Citation Nr: 22015657 Decision Date: 03/18/22 Archive Date: 03/18/22 DOCKET NO. 18-20 857 DATE: March 18, 2022 REMANDED Entitlement to an initial compensable rating for deviated nasal septum, traumatic (claimed as difficulty breathing due to nose condition), is remanded. Entitlement to service connection for a left-hand condition (claimed as tingling in two middle fingers on both hands), to include as a cold weather injury, is remanded. Entitlement to service connection for a right-hand condition (claimed as tingling in two middle fingers on both hands), to include as a cold weather injury, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1974 to March 1980. This matter is before the Board of Veterans' Appeals (Board) on appeal from an October 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in October 2021. A transcript of the hearing is associated with the electronic claims file. 1. Entitlement to an initial compensable rating for deviated nasal septum, traumatic (claimed as breathing difficulty due to nose condition), is remanded. 2. Entitlement to service connection for a left-hand condition (claimed as tingling in two middle fingers on both hands), to include as a cold weather injury, is remanded. 3. Entitlement to service connection for a right-hand condition (claimed as tingling in two middle fingers on both hands), to include as a cold weather injury, is remanded. At his October 2021 hearing, the Veteran testified that when he has difficulty breathing through his nose he often feels as though the left side is completely blocked. The Board notes that the Veteran has not been given a VA examination for his deviated nasal septum since October 2016. Accordingly, remand is warranted to provide the Veteran with an updated examination to determine the current severity of his deviated nasal septum. See Snuffer v. Gober, 10 Vet. App. 400(1997) (noting that a veteran is entitled to a new VA examination where there is evidence that the condition has worsened since the last examination); Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (determining that Board should have ordered contemporaneous examination of Veteran because a 23-month-old exam was too remote in time to adequately support the decision in an appeal for an increased rating]). At his hearing, the Veteran also testified that during his active military service he started having problems with things like a runny nose, sore throat, and sinus problems. He testified to both sinus infections while in service and current sinus infections. The Board notes that the Veteran's service treatment records contain several complains of sinus problems, and current VA treatment records show treatment for such. The Veteran's original claim for service connection was for "difficulty breathing due to nose condition." The Board notes that no additional respiratory, sinus, and/or allergy conditions were previously considered. Accordingly, on remand in addition to determining the current severity of the Veteran's deviated nasal septum, the Veteran will also be given an examination to determine any other related conditions for which he may be service connected. At his October 2021 hearing, the Veteran also testified that while he was deployed in Germany in the winter of 1978-79, he was exposed to extreme cold weather during the course of his regular duties as a mechanic. He further testified that he noticed cold sensitivity to his hands during that time that never went away, including that his fingers would get cold and then start tingling and go numb. The Board notes that the Veteran's original claim for service connection was for "tingling in two middle fingers on both hands" and that he has not been given an examination to determine residuals of a cold weather injury. Accordingly, remand is warranted to provide the Veteran an examination for such. Finally, the Board also notes that the Veteran testified that there were relevant outstanding medical records from his private provider that had not yet been provided to VA. Since his hearing, the Veteran has not provided any additional medical evidence. Accordingly, remand is also warranted to update the record. The matters are REMANDED for the following action: 1. Update the electronic file with any new VA treatment records and private treatment records. Specifically contact the Veteran and obtain authorizations to obtain private treatment records from Dr. Prince. 2. After the record has been updated, schedule the Veteran for an examination to determine the current severity of his deviated nasal septum. The examiner should be given a copy of the Veteran's entire claims file and a note that such was reviewed should be included in his or her report. The examiner should also diagnose any other conditions causing the Veteran's breathing difficulty including other respiratory, sinus, and/or allergy conditions and provide an opinion as to whether they were at least as likely as not (50 percent probability or greater) caused by the Veteran's military service and/or at least as likely as not (50 percent probability or greater) due to or aggravated by his deviated nasal septum. In formulating an opinion, the examiner should specifically consider and address the Veteran's service treatment records showing several complaints of sinus problems and his October 2021 hearing testimony regarding such. A detailed rationale for the opinion must be provided. If the reviewing clinician is unable to offer the requested opinion, it is essential that the reviewing clinician offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Schedule the Veteran for an examination to determine whether his claimed hand injuries of "tingling in two middle fingers on both hands" is related to residuals of a cold weather injury. The examiner should be given a copy of the Veteran's entire claims file and a note that such was reviewed should be included in his or her report. The examiner should provide a diagnosis for any found condition(s); and provide an opinion as to whether such condition(s) are at least as likely as not (50 percent probability or greater) related to the Veteran's military service, including cold weather exposure. In formulating an opinion, the examiner should specifically consider and address the Veteran's October 2021 hearing testimony regarding cold weather exposure while serving in Germany. A detailed rationale for the opinion must be provided. If the reviewing clinician is unable to offer the requested opinion, it is essential that the reviewing clinician offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Ruiz, Associate Attorney 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.