Citation Nr: 22034722 Decision Date: 06/14/22 Archive Date: 06/14/22 DOCKET NO. 18-09 355 DATE: June 14, 2022 REMANDED Entitlement to service connection for a sinus disorder, diagnosed as allergic rhinitis is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1970 to March 1979. This matter comes to the Board of Veterans' Appeals (Board) from a rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the claim most recently in May 2019. Specifically, in the May 2019 Remand, the Board requested that the RO obtain any outstanding VA treatment records and obtain an addendum medical opinion to determine the nature and etiology of the Veteran's allergic rhinitis. In accordance with the Remand directives, additional VA treatment records were associated with the claims file in July 2019 and June 2020. Additionally, the Veteran underwent a Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx, and Pharynx DBQ in November 2019, and addendum medical opinions were associated with the claims file in November 2019 and July 2020. The Board, however, finds that the VA addendum medical opinions are inadequate. As there has not been substantial compliance with the remand directives, further remand is necessary. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a sinus disorder, diagnosed as allergic rhinitis is remanded. The Veteran contends that service connection is warranted for allergic rhinitis. Specifically, the Veteran asserts that his symptoms began during service in the early 1970s and that he was exposed to hazardous materials, fumes, and dust when his ship was in the shipyard. See January 2016 Notice of Disagreement. As noted above, the Veteran underwent a Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx, and Pharynx DBQ in November 2019, at which time the examiner noted a diagnosis of allergic rhinitis. At the time of the examination, the Veteran reported that his condition onset in the early 1970s. He further stated that, at that time, he experienced sneezing and a dry nose. The examiner, a general practitioner, opined that it was less likely than not that the Veteran's allergic rhinitis was incurred in or caused by the claimed in-service injury, event, or illness. In providing the opinion, the examiner acknowledged that the Veteran had nasal congestion in 1976; an upper respiratory infection in 1977; and some rhinitis in 1978. The examiner noted that during the April 2015 VA examination, the Veteran had episodes of rhinitis, but because of the lack of consistency and the seasonal nature of his symptoms, it was not believed that his symptoms are related to service. Another addendum medical opinion was associated with the claims file in July 2020. This examiner, a specialist in Physical Medicine and Rehabilitation, opined that it was less likely than not that the Veteran had rhinitis/allergic rhinitis/seasonal allergies while on active duty or in the first years upon separation from the military. The examiner reasoned that while the Veteran reported that his symptoms began in the 1970s, his medical records were negative for such until 1999 according to the November 2019 examiner. The examiner also noted that this diagnosis was based on history, rather than upon a finding of a clinical abnormality. The examiner acknowledged that the Veteran complained of nasal congestion with postnasal drainage in 1976; head congestion with rhinorrhea and pharyngeal pain in March 1977 (prior to being diagnosed with an upper respiratory infection); and a runny nose in April 1978. The examiner also acknowledged the April 1978 assessment of rhinitis but noted that there was no indication that the Veteran had allergic rhinitis or a chronic condition as opposed to a singular event. The examiner stated that there was a lack of documentation and that there were no comments while on active duty or within a year of separation that the Veteran had allergic rhinitis, rhinitis, or seasonal allergies. The Board finds that the medical opinions are inadequate. Here, the November 2019 VA examiner did not determine whether the Veteran's current condition is related to his rhinitis during service. In regard to the July 2020 opinion, the examiner seemed to ignore the Veteran's lay statements and did not determine whether the Veteran's current condition was related to exposure to dust and fumes, as the Veteran contends. Additionally, the examiner found that there was no evidence of chronicity of care. However, the lack of chronicity of care, while a relevant factor, cannot be the sole basis for a finding of a lack of nexus. Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). Therefore, remand is warranted to obtain an adequate medical opinion before the claim can be adjudicated. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate them with the Veteran's claims folder. 2. Next, obtain any outstanding private treatment records related to the Veteran's claims being remanded. The Veteran's assistance should be requested as needed. All obtained records should be associated with the evidentiary record. If the RO cannot obtain records identified by the Veteran, a notation to that effect should be inserted in the file. The Veteran is to be notified of unsuccessful efforts in this regard, in order to allow him the opportunity to obtain and submit those records for VA review. 3. Then, schedule the Veteran for a VA examination with a qualified clinician, preferably an allergist, to determine the etiology of the Veteran's allergic rhinitis. The examiner must review the claims folder, including a copy of this Remand and all lay statements of record. The examiner should provide an opinion as to the following: (a) First, identify all sinus disorders, to include allergic rhinitis of record during the appeal period. (b) Then, provide an opinion was to whether it is at least as likely as not (an approximate balance of positive and negative evidence) that the Veteran has a sinus disorder, to include allergic rhinitis, that manifested in service, or is otherwise related to service, to include as due to exposure to hazardous materials, fumes, and dust when his ship was in the shipyard. The examiner is reminded that the Veteran is competent to provide information about observable symptoms and events. If the examiner, however, finds any reason to discount the Veteran's assertions in any regard, the examiner should clearly so state, and explain why. (c) If it is determined that there is another more likely etiology for the Veteran's condition, that should be stated. A complete, well-reasoned rationale must be provided for any opinion offered. If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. . TIFFANY HANSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Eric Struening 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.