Citation Nr: 21041544 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 18-12 716 DATE: July 9, 2021 ORDER Entitlement to service connection for allergic rhinitis is dismissed. Entitlement to service connection for sinusitis is denied. REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a lumbar spine disability is remanded. Entitlement to service connection for a right ankle disability is remanded. Entitlement to service connection for a left ankle disability is remanded. FINDINGS OF FACT 1. Entitlement to service connection for allergic rhinitis was granted in a December 2020 rating decision. 2. At no time during the pendency of the claim has the Veteran been diagnosed with sinusitis. CONCLUSIONS OF LAW 1. The criteria for dismissal of the issue of entitlement to service connection for allergic rhinitis have been met. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 19.55 (2020). 2. The criteria for service connection for sinusitis have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1987 to September 2007. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a June 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. This matter was previously before the Board in May 2020, when it was remanded for further development. 1. Entitlement to service connection for allergic rhinitis The appeal for entitlement to service connection for allergic rhinitis is dismissed, as service connection was granted for this disability in December 2020, effective December 21, 2013, the date of the claim was received. As such, there remains no case or controversy as to this issue. 38 U.S.C. § 7105. 2. Entitlement to service connection for sinusitis The Veteran contends he has sinusitis, which was incurred in or caused by service, to include hazardous environmental exposures. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of sinusitis and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Review of the Veteran's post-service treatment records reflects no treatment or diagnosis of sinusitis. Instead, the Veteran is diagnosed with allergic rhinitis; as noted above, this has been separately service connected. The December 2020 VA examiner evaluated the Veteran and determined that, while he experiences subjective symptoms of runny nose, occasional headache, itchy and watery eyes, he does not have a diagnosis of sinusitis. Rather, the VA examiner identified his symptoms as indicative of chronic allergic rhinitis. In this regard, the Board notes that imaging studies, specific diagnostic testing and review of the Veteran's medical records was conducted by the VA examiner. The examiner further cited a November 2020 x-ray which was negative for sinusitis. It was specifically noted that there are no findings, signs or symptoms to support a sinusitis diagnosis. Pertinently, the Veteran has been service connected for allergic rhinitis during the pendency of this appeal, and he is in receipt of compensation for his claimed symptoms. While the Veteran believes he has a current diagnosis of sinusitis, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires medical education and knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Lacking a current diagnosis, the cornerstone element of service connection has not been met, and service connection for sinusitis cannot be established on any basis. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (holding that a current diagnosis is the cornerstone of a claim for service connection). Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for sinusitis is not warranted. 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a left knee disability is remanded. 2. Entitlement to service connection for a right knee disability is remanded. 3. Entitlement to service connection for a lumbar spine disability is remanded. 4. Entitlement to service connection for a right ankle disability is remanded. 5. Entitlement to service connection for a left ankle disability is remanded. When VA undertakes to obtain an examination/opinion, it must ensure that the examination/opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion/examination is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Pursuant to May 2020 Board remand instructions, the Veteran was afforded VA examinations to assess the nature and etiology of his claimed bilateral knee, bilateral ankle and low back disabilities in December 2020. The examiner provided identical opinions for all the aforementioned claims that they are less likely as not related to a specific exposure event in service. The rationale was also the same that service treatment records are silent for treatment or diagnosis of these conditions, and medical literature has not shown that environmental exposures in Southwest Asia are related. The Board notes that absence of evidence in the service treatment records is an insufficient basis, by itself, for a negative opinion. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). The AOJ correctly requested addendum opinions, citing the examiner's failures to specifically address the Veteran's lay statements of record, including reports of pain and continuity of symptomatology since service; and the private medical evidence of record, including April 2015 treatment records. However, the examiner merely added a statement that lay statements and private medical evidence were reviewed, and that since there were no medical records with knee complaints until 6 years after separation, and none with ankle and back complaints until 8 years after separation, the claimed disabilities are less likely than not related to service. In that connection, the Board notes that the absence of a documented disability during service and the mere passage of time before treatment is an insufficient basis for a negative opinion. See, e.g., Dalton v. Nicholson, 21 Vet. App. 23 (2007). As specifically noted in the May 2020 Board remand instructions, the referenced private medical records in April 2015 contain reports of longstanding symptomatology of the knees, ankles and low back, including pain and swelling. In addition, a VA knee treatment note of February 2013 indicates a knee pain history spanning at least five years. The examiner made no mention of these facts. Additionally, the Veteran explained during sworn testimony before the undersigned in March 2020 that his in-service duties included going up and down several different decks, working on sonar equipment, carrying heavy tools and physically strenuous duties generally. He testified that it was during the latter half of his 20-year active Navy service that his aches and pains began and continued to the present day. In this regard, the Board notes that an in-service incurrence is conceded, due to the nature and time span of his active service. The VA examiner made no mention of the 20-year length of the Veteran's active service, the Veteran's testimony or reports, and made no mention that the Veteran's medical providers have described his claimed orthopedic disabilities as longstanding. The Board thus finds that an addendum opinion is necessary for proper adjudication of these claims. The matters are REMANDED for the following action: Obtain an addendum opinion from a qualified examiner regarding the etiology of the Veteran's bilateral knee, bilateral ankle, and lumbar spine disorders. If the examiner determines the Veteran should be given another examination (including via telehealth if an in-person examination is not possible) to answer the below questions, one should be scheduled. The examiner is asked to provide a thorough, well-reasoned opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's bilateral knee, bilateral ankle, and lumbar spine disorders had onset in service, within one year of service separation, or are otherwise related to active service. In rendering this decision, the examiner must specifically discuss each of the following: (a). The Veteran's conceded in-service duties, including going up and down several different decks, working on sonar equipment, carrying heavy tools and physically strenuous duties generally (b). The private medical records in April 2015 documenting reports of longstanding symptomatology of the knees, ankles and low back, including pain and swelling. (c). The VA knee treatment note of February 2013 indicating a knee pain history spanning at least five years. (d). The Veteran's competent and credible March 2020 testimony specifically describing how his knee, ankle, and back pain began during his service and how those same symptoms have persisted from his time in service to the present. A complete rationale for all opinions must be provided. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Comninos, Georgio 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.