Citation Nr: 23019294 Decision Date: 03/29/23 Archive Date: 03/29/23 DOCKET NO. 19-15 609 DATE: March 29, 2023 REMANDED Entitlement to service connection for sinusitis, to include as secondary to service-connected residuals of fractured mandible and maxilla, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1953 to September 1955. He testified at a virtual Board hearing before the undersigned in July 2021. This case was before the Board in April 2022 and December 2022 when it was remanded for additional development. Previously on appeal and remanded most recently in December 2022 was the additional issue of entitlement to service connection for headaches. A February 2023 rating decision granted service connection for paroxysmal hemicrania, claimed as headaches. As this claim has been granted in full, it is no longer before the Board for appellate consideration. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). 1. Entitlement to service connection for sinusitis is remanded. Another remand is unfortunately required. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. See Stegall v. West, 11 Vet. App. 268 (1998). The December 2022 Board remand directed, in pertinent part, that a VA examiner provide an addendum medical opinion as to the nature and etiology of the Veteran's sinusitis. The examiner was asked first to identify whether sinusitis had been found during the period of the appeal (since June 2016), considering and discussing a 2016 VA examiner's diagnosis of sinusitis, 2019 treatment of sinusitis with medication, and the Veteran's complaints of ongoing sinusitis since service. Thereafter, the examiner was to provide opinions as to whether the Veteran's sinusitis existed prior to service, was incurred in service including as a result of a motor vehicle accident, and whether it was caused or aggravated by his service-connected residuals of fractured mandible and maxilla. A VA medical opinion was obtained in January 2023. The Veteran's representative maintains this medical opinion is incomplete (see March 2023 Appellate Brief) and the Board agrees. In pertinent part, while the VA examiner stated that sinusitis was not currently shown on examination, he did not provide an opinion as to whether it was present at any time during the appeal period. Notably, the requirement for service connection that a current disability be present is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim even though the disability resolves prior to the adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). On remand, this inadequacy should be corrected and another medical opinion should be provided. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matter is REMANDED for the following action: Forward the Veteran's claims file to an appropriate VA examiner who must review the claims file (to include this remand) and identify whether sinusitis is found during the period of the appeal (since June 2016). In doing so, the examiner must specifically consider and discuss the 2016 VA examiner's diagnosis of sinusitis, 2019 treatment of sinusitis with medication, and the Veteran's complaints of ongoing sinusitis since service. The examiner must reconcile any contradictory findings and provide rationale for the conclusion reached. Thereafter, if sinusitis is found to be present during the period of the appeal, the examiner must answer the following questions: a) Is there clear and unmistakable (obvious, manifest, or undebatable) evidence that sinusitis pre-existed the Veteran's military service? b) If it is determined that sinusitis clearly and unmistakably pre-existed service, is there clear and unmistakable (obvious, manifest, or undebatable) evidence that the pre-existing sinusitis was not aggravated beyond the natural progression of the condition? The term "aggravated" in the above context refers to a permanent worsening of the underlying condition, as contrasted to temporary or intermittent flare-ups of symptomatology which resolve with return to the baseline level of disability. c) If it is determined that sinusitis did not clearly and unmistakably pre-exist service, did it at least as likely as not have its onset during service or is it otherwise related to any incident from active military service (as distinguished from any post-service incident), to include a 1954 vehicle accident? d) Is it at least as likely as not that the Veteran's sinusitis is caused or aggravated by his service-connected residuals of fractured mandible and maxilla? For the purposes of secondary service connection, the examiner is advised that aggravation is defined as "any increase in disability." See Allen v. Brown, 7 Vet. App. 439, 448 (1995). If the examiner determines that the requested opinion may not be provided without a physical examination of the Veteran, then such should be scheduled. A complete rationale must be provided for all opinions presented. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should provide an explanation stating why this is so. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Fletcher, Kathleen 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.