Citation Nr: 22049331 Decision Date: 08/30/22 Archive Date: 08/30/22 DOCKET NO. 19-28 953A DATE: August 30, 2022 REMANDED The issue of entitlement to service connection for sinusitis, to include as a secondary to service-connected allergic rhinitis, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1979 to January 2003, to include service in Southwest Asia. He testified before the undersigned Veterans Law Judge via video conference in May 2022. A transcript of the hearing is associated with the claims file. The Veteran is seeking service connection for sinusitis as directly related to his period of military service or, in the alternative, as secondary to his service-connected allergic rhinitis. As for direct service connection, the Veteran testified that he experienced symptoms of sinusitis during active service, which he stated included an itchy, runny, and stuffy nose, rough throat, and pain in his cheekbones. The Veteran testified that he went to sick call for his symptoms and, in this regard, his service treatment records (STRs) show that he was diagnosed with and treated for sinusitis in March 1994. The Veteran also testified that he was exposed to burn bits during his active service in Southwest Asia and, in this regard, the Board acknowledges that the Veteran is presumed to have been exposed to fine particulate matter during his service in Southwest Asia. See 38 C.F.R. § 3.320(a). Service connection for sinusitis may be granted on a presumptive basis if the disease manifested to any degree (including non-compensable) within 10 years from the date of separation from a qualifying period of military service. The Veteran reported that his disability onset in 1996, however, the record does not currently indicate that sinusitis manifested during the necessary window. Instead, the record reflects that he was diagnosed with rhinitis during this time period. See a November 2010 VA treatment record. As discussed below, the record reflets that these conditions have overlapping symptoms. As for secondary service connection, the Veteran has asserted that his sinusitis symptoms are similar to his symptoms of allergic rhinitis, for which service connection is established. In this regard, the lay and medical evidence of record does, indeed, suggest that the Veteran's allergic rhinitis and sinusitis symptoms overlap which raises a question as to whether his sinusitis is a result or manifestation of his service-connected allergic rhinitis. See e.g., August 2020 VA treatment record. The Veteran was afforded a VA sinus examination in November 2018, during which the examiner did not render a diagnosis of sinusitis, as he stated that there was no pathology evident during the examination to render a diagnosis and the medical records did not reveal evidence of sinusitis. Nevertheless, the November 2018 VA examiner opined that the Veteran's sinusitis is not likely proximately due to or a result of his allergic rhinitis. However, the Board's review of the record reveals that a March 2019 CT scan of the Veteran's sinuses revealed chronic sinusitis. In fact, a VA treatment record dated as early as October 2018 shows the Veteran was diagnosed with sinusitis, a diagnosis that VA clinicians have continued since. See e.g., VA treatment records dated October 2018, August 2020, and April 2021. As such, the Board finds the November 2018 examination is inadequate because the examiner did not consider the other evidence of record that shows the Veteran has a current diagnosis of sinusitis during the appeal period. The opinion is also inadequate because the examiner did not provide a rationale in support of his opinion, address the aggravation element of the secondary service connection claim, or address whether sinusitis is directly related to the Veteran's period of active service. Therefore, a remand is needed to obtain an addendum opinion that addresses whether the current diagnosis of sinusitis was incurred during the Veteran's period of active service or, in the alternative, is secondary to (caused or aggravated by) his service-connected allergic rhinitis. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes the effort to provide an examination for a service connection claim, even if not statutorily obligated to do so, it must provide an adequate one). The matters are REMANDED for the following action: 1. Contact the Veteran in order to have him identify the names and addresses of all health care providers who have treated him for the issue on appeal. The Veteran should also be notified that he may submit evidence or treatment records to support his claim. The Board is particularly interested any outstanding records of VA medical treatment (generated prior to the appeal period, and after the last treatment notes of record). The AOJ should attempt to obtain any such records. All efforts to obtain such records should be documented in the claims folder. All available records should be associated with the Veteran's VA claims folder. 2. Arrange for an appropriate health care provider to review the claims file and provide an opinion as to the following: (a) Did the Veteran's sinusitis have its clinical onset during active service or otherwise due to an event or incident of the Veteran's period of active service, to include his presumed exposure to burn pits during service in Southwest Asia? In answering the foregoing, the examiner must consider the service record that shows the Veteran was treated for sinusitis in March 1994 and that he is competent to report his symptoms, to include when they began. The examiner must state whether sinusitis manifested to any degree (including non-compensable) within 10 years from the date of separation. (b) Was or is the Veteran's sinusitis (a) caused or (b) aggravated beyond its normal progression by the service-connected allergic rhinitis? Aggravation means an increase in disability any additional impairment of earning capacity of the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Turnipseed, 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.