Citation Nr: 22012309 Decision Date: 03/03/22 Archive Date: 03/03/22 DOCKET NO. 17-22 412A DATE: March 3, 2022 ORDER Restoration of service connection for posttraumatic stress disorder (PTSD), with alcohol use and unspecified depressive disorder, is granted. A separate 10 percent rating, but no higher, for allergic rhinitis is granted. REMANDED Entitlement to a disability rating in excess of 10 percent for sinusitis is remanded. FINDINGS OF FACT 1. The grant of service connection for PTSD in a July 2014 rating decision was not clearly and unmistakably erroneous. 2. The Veteran's allergic rhinitis separately causes 50 precent blockage of the nasal passage on each side, without complete nasal blockage or polyps. CONCLUSIONS OF LAW 1. The criteria for restoration of service connection for PTSD are met. 38 U.S.C. §§ 1110, 5109A (2021); 38 C.F.R. §§ 3.103, 3.105, 3.303, 3.304 (2021). 2. The criteria for a separate 10 percent rating for allergic rhinitis are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.97, Diagnostic Code (DC) 6522. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1984 to February 1994. These matters come before the Board of Veterans' Appeals (Board) on an appeal from January 2016 and October 2016 rating decisions by a Department of Veterans Affairs (VA) Regional Office, which is the Agency of Original Jurisdiction (AOJ). In February 2016, the Veteran and her former spouse provided testimony before a Decision Review Officer. Then, in June 2021, the Veteran testified before the undersigned Veterans Law Judge at a Board hearing. Transcripts of both hearings are associated with the record. Additional evidence relevant to the Veteran's appeal for an increased rating for her sinusitis has been associated with the record since the most recent April 2017 statement of the case. However, the Veteran, through her representative, waived initial AOJ review of this evidence in the December 2021 Appellate Brief. Therefore, the Board may review the evidence in the first instance. At this juncture in the appeal, the Board has recharacterized the single increased rating claim for sinusitis with allergic rhinitis into separate rating claims for rhinitis and sinusitis. Locklear v. Shinseki, 24 Vet. App. 311, 315 (2011) (characterization of a claim generally is within VA's discretion). The recharacterization is to maximize the Veteran's benefits. Bradley v. Peake, 22 Vet. App. 280, 294 (2008). 1. Propriety of the January 2016 severance of service connection for PTSD with alcohol use and unspecified depressive disorder. The Veteran contends that the January 2016 severance of service connection for PTSD was improper. Specifically, she contends that she never claimed PTSD, but rather claimed a depressive disorder, and PTSD was diagnosed after she reported an in-service military sexual trauma (MST) in response to an inquiry by a VA examiner. She contends that the MST did in fact occur, and that she has current psychiatric symptoms that had their onset in, or are otherwise related to her active service, to include the MST. Upon review of the record, the severance of service connection was based on conflicting medical opinions, and therefore reasonable minds could disagree on the nature and etiology of her current psychiatric disorders. Further, the record includes a medical opinion which can be used to corroborate the occurrence of the MST. Therefore, the July 2014 grant of service connection for PTSD with alcohol use and unspecified depressive disorder cannot be said to be clearly and unmistakably erroneous. Service connection will be severed only where evidence establishes that it is clearly and unmistakably erroneous (CUE) (the burden of proof being on the Government). 38 C.F.R. § 3.105(d). VA must assure both that due process has been observed in the process of severance and that CUE exists in the award of service connection. 1. Due Process When severance of service connection is considered warranted, a rating proposing severance will be prepared setting forth all material facts and reasons. The claimant will be notified at his or her latest address of record of the contemplated action and furnished detailed reasons therefor and will be given 60 days for the presentation of additional evidence to show that service connection should be maintained. Unless otherwise provided in paragraph (i) of this section, if additional evidence is not received within that period, final rating action will be taken, and the award will be reduced or discontinued, if in order, effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires. 38 C.F.R. § 3.105(d). The initial question for the Board is whether the AOJ followed the due process requirements of 38 C.F.R. § 3.105(d) for severing service connection. The AOJ originally granted service connection for PTSD with alcohol use and unspecified depressive disorder in a July 2014 rating decision. Shortly thereafter, in November 2014, the AOJ proposed to sever service connection for PTSD. The AOJ stated that the decision to grant service connection was clearly and unmistakably erroneous because there was no evidence linking the current psychiatric diagnosis to her military service. In May 2015, the Veteran prematurely filed a notice of disagreement to the proposed decision, but requested a hearing. Nonetheless, in a July 2015 rating decision, the AOJ severed service connection for this disability prospectively effective October 1, 2015. The AOJ reiterated November 2014 rating decision that had proposed to sever service connection, and concluded that severance was proper. However, the Veteran reiterated her desire for a predetermination hearing, and in a December 2015 rating decision, the AOJ noted that there was a clear and unmistakable error in the July 2015 decision, as the Veteran was not afforded the requested predetermination hearing as required by law, and rescinded the severance. The Veteran was scheduled for a hearing in January 2016, but in a January 2016 correspondence, the Veteran withdrew her hearing request. However, in another correspondence later that month, the Veteran noted that the request to withdraw the appeal and hearing was in error, and again requested a predetermination hearing. Unfortunately, prior to receiving the cancellation of the hearing, and the request for another predetermination hearing, the AOJ severed service connection for PTSD in a January 2016 rating decision, prospectively April 1, 2016. The AOJ again reiterated the November 2014 proposal to sever service connection, and concluded severance was proper. Thereafter, the AOJ acknowledged receipt of the predetermination hearing request, and scheduled the Veteran for a hearing with a Decision Review Officer in February 2016. The AOJ reviewed the January 2016 decision for error based on the testimony received, but in a May 2016 rating decision, the AOJ concluded that the severance was proper. Therefore, it concluded a revision of the decision was not warranted. The Veteran then appealed the January 2016 severance of service connection, and the current process followed. The AOJ followed the proper due process steps for severing service connection. The AOJ issued the proposed rating in November 2014, and the Veteran was notified at her latest address of record of this contemplated action and furnished detailed reasons therefor, and was given 60 days for the presentation of additional evidence to show that service connection should be maintained in an April 2015 notice letter. The AOJ issued the January 2016 rating decision, which severed service connection prospectively effective April 1, 2016. The resulting period for which the Veteran was awarded service connection PTSD began October 3, 2013, and ended April 1, 2016, a period of less than ten years. 38 C.F.R. § 3.957. Notice of this rating decision, plus her appeal rights, was sent to the Veteran on January 27, 2016. The April 1, 2016, date was greater than the last day of the month in which a 60-day period from the date of the January 2016 notice expired. As above, the AOJ took corrective action for procedural errors in scheduling the Veteran for a hearing. Thus, all due process requirements were met in the severance of service connection PTSD. See 38 C.F.R. § 3.105(d). 2. Existence of CUE in the Award of Service Connection Having met the due process requirements, the remaining question before the Board in this case is whether the grant of service connection PTSD was clearly and unmistakably erroneous. The Board concludes that the severance of service connection was improper because the grant was based on a VA examiner's positive nexus opinion, which confirmed the existence of the stressor based on in-service MST. Further, the medical evidence that contradicts this opinion is of less probative value, and merely shows that reasonable could differ on whether the Veteran has PTSD that is related to an in-service MST. Therefore, the grant of service connection was not a clear and unmistakable error. To establish that a grant of service connection was the product of CUE, VA must show that (1) either the correct facts as they were known at the time were not before the adjudicator, the adjudicator made an erroneous factual finding, or the statutory or regulatory provisions were incorrectly applied; (2) the alleged error was undebatable, not merely a disagreement as to how the facts were weighed or evaluated; and (3) the error manifestly changed the outcome of the prior decision. See Allen v. Nicholson, 21 Vet. App. 54, 58-59 (2007) (internal citations omitted). A clear and unmistakable error is one about which reasonable minds could not differ. See 38 C.F.R. § 3.105(a)(1)(i). In most respects, the CUE standard for severing service connection under 38 C.F.R. § 3.105(d) is equivalent to the CUE standard for reversing or revising a prior final decision under 38 C.F.R. § 3.105(a). See Baughman v. Derwinski, 1 Vet. App. 563, 566 (1991). However, the determination is not limited to the law and the record that existed at the time of the original decision. VA may consider medical evidence and diagnoses that postdate the original award of service connection to demonstrate that the diagnosis on which service connection was predicated is clearly erroneous. Stallworth v. Nicholson, 20 Vet. App. 482, 488 (2006). Turning to the evidence of record, the Veteran applied for service connection for "mental health issues including depression" in October 2013. See October 2013 Fully Developed Claim. The Veteran's service treatment records (STRs) did not note any mental health issues on examination upon entry into active service in a January 1984 evaluation. However, in July 1985, the Veteran was seen for a psychiatric referral after not being able to gain weight. She was initially assessed with depression and anxiety, and referred for a psychiatric evaluation, which occurred later that month. After noting the Veteran's issues eating, coping with her job, frustration with her hours, and the insensitivity of her bosses, the provider found there was no mental disorder present. She was then seen again in service in September 1986 for a depressed mood with difficulty eating and sleeping. She was noted to be experiencing relationship problems, and was assessed with an adjustment reaction and a depressed mood. A follow-up later in September 1986 noted she was still depressed but more active, and continued the adjustment reaction assessment. Then, March 1991, she was observed to have the smell of alcohol on her breath during her working hours, and she was referred for a psychiatric evaluation. She underwent the evaluation in April 1991, at which time she presented in moderate emotional distress marked by dysphoria, tearfulness, and anxiety. She reported prior psychiatric contact in 1987 over difficult feelings related to a personal relationship, and she reported a history of prior sexual abuse. At that time, she was diagnosed with episodic alcohol abuse and occupational problems. Finally, an August 1991 quarterly security clearance mental health check noted no security concerns, and her January 1994 separation examination did not note any psychiatric problems. Following service, she began following treatment with VA in July 2013, where she noted she had been previously diagnosed with bipolar disorder after her military service. She described her symptoms as having "ups and downs," and she was taking Depakote at that time. She also reported being prescribed Amitriptyline before service for "possibly depression." The clinician noted that she did not endorse an MST at that time, however later in the consultation she reported experiencing an MST during the MST screening. She had a negative depression screening and a negative PTSD screening. She was then scheduled for an initial VA psychiatric examination in February 2014, at which time the examiner diagnosed PTSD related to MST, with alcohol use and unspecified depressive disorder. The examiner noted stressors of a childhood sexual abuse by a sister's husband, and importantly, an MST. In this regard, the Veteran reported that while she was in A-school, during New Year's Eve, she was out a long way from base. At the end of the night, she stated she wanted to go back to the barracks, but a male service member wanted to stay in a hotel. She stated they were in another city a long way away from base, so she stayed. She reported that she went to sleep, and when she awoke, he "was there." She reported it was sad, and she thinks about it, but tries not to. She also reported that she stayed away from people because of this incident, and she never put herself in the same situation, and she endorsed experiencing some flashbacks. Notably, earlier in the examination, the examiner detailed that the Veteran had experienced flashbacks and panic attacks in 2001, and that she did not currently experience such symptoms, noting the medications have helped. She was also found to have nightmares related to PTSD. Importantly, the examiner stated the stressor was sufficient to support a diagnosis of PTSD, which was endorsed, and that it was related to a personal assault, i.e. the MST. The examiner then opined that the claimed condition was at least as likely as not incurred in or caused by the claimed in-service event. Parenthetically, the Veteran later clarified that the MST occurred in 1987 during her Board hearing testimony, and in other statements of record. She also consistently reported the circumstances and nature of the event. Finally, she also reported that the service member who assaulted her was a superior, and she was afraid that no one would believe her if she reported it, or that nothing would happen. Based on the foregoing examination, the AOJ granted service connection for PTSD in the July 2014 rating decision. However, on its own accord, the AOJ then requested another etiological opinion regarding whether the diagnosed PTSD was at least as likely as not incurred in or caused by the MST or the treatment for depression and anxiety in July 1985. In the explanation for the proposal, it is clear the AOJ did not know there was an etiological opinion included in the February 2014 examination. Thus, a VA clinician provide an opinion in October 2014, stating that the claimed condition was less likely than not incurred in or caused by service. The clinician first noted that VA treatment records begin in 2013, and did not include diagnoses or screens of PTSD or MST. Rather, they noted diagnoses of bipolar disorder from 2009, which he noted was not service-connected, and alcohol abuse disorder and a mood disorder. The examiner's rationale for his opinion noted that the Veteran did not file a timely report of her MST, and the records did not reflect that she experienced any symptoms prior to the most recent claim, or that there were reports of lasting disability prior to the claim. The clinician further noted that there were no markers such as change in occupational or social functioning that may imply an MST occurred, and there were not details consistent with symptoms of an MST, "only that she had voluntarily gone to a motel with a man." The clinician further noted that although the Veteran reported briefly experiencing panic attacks in 2001, those were controlled by medication. Thus, based on the foregoing, the clinician opined that the current psychiatric condition was less likely than not incurred in or caused by the reported MST or treatment for depression in July 1985. Based on this opinion, the AOJ proposed to, and ultimately did, sever service connection for PTSD. Following the severance process, private mental health treatment records were added to the record in March 2016. The records show that the Veteran was seen in October 2011 for mostly depressive mental health symptoms. She told her provider that she had been previously told she had bipolar disorder, and the provider noted a diagnosis of bipolar with a history since military service. She continued mental health treatment privately, with June 2012 records noting she was sad and depressed. After a review of the record, the Board finds that the February 2014 VA examination report and opinion renders the Board unable to state that the grant of service connection was clearly and unmistakably erroneous. See Stallworth, supra. The Board cannot state that the July 2014 grant of service connection was the kind of error that, when called to the attention of reviewers, compels the conclusion, to which reasonable minds could not differ, that the results would be manifestly different but for the error. See Fugo v. Brown, 6 Vet. App. 40, 43 (1993). Service connection for PTSD requires: (1) medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); (2) credible supporting evidence that the claimed in-service stressor actually occurred; and (3) medical evidence of a nexus between current symptomatology and the claimed in-service stressor. 38 C.F.R. § 3.304. Moreover, although service connection for PTSD requires a stressor to be corroborated, the United States Court of Appeals for the Federal Circuit observed that 38 C.F.R. § 3.304(f)(5) specifically states that a medical opinion may be used to corroborate a personal assault stressor, noting "medical opinion evidence may be submitted for use in determining whether the occurrence of a stressor is corroborated." See Menegassi v. Shinseki, 683 F.3d 1379, 1382 (Fed. Cir. 2011) (observing that the United States Court of Appeals for Veterans Claims erred when it determined that a medical opinion based on a post-service examination of a veteran cannot be used to establish the occurrence of a stressor); see also Patton v. West, 12 Vet. App. 272, 280 (1999) (rejecting the requirement that "something more than medical nexus evidence is required for 'credible supporting evidence'" in personal assault cases). Here, the grant of service connection was based on a VA examination which found the Veteran had a diagnosis of PTSD, detailed an in-service MST as the only stressor sufficient for the diagnosis of PTSD, and included an opinion relating the PTSD to the event in service. This examination in and of itself, performed by a qualified clinician, corroborates the Veteran's reported in-service MST. Importantly, the Board finds this examination highly probative. The examiner included a thorough review of the record, including citing to evidence, and considered the lay statements of record. Further, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). In contrast, the Board does not afford much probative weight to the October 2014 negative opinion. Specifically, the opinion casts doubt on the probability of the occurrence of the MST because the Veteran did not report it. This is an antithesis to the purpose of 38 C.F.R. § 3.304(f)(5). In cases involving an allegation that PTSD is connected to personal assault, the Federal Circuit has held that "the absence of a service record documenting an unreported sexual assault is not pertinent evidence that the sexual assault did not occur." AZ v. Shinseki, 731 F.3d 1303, 1318 (Fed. Cir. 2013) (purpose of Federal Rule of Evidence 803 does not apply because most people do not report personal assaults) (emphasis added). The examiner also noted the record confirms only that the Veteran voluntarily went to a hotel with a man. This statement presumes to diminish the credibility of her MST report based on preceding factors wholly unrelated to the MST. The examiner also relied on the fact that the Veteran reported symptoms of the MST only after applying for service connection. However, the later private treatment records show she sought treatment and care for her mental health symptoms at least two years prior to applying for compensation benefits, further negating the October 2014 clinician's opinion. The examiner did note the Veteran's symptoms of panic attacks in 2001, albeit excluding the flashbacks, but disregarded these symptoms because they were effectively treated with medication. The effective treatment of a psychiatric symptom does not negate the presence or importance of that symptoms; but rather it shows the efficacy of the treatment. Finally, the examiner noted VA treatment records were silent for reports of MST; however, as noted above, the July 2013 record does not a reported experience of MST in the MST screen. Accordingly, the probative evidence of record actually weighs in favor of the grant of service connection. Accordingly, the February 2014 examiner's opinion establishes that the Veteran's in-service experiences caused her current disability. The Board has no reason to doubt the veracity of the Veteran's statements regarding her experiences in service, which she is competent to provide, and are consistent with place, type, and circumstance of the Veteran's service. See Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Notably, she was found to be a reliable source of information by the examiner, and she has consistently described the nature and circumstances of the MST. Based on the foregoing, the Board is unable to find that the rating decision that granted service connection was clearly and unmistakably erroneous. Importantly, the AOJ indicated the error in the decision was that no nexus opinion was provided, which as shown above, was not the case. Consequently, the AOJ has failed to identify a clear and unmistakable error. See Allen, supra. Accordingly, the severance of service connection was based on a an insufficiently probative October 2014 VA opinion, which did not negate the probative value of the February 2014 opinion, and was not an error for which reasonable minds could not differ. See Fugo, 6 Vet. App. at 43. Consequently, while as noted above, the record is not without conflict as to the nature and etiology of the Veteran's current psychiatric disability, the Board concludes that the grant of service connection for PTSD with alcohol use and unspecified depressive disorder was not "clearly erroneous", and thus severance of service connection for this disability, effective April 1, 2016, was improper. Restoration of service connection is warranted. 2. Entitlement to a compensable rating for allergic rhinitis. The Veteran contends that her sinusitis with allergic rhinitis is more severe than is contemplated by the currently assigned 10 percent rating. Initially, the Board has separated the rhinitis from the sinusitis, and will address the sinusitis in the remand section below. The two disorders, while previously evaluated together, are more properly evaluated separately. See Bradley, supra. In this regard, the Veteran has been service-connected for both rhinitis and sinusitis as a combined disorder, and she has described the symptoms of each disorder throughout her current appeal. The Veteran was originally granted service connection for allergic rhinitis only, noted as claimed as sinusitis, in a November 1998 rating decision. The disability was rated pursuant to DC 6522 for rhinitis. In a February 2004 rating decision however, the AOJ noted that the allergic rhinitis has progressed into sinusitis, and awarded a 10 percent rating, changing the DC to 6513 for chronic maxillary sinusitis. The AOJ included the allergic rhinitis in the rating for sinusitis, and it has been included as such since that time. Importantly, in general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran's service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). As will be described below, the Veteran's manifestations of sinusitis and rhinitis result in different symptomatology and functional limitation, and thus should be rated separately. The current appeal arises from an increased rating claim for sinusitis with allergic rhinitis received by VA on July 28, 2016. Thus, the period on appeal for the Veteran's increased rating claim begins that date, plus the one-year look-back period. See Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. Allergic rhinitis is rated pursuant to DC 6522, which explicitly compensates for allergic or vasomotor rhinitis. Under the applicable rating criteria, a 10 percent rating is assigned for a 50-percent obstruction of the nasal passage on both sides, or complete obstruction on one side. A 30 percent rating is assigned with evidence of polyps. 38 C.F.R. § 4.97, DC 6522. Turing to the medical evidence of record, the Veteran underwent a VA examination for sinusitis and rhinitis in August 2016. At that time, she was noted to have diagnoses of pansinusitis and allergic rhinitis. Upon evaluation, she was found to have greater than 50 percent obstruction of the nasal passages on both sides due to rhinitis, without complete obstruction on either; and importantly, she did not have polyps. The Veteran's VA treatment records show the same level of severity, with common reports of congestion. See e.g. March 2018 VA Treatment Record. Further, the Veteran testified that she has to blow her nose every day. Accordingly, as the Veteran has a 50 percent blockage on both sides due to rhinitis, she warrants a 10 percent rating pursuant to DC 6522. However, the only other and higher rating available for allergic rhinitis, the 30 percent rating, requires polyps. The Veteran does not report, and the evidence of record does not show, that she has polyps. Therefore, a higher 30 percent rating is not warranted. In reaching this decision, the Board has resolved all doubt in the Veteran's favor, and has awarded a separate 10 percent rating for allergic rhinitis. However, insofar as the Board has denied a higher 30 percent rating herein, the balance of the evidence weighs against her symptoms more nearly approximating a 30 percent rating under the ratings criteria. Therefore, the benefit of the doubt doctrine is not applicable to that aspect, and a higher separate rating must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND Entitlement to a disability rating in excess of 10 percent for sinusitis. The Veteran contends that her service-connected sinusitis is more severe than is reflected by the currently assigned disability rating. Upon review, the record reflects a possible worsening of her conditions since the most recent examination, such that a new VA examination is warranted. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Additionally, the most recent VA treatment records are from March 2018, notwithstanding 4 pages of records from March 2021 related to a leg fracture. Thus, updated VA treatment records should also be obtained and associated with the record on remand. In this regard, in June 2021, she testified that she has frequent sinus pain, including pain in the middle of her forehead, her cheeks, and into her teeth. She reported experiencing sinus headaches once a week, and that she is prescribed a nasal spray and takes Sudafed when she has sinus pain. She also reported that she was recently scheduled for another sinus surgery, which had to be cancelled because of heart problems. Finally, she reported a severe sinus infection requiring antibiotics over a year prior to the hearing. As detailed in the preceding section, the Veteran last underwent a VA examination for her sinusitis in August 2016. At that time, the examiner noted her chronic maxillary and ethmoid sinusitis had progressed to pansinusitis. She was noted to have symptoms of episodes of sinusitis, pain in the sinus, headaches, and tenderness in the sinus. She was endorsed with having two non-incapacitating episodes of sinusitis characterized by headaches, pain, and purulent discharge or crusting within the prior twelve months, but no incapacitating episodes. The VA treatment record that are of record note continuing frequent treatment for sinusitis, including a January 2018 note of a yellow-green nasal drainage present for three to four weeks, with facial pain and teeth pain, and a diagnosis of acute sinusitis. In February 2018, she reported just finishing a series of amoxicillin, however she stated she feels like she has a sinus infection all the time. She reported facial soreness and teeth pain at that time, and she continued with Flonase daily, Zyrtec, and did sinus rinses. The last treatment of record is from March 2018, wherein she underwent comparative CT scans of her sinuses, which showed increased mucous. Based on the foregoing, the medical evidence of record and the Veteran's statements indicate there has been a possible worsening of her sinusitis since the most recent August 2016 VA examination. Therefore, the Veteran should be scheduled for a VA examination to ascertain the current severity of her service-connected sinusitis. The matter is REMANDED for the following action: 1. Obtain any outstanding VA or private treatment records. Request that the Veteran assist with locating these records, if possible. Associate these records with the claims file. 2. After completing the above development, schedule the Veteran for a VA examination with an appropriate clinician to determine the current severity of her pansinusitis. The record, to include a copy of this Remand, must be made available to the examiner, and all indicated tests and studies should be accomplished. The examiner should describe the nature and severity of all manifestations of the Veteran's pansinusitis, to include the functional effects associated with such disability. A rationale for any opinion offered should be provided. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jonathan M. Estes 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.