Citation Nr: 21042477 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 16-60 681 DATE: July 13, 2021 REMANDED Entitlement to service connection for a respiratory disability, to include rhinitis and persistent coughing, and as due to environmental exposures in Southwest Asia, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1989 to August 1989 and from October 1989 to June 1995, to include service in Southwest Asia. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in September 2019 when it was remanded for further development. Entitlement to service connection for a respiratory disability, to include rhinitis and persistent coughing, is remanded. A remand is required for an addendum medical opinion. Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). When a Veteran has provided competent lay statements of an in-service injury, the examiner must consider and address them when developing his rationale. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (holding that when the Veteran has provided lay testimony of an in-service injury, an examiner cannot ignore that lay evidence and base his or her opinion that there is no relationship to service on the absence of in-service corroborating medical records). The Veteran's DD-214 indicates that he served in the Southwest Asia Theatre of Operations after August 2, 1990. The Veteran contends that his respiratory disability is due to service. He contends that he has experienced respiratory issues for the last 10 years and has consistently dealt with excess phlegm. The drainage of his sinuses creates coughing fits, which in turn, interferes with normal sleep habits. See VA Form 9, December 2016. The Veteran underwent a VA Respiratory examination in February 2016. The examiner indicated that the Veteran did not have a diagnosis of a respiratory condition, but noted the Veteran reported a history of rhinitis. The examiner failed to provide an opinion on whether the Veteran's rhinitis was related to service. The September 2019 Board remand found the February 2016 examination inadequate, as it was unclear from the record whether or not the Veteran had a respiratory condition. Pursuant to the September 2019 Board remand, the Veteran was afforded a VA Respiratory examination in February 2020. A 2016 diagnosis of pulmonary nodules were noted. The examiner noted the shortness of breath reported during this examination is "felt to be most in part due to the Veteran's obesity and level of conditioning, and the coughing is of undetermined origin." No specific respiratory condition was identified based on history. The examiner noted that post-service reports show approximately 20 years ago a gradual appearance of symptoms over time, including feelings of a sinus drainage that impedes airflow when the Veteran lies down and includes coughing for a few days. Fairly consistent episodes one time lasted over 5 months. The Veteran reported being treated for a sinus infection, and having imaging of his sinuses, however, no results were known. The Board finds the February 2020 VA examination report inadequate. Specifically, it appears that the examiner did not address the Board remand directive pertaining to the Veteran's lay statements of record indicating a history of rhinitis. No opinion was provided if the Veteran currently has, or has ever had, a diagnosis of rhinitis. In addition, the report notes a history of persistent coughing, to include one episode lasting over 5 months, however, no opinion was provided regarding if the coughing was related to environmental hazards during his time in the Southwest Asia Theatre. Accordingly, remand is required for an addendum VA medical opinion. The matter is 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 any respiratory disabilities. 2. Obtain an addendum VA medical opinion. If the examiner deems that another examination is necessary, then the Veteran should be afforded another examination by an appropriate clinician to determine the nature and cause of any respiratory disability, to include chronic cough and rhinitis, if diagnosed. The examiner is advised to evaluate this Veteran with Southwest Asia service for any chronic disability pattern. The Veteran has claimed disability patterns related to signs and symptoms involving the respiratory system. The examiner must respond to the following: (a) Please diagnose all respiratory disabilities found. All diagnostic findings (or lack thereof) must be reconciled with conflicting evidence in the record (to include his reports of rhinitis and chronic cough). (b) Please opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's rhinitis, if diagnosed, had onset in, or is otherwise related to, active service, to include environmental exposures in Southwest Asia. (c) Please opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's chronic cough, if diagnosed, had onset in, or is otherwise related to, active service, to include environment exposures in Southwest Asia. (d) Please opine if the Veteran has any respiratory pattern that is: (1) an undiagnosed illness; (2) a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology; (3) a diagnosable chronic multi-symptom illness with a partially explained etiology; or (4) a disease with a clear and specific etiology and diagnosis. The examiner must address the February 2016 VA examination noting a history of rhinitis and the February 2020 VA examination noting a history of a persistent cough. (Continued on the next page) A complete rationale should accompany each opinion provided and should be based on examination findings, historical records, and medical principles. J. CONNOLLY Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Krista Johnson, 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.