allergic rhinitis); (b) the November 2015 medical opinion by Dr. D.K. C. (including reference "sinus lining thickened around area of 4"); (c) the May 2015 medical opinion by Dr. D.T.S. (including reference to "dental implants were responsible for some of his sinus disease"); (d) the May 2016 medical opinion of Drs. D.R.K. and S.R.F. (including reference to an "area of chronic infection at the mesial root of tooth and untreated MB canal"); (e) from Cassity Implants, the October 2011 report of implant of tooth #3 with sinus and facial grafting, the December 2014 report of implant of tooth #12 with socket and facial grafting and subsequent infections; and in-service, the August 1976 report of root canal of tooth #14, September 1976 apicoectomy, and December 1978 report of separation from service. A complete rationale should be provided for all opinions 3. After completing any other development that may be warranted, readjudicate the claim on appeal. A. Yaffe Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Beach, 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.