Citation Nr: 21042832 Decision Date: 07/14/21 Archive Date: 07/14/21 DOCKET NO. 17-03 264 DATE: July 14, 2021 ORDER Entitlement to service connection for chronic sinusitis is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder other than PTSD, to include unspecified depressive disorder or major depressive disorder, is remanded. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had chronic sinusitis at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for chronic sinusitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July1976 to November 1976, June 25, 1977 to July 9, 1977, from June 10, 1978 to June 24, 1978, and from August 1979 to September 1981. This matter comes before the Board of Veterans' Appeals (Board) from a July 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran's claims were remanded by the Board in January 2019. Upon remand, the Veteran was granted service connection for posttraumatic stress disorder (PTSD) and allergic rhinitis. See October 2020 and March 2021 rating decisions. While the Veteran's representative contends in a April 2021 correspondence that the Veteran is entitled to an earlier effective date for the grant of service connection for PTSD, the Board does not have jurisdiction over that issue as it has not been perfected for appeal. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (indicating the Veteran must separately appeal for an earlier effective date since it is a "downstream" issue from his initial claim for service connection). If the Veteran wishes to disagree with the aforesaid effective date, he may do so by filing a notice of disagreement (VA Form 21-0958) within one year of the March 2021 rating decision. In view of the facts found, and to provide broader consideration on appeal, the Board has recharacterized the claim of entitlement to service connection for depression as one for an acquired psychiatric disorder other than PTSD, to include unspecific depressive disorder or major depressive disorder. 1. Entitlement to service connection for chronic sinusitis 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 chronic 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). Upon remand, the October 2020 VA examiner opined that the Veteran does not have a current diagnosis of chronic sinusitis. See also April 2013 VA examination report. Rather, the Veteran was diagnosed with allergic rhinitis. The VA examiner noted that the Veteran did not report a history of chronic sinusitis or treatment for chronic sinusitis. Rather, the Veteran reported allergic rhinitis symptoms with occasional flares while on active duty. As previously indicated, upon remand, the Veteran was granted service connection for allergic rhinitis. See October 2020 rating decision. During a previous April 2013 VA examination, the chosen VA examiner declined to endorse a diagnosis of a sinus condition after a review of the claims file and an in-person evaluation and interview. Available VA medical records do show that the Veteran has received treatment for sinus congestion, but at no point has the Veteran been diagnosed with sinusitis through VA; instead, his sinus symptomatology has been attributed to diagnosed allergic rhinitis. While the Veteran believes he has a current diagnosis of chronic sinusitis, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. 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, namely the April 2013 and October 2020 VA examination reports. As the preponderance of the evidence weighs against the Veteran's claim for service connection for chronic sinusitis, the reasonable doubt doctrine is not for application, and therefore the claim must be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). REASONS FOR REMAND 1. Entitlement to service connection for an acquired psychiatric disorder other than PTSD is remanded. Upon remand, the Veteran was granted service connection for PTSD on the basis of the March 2021 VA examiner's medical opinion that it was at least as likely as not that the Veteran's PTSD was caused by the claimed for in-service events, including the Veteran's experience dealing with body recovery and severed heads. The Board's review of the March 2021 VA examination report does not reflect that the VA examiner noted the Veteran's prior diagnosis of unspecified depressive disorder, nor did the VA examiner provide a medical opinion as to whether that diagnosis is related to those same in-service events or his now service-connected PTSD disability. Although the March 2021 examiner noted that the Veteran did not experience any other psychiatric disabilities, as that examiner did not even note the prior diagnosis of an unspecified depressive disorder, it is still not clear whether all of the Veteran's psychiatric symptomatology can be attributed solely to his PTSD. Therefore, the Board finds that an addendum medical should be obtained upon remand. The matter is REMANDED for the following action: Obtain an addendum medical opinion from the March 2021 VA medical examiner, or another appropriate clinician if deemed unavailable; it is left to the discretion of the VA examiner as to whether an in-person examination is needed to provide the herein requested medical opinions. The examiner shall review the entire claims file, to include all lay statements and include a copy of this REMAND in the examination report. The examiner is first request to determine whether the Veteran has any acquired psychiatric disorder other than the service-connected PTSD, or if not, whether all of the Veteran's documented psychiatric symptomatology can be appropriate attributed to the PTSD. If a diagnosis of an acquired psychiatric disorder other than PTSD is endorsed, the VA examiner is requested to opine as to the following: a. Is it at least as likely as not (50 percent probability or greater) that the Veteran's claimed for acquired psychiatric disorder other than PTSD was incurred during service, or is otherwise directly related to an in-service injury, disease or event, to include, but not limited to, his claimed in-service stressors? b. Is it at least as likely as not (50 percent probability or greater) that the Veteran's claimed for acquired psychiatric disorder other than PTSD is proximately due to, and/or aggravated beyond its natural progression by the Veteran's service-connected PTSD disability? In setting forth this opinion, the examiner should note that the term "aggravated by" refers to a chronic or permanent worsening of the underlying condition, as contrasted to mere temporary or intermittent flare-ups of symptoms that resolve and return to the baseline level of disability. If the opinion is that a service-connected disability or combination of service-connected disabilities aggravated the pancreatitis, the examiner should specify, so far as possible, the degree of disability resulting from such aggravation. A complete rationale is required for any opinion. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic, and requests flexibility and understanding in affording the Veteran an opportunity to report for an examination. In considering whether there is a diagnosable acquired psychiatric disorder other than PTSD, and setting forth any opinion as to the likely etiology of such a condition, the VA examiner should specifically address the October 2019 VA examination report wherein the Veteran was diagnosed with an unspecified depressive disorder. See VBMS, document titled "C&P Exam," dated October 29, 2019. C. M. Collins Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.R. Fey, 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.