SLEEP APNEA SYNDROMES (OBSTRUCTIVE CENTRAL MIXED)

SHAUN S. SPERANZA · 2026 · Case ID: A26040941

MIXED

Summary

The veteran, who served in the U.S. Navy from October 2003 to November 2010, appeals the denial of service connection for obstructive sleep apnea (OSA) and sinusitis, and the remand of a skin disability claim. The Board granted service connection for OSA, finding the veteran's in-service sleep-related symptoms, weight gain during service, and subsequent VA treatment records were highly probative and weighed in favor of the claim. Despite an initial inadequate VA examination, a subsequent private examiner provided an adequate opinion linking the OSA to service. Service connection for sinusitis was also granted. The Board found the veteran's lay statements regarding sinus issues and exposure to paint fumes and other chemicals during service, supported by STRs showing multiple sinus treatments and MPRs confirming relevant assignments, were highly probative. Although the veteran served in Southwest Asia, the Board noted that a remand to confirm this for presumptive sinusitis was unnecessary as the claim was fully granted. The claim for a skin disability, specifically pseudofolliculitis barbae (PFB), was remanded due to a pre-decisional duty to assist error. The March 2019 VA examination was inadequate because it failed to address the veteran's current symptoms, did not confirm whether a physical examination of the skin under the beard was performed, and did not adequately consider the in-service weight gain and subsequent diagnosis.

Rationale

Veteran's lay statements regarding sleep symptoms during service; STRs showing sleep-related symptoms during service; MPRs confirming service locations and dates; VA treatment records showing OSA diagnosis and treatment; Adequate private medical opinion linking OSA to service

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210721-174335

Full Decision Text

Citation Nr: A26040941
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 210721-174335
DATE: April 30, 2026

ORDER

Service connection for obstructive sleep apnea (OSA) is granted.

Service connection for sinusitis is granted.

REMANDED

Service connection for a skin disability, claimed as pseudofolliculitis barbae (PFB), is remanded.

FINDINGS OF FACT

1. The Veteran's OSA is related to service.

2. The Veteran's sinusitis is related to service.

CONCLUSIONS OF LAW

1. The criteria for direct service connection for obstructive sleep apnea (OSA) have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for direct service connection for sinusitis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from October 2003 to November 2010.

This matter comes before the Board of Veterans' Appeals (Board) from a July 2020 rating decision issued by the Department of Veterans Affairs (VA) regional office, an agency of original jurisdiction (AOJ). The appeal is being reviewed under the modernized review system, commonly referred to as the "AMA," as established by the Veterans Appeals Improvement and Modernization Act of 2017. 115 Pub. L. No. 55, 131 Stat. 1105.

In the July 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on January 22, 2025.

Therefore, the Board may only consider the evidence of record at the time of the July 2020 rating decision on appeal, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302 (a). If evidence was submitted either (1) during the period after the AOJ issued the rating decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claim for entitlement to service connection for a skin disability, claimed as pseudofolliculitis barbae (PFB), any evidence the Board could not consider will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

When a Veteran seeks service connection for a disability, he seeks compensation for his symptoms, regardless of how those symptoms are diagnosed or labeled. Accordingly, the Board has recharacterized the Veteran's claim for pseudofolliculitis barbae (PFB) as a claim for a skin disability. See Clemons v. Shinseki, 23 Vet. App. 1 (2009).

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Generally, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Service connection is warranted on a presumptive basis for asthma, rhinitis, sinusitis, and rhinosinusitis, as chronic diseases associated with exposure to fine particulate matter, if the conditions manifest to any degree (
38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Generally, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Service connection is warranted on a presumptive basis for asthma, rhinitis, sinusitis, and rhinosinusitis, as chronic diseases associated with exposure to fine particulate matter, if the conditions manifest to any degree (including non-compensable), for qualifying service in Southwest Asia or certain other areas during the Persian Gulf War. 38 C.F.R. § 3.320. These provisions became effective on August 5, 2021. See Interim Final Rule, 86 FR 42724 (August 5, 2021).

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act) provides presumptive service connection for toxic exposure. See PACT Act of 2022, Pub. L. 117-168 (Enacted, August 10, 2022). The PACT Act removed a previous requirement for manifestation within 10 years and for manifestation to a compensable degree. See PACT Act of 2022, Pub. L. 117-168 (Enacted, August 10, 2022). The Southwest Asia theater of operations means Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations, as defined in § 3.317(e)(2). Qualifying areas further include Afghanistan, Syria, Djibouti, or Uzbekistan on or after September 19, 2001, during the Persian Gulf War, as specified in 38 C.F.R. § 3.320 (a)(5). Covered veterans are presumed to have been exposed to fine, particulate matter during such service, unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.320 (a)(4).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

1. Service connection for obstructive sleep apnea (OSA).

The Veteran seeks service connection for OSA. See July 2021 VA Form 10182. The AOJ found the Veteran experiences a current disability, as he is diagnosed with OSA, and he experienced a qualifying event during service, as his service treatment records (STRs) indicate he reported trouble sleeping in June 2007. See July 2020 Rating Decision. These favorable findings are binding on the Board. See 38 C.F.R. § 3.104(c).

The Veteran reported he did not snore or experience difficulty sleeping prior to service, he began experiencing sleep-related symptoms, including gasping for air in his sleep, snoring loudly, and daytime sleepiness during service, he sought treatment for his sleep-related symptoms while he was stationed in Everett, WA, his doctor asked if he snored, the Veteran did not know if he snored, and no follow-up sleep-related testing or treatment occurred at that time. See March 2012 VA Form 21-526; December 2018 VA Form 21-526EZ; July 2019 VA Form 21-526EZ; February 2020 HLR - Informal Conference; January 2025 Hearing Transcript. The Veteran indicated his sleep-related symptoms continued and worsened, and the Veteran's family told him that he snored loudly and stopped breathing in his sleep when he went home on leave from the military. See January 2025 Hearing Transcript. The Veteran reported that he was deployed to Sigonella Sicily, and his fellow service member stationed with him in Sicily told the Veteran that he snored loudly. See January 2025 Hearing Transcript. The Veteran also suggested that his OSA may be attributable to weight gain during service, as he gained weight in 2009 and 2010 due to cortisone shots to treat his knee disability, or to a toxic exposure risk activity (TERA) during service. Id. The Veteran reported multiple in
indicated his sleep-related symptoms continued and worsened, and the Veteran's family told him that he snored loudly and stopped breathing in his sleep when he went home on leave from the military. See January 2025 Hearing Transcript. The Veteran reported that he was deployed to Sigonella Sicily, and his fellow service member stationed with him in Sicily told the Veteran that he snored loudly. See January 2025 Hearing Transcript. The Veteran also suggested that his OSA may be attributable to weight gain during service, as he gained weight in 2009 and 2010 due to cortisone shots to treat his knee disability, or to a toxic exposure risk activity (TERA) during service. Id. The Veteran reported multiple in-service TERAs: 1) his military occupational specialty (MOS) as a deck seaman subjected him to fumes from paint because he was required to manage, use, and distribute paint from the paint locker; 2) he was exposed to mold, gasoline, smoke, and other toxins during his service in Sicily when he used gasoline to burn files contaminated with mold in a burn pit; 3) he was deployed to Iraq for two to four weeks in 2007 after he volunteered for Individual Augmentation (IA) in support of Operation ENDURING FREEDOM; and 4) he was deployed to Bahrain for two months for training in 2008 to 2009. Id. The Veteran reported he was first diagnosed with OSA in November 2011, but he did not obtain a continuous positive airway pressure (CPAP) because his transient living situation led him to miss the appointment letters indicating he should be fitted for a CPAP, so he sought treatment for the same sleep-related symptoms in February 2018 and was diagnosed with OSA again. See November 2019 VA Form 21-4138; January 2025 Hearing Testimony.

The Veteran's mother, G.C.W., reported that the Veteran did not experience sleep-related symptoms before he enlisted into service, she first heard him snoring and breathing abnormally when he returned home on leave from service, and she has noticed that his snoring has worsened over the years. See July 2019 VA Form 21-4138. The Veteran's uncle, Pastor J.H.E., reported that he first heard the Veteran snoring loudly, gasping for air, and breathing abnormally in his sleep when the Veteran returned home on leave from service. See July 2019 Buddy/Lay Statement. The Veteran's fellow service member submitted a statement indicating he served with the Veteran from November 2007 to November 2010, observed the Veteran stop breathing in his sleep in March 2008, and observed the Veteran snoring so loud that he didn't hear his phone or his fellow service member banging on the Veteran's door in July 2008. See July 2019 Buddy/Lay Statement.

Veterans are competent to provide evidence of that which they experience, including symptoms and medical history. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Lay people are competent to describe visible or otherwise observable symptoms of disability. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Veteran is competent to describe the onset of his sleep-related symptoms, to recount the events that occurred in service, and to report the medical treatment history for his OSA. The Veteran's mother, uncle, and fellow service member are competent to describe their observations of the Veteran's symptoms. If lay evidence is competent, the Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The lay statements are consistent with other evidence and are therefore credible. The Veteran's lay statements and the Veteran's mother's, uncle's, and fellow service member's lay statements constitute highly probative evidence weighing in favor of the claim.

Service treatment records (STRs) demonstrate that the Veteran began experiencing sleep-related symptoms during service. STRs indicate the Veteran did not experience any sleep-related symptoms or conditions when he enlisted into service in March 2003. See March 2015 STRs. A January 2007 annual health assessment noted the Veteran's health risks are remarkable for body mass index (BMI) and sleep. Id. STRs support the Veteran's lay statements indicating he began experiencing sleep-related symptoms during service. STRs are consistent with other probative evidence demonstrating the Veteran's OSA is related to service. STRs constitute highly probative evidence weighing in favor of the claim.

Military personnel records (MPRs) confirm the Veteran's statements describing TERAs during service. Performance evaluations verify that the Veteran served as a deck seaman at Momsen Naval Base
. STRs indicate the Veteran did not experience any sleep-related symptoms or conditions when he enlisted into service in March 2003. See March 2015 STRs. A January 2007 annual health assessment noted the Veteran's health risks are remarkable for body mass index (BMI) and sleep. Id. STRs support the Veteran's lay statements indicating he began experiencing sleep-related symptoms during service. STRs are consistent with other probative evidence demonstrating the Veteran's OSA is related to service. STRs constitute highly probative evidence weighing in favor of the claim.

Military personnel records (MPRs) confirm the Veteran's statements describing TERAs during service. Performance evaluations verify that the Veteran served as a deck seaman at Momsen Naval Base from July 2004 to July 2005, the Veteran was serving in Everett, WA when he reported sleep-related symptoms in January 2007, and the Veteran served in Sicily from October 2007 to June 2009. See March 2020 DPRIS Response. MPRs are consistent with the Veteran's lay statements indicating his sleep-related symptoms began while he was serving in Everett, WA and the Veteran's lay statements reporting participation in TERAs during service, as the records confirm that the Veteran served in Everett, WA in January 2007, served as a deck seaman for 1 year, and served in Sicily for two years. Id. MPRs indicate the Veteran's lay statements are consistent with the places, types, and circumstances of his service. 38 U.S.C. § 1154 (a); 38 C.F.R. § 3.303 (a). MPRs are consistent with other probative evidence showing the Veteran's OSA is related to service. MPRs constitute highly probative evidence weighing in favor of the claim.

VA treatment records support the Veteran's statements and suggest the Veteran's OSA is related to service. The Veteran established care at the VA in January 2011 and reported multiple medical issues stemming from service. See February 2020 CAPRI. At an April 2011 primary care appointment, the Veteran reported that he snores loudly and occasionally stops breathing in his sleep, and the provider indicated a sleep study should be performed. Id. A November 2011 sleep study diagnosed the Veteran with moderate OSA, but the Veteran did not obtain a CPAP at that time. Id. The Veteran sought treatment for symptoms consistent with OSA again in April 2018, a June 2018 sleep study confirmed the Veteran's moderate OSA diagnosis, and the Veteran began using a CPAP shortly thereafter. See January 2019 CAPRI. Thus, VA treatment records indicate the Veteran sought treatment for symptoms consistent with OSA immediately after he separated from service. VA treatment records are consistent with other probative evidence demonstrating the Veteran's OSA is related to service. VA treatment records constitute highly probative evidence weighing in favor of the claim.

A March 2019 VA examiner diagnosed the Veteran with OSA and opined the Veteran's OSA is less likely than not related to service, but the opinion is inadequate. See March 2019 VA Examination. Inadequate medical examinations include examinations that contain only data and conclusions, do not provide an etiological opinion, are not based upon a review of medical records, or provide unsupported conclusions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The opinion is inadequate because the rationale is not based on a review of the Veteran's STRs. The rationale explained the Veteran's OSA was most likely caused by the Veteran's elevated BMI greater than 30 and narrow oropharyngeal airways, his sleep-related symptoms during service are not competent medical evidence of OSA because trouble sleeping can present in a variety of medical settings, and he was not diagnosed with OSA until several years after service, when his BMI was elevated. See March 2019 VA Examination. However, the examiner did not acknowledge or discuss STRs showing the Veteran's BMI became elevated after the Veteran gained weight during service, as STRs indicate he weighed 213lbs in January 2007, 220lbs in March 2008, and 240lbs in March 2010, he was placed on a weight-management program in January 2010, and he was 246lbs at the time of his November 2011 diagnosis. See February 2020 CAPRI; March 2015 STRs. Thus, the opinion is inadequate, because the rationale indicated the Veteran's OSA is related to weight gain but did not acknowledge that the Veteran gained weight during service.

A June 2020 VA examiner diagnosed OSA and opined the Veteran's OSA is likely related to the
the Veteran's BMI became elevated after the Veteran gained weight during service, as STRs indicate he weighed 213lbs in January 2007, 220lbs in March 2008, and 240lbs in March 2010, he was placed on a weight-management program in January 2010, and he was 246lbs at the time of his November 2011 diagnosis. See February 2020 CAPRI; March 2015 STRs. Thus, the opinion is inadequate, because the rationale indicated the Veteran's OSA is related to weight gain but did not acknowledge that the Veteran gained weight during service.

A June 2020 VA examiner diagnosed OSA and opined the Veteran's OSA is likely related to the Veteran's service in Southwest Asia, but the examiner clarified in a July 2020 addendum that the Veteran's OSA is less likely than not related to an exposure in Southwest Asia because the evidence does not confirm that the Veteran served in combat or "boots on the ground" in Southwest Asia. See June 2020 VA Examination; July 2020 VA Examination. The opinion is inadequate because the rationale did not address the Veteran's lay statements reporting sleep-related symptoms and in-service TERAs, including exposure to paint fumes, mold, gasoline, smoke, and other toxins, and did not acknowledge or address STRs showing the Veteran gained weight during service. See Nieves-Rodriguez, 22 Vet. App. at 304; Stefl, 21 Vet. App. at 124. The opinion and addendum are not consistent with the probative evidence demonstrating the Veteran's OSA is related to service. The June 2020 VA opinion and July 2020 addendum are not probative.

A February 2025 private examiner, Dr. M.B., opined the Veteran's OSA is at least as likely as not related to service. See February 2025 Medical Treatment Record. The opinion is adequate because the rationale was based on a consideration of the Veteran's history and lay statements, a review of the Veteran's STRs, MPRs, and VA treatment records, and an analysis of relevant medical literature. See Nieves-Rodriguez, 22 Vet. App. at 304; Stefl, 21 Vet. App. at 124. The rationale acknowledged STRs showing the Veteran's weight fluctuated during service and noted that the Veteran's weight fluctuation created an increased risk of developing OSA, emphasized STRs indicating the Veteran's reported sleep-related symptoms during service, including persistent sleep disturbances, difficulty initiating and maintaining sleep, and feeling tired upon waking, are "...consistent with sleep-disordered breathing, including snoring and excessive daytime fatigue." See February 2025 Medical Treatment Record. The opinion is consistent with the other probative evidence demonstrating the Veteran's OSA is related to service. The February 2025 private medical opinion constitutes highly probative evidence weighing in favor of the claim.

In sum, the probative evidence weighs in favor of the claim. Service connection for obstructive sleep apnea (OSA) is granted.

2. Service connection for sinusitis.

The Veteran seeks service connection for sinusitis. See July 2021 VA Form 10182. The AOJ found the Veteran experienced a qualifying event during service, as his service treatment records (STRs) indicate he was treated for sinusitis in March 2009. See July 2020 Rating Decision. This favorable finding is binding on the Board. See 38 C.F.R. § 3.104(c).

The Board considered whether the Veteran is entitled to presumptive service connection for sinusitis, because the Veteran reported that he served in Bahrain and Iraq after September 19, 2001, but the Veteran's service in the Southwest Asia theater is not confirmed by the claims file. See 38 C.F.R. § 3.320; Interim Final Rule, 86 FR 42724 (August 5, 2021); PACT Act of 2022, Pub. L. 117-168 (Enacted, August 10, 2022); see also August 2012 MPRs; March 2015 STRs; March 2020 DPRIS Response. However, remand is not necessary to determine if the Veteran served in the Southwest Asia theater because this decision constitutes a full grant of the benefit sought, and the Veteran's claim was filed on December 21, 2018, three years prior to the August 5, 2021 effective date for the PACT Act, so a remand could not produce an effective date earlier than the Veteran's December 21, 2018 claim date for sinusitis. See 38 C.F.R. § 3.320; Interim Final Rule, 86 FR 42724 (August 5, 2021
also August 2012 MPRs; March 2015 STRs; March 2020 DPRIS Response. However, remand is not necessary to determine if the Veteran served in the Southwest Asia theater because this decision constitutes a full grant of the benefit sought, and the Veteran's claim was filed on December 21, 2018, three years prior to the August 5, 2021 effective date for the PACT Act, so a remand could not produce an effective date earlier than the Veteran's December 21, 2018 claim date for sinusitis. See 38 C.F.R. § 3.320; Interim Final Rule, 86 FR 42724 (August 5, 2021). Thus, the Veteran can receive no benefit from the Board remanding the claim to determine if the Veteran served in the Southwest Asia theater, and this decision constitutes a full grant of the benefit sought.

The Veteran claimed he currently experiences sinusitis, and reported that his sinuses have not properly functioned since he contracted a sinus infection and swine flu while stationed in Sicily. See July 2021 VA Form 10182; February 2020 HLR - Informal Conference; January 2025 Hearing Transcript. The Veteran also suggested his sinusitis may be attributable to an in-service TERA and described multiple in-service TERAs: 1) his military occupational specialty (MOS) as a deck seaman required him to manage, use, and distribute paint from the paint locker and subjected him to fumes from paint; 2) he was exposed to mold, gasoline, smoke, and other toxins in Sicily when he used gasoline to burn files contaminated with mold in a burn pit; 3) he was deployed to Bahrain for two months in 2008 to 2009 for training; and 4) he was deployed to Iraq for two to four weeks in 2007 after he volunteered for Individual Augmentation (IA) in support of Operation ENDURING FREEDOM. See January 2025 Hearing Transcript. The Veteran is competent to describe his symptoms and their onset, to recount the events that occurred during service, and to observe a continuity of symptomatology for sinusitis since service. See Layno, 6 Vet. App. at 469; Jandreau, 492 F.3d at 1376-77. The Veteran's statements indicate he began experiencing sinusitis during service after contracting an illness and participating multiple in-service TERAs, and he has continued to experience sinusitis since service. The statements are consistent with other evidence and are therefore credible. The Veteran's lay statements constitute highly probative evidence weighing in favor of the claim.

Service treatment records (STRs) support the Veteran's lay statements indicating he contracted swine flu and repeated sinus infections during service and his lay statements reporting exposure to fumes from paint and other chemicals from working in the paint locker. The Veteran sought treatment for a headache, cough, and cold symptoms in October 2003 and was diagnosed with sinusitis in November 2003. See March 2015 STRs. An August 2004 medical questionnaire for potential respirator users reflects that the Veteran reported exposure to hazardous solvents and airborne chemicals, noting that he has inhaled fumes in the paint locker, and exposure to dusty environments. Id. The Veteran sought treatment for nasal congestion, coughing, or cold-like symptoms multiple times: June 2006, November 2006, May 2007, March 2009, July 2009, August 2009, and November 2009. Id. In November 2009, the provider indicated the Veteran was treated with albuterol inhaler, nasal spray, and oral medication for influenza with reactive airway disease (RAD), mild asthma exacerbation, and mild erythema of the lower extremities. Id. The Veteran's June 2010 report of medical history at separation indicates the Veteran reported a medical history of bronchitis and H1N1 virus during service. Id. STRs support the claim, because the records show that the Veteran experienced symptoms consistent with sinusitis numerous times throughout his service. STRs are consistent with other probative evidence demonstrating the Veteran's sinusitis is related to service. STRs constitute highly probative evidence weighing in favor of the claim.

Military personnel records (MPRs) confirm a history of assignments consistent with the Veteran's statements. MPRs reveal the Veteran served as a deck seaman for 1 year and served in Sicily for two years. See August 2012 MPRs; March 2020 DPRIS Response. MPRs verify the Veteran's statements indicating he was exposed to fumes from paint and other chemicals while working in the paint locker during service and his statements reporting service in Sicily are consistent with the places, types, and circumstances of his service. 38
his service. STRs are consistent with other probative evidence demonstrating the Veteran's sinusitis is related to service. STRs constitute highly probative evidence weighing in favor of the claim.

Military personnel records (MPRs) confirm a history of assignments consistent with the Veteran's statements. MPRs reveal the Veteran served as a deck seaman for 1 year and served in Sicily for two years. See August 2012 MPRs; March 2020 DPRIS Response. MPRs verify the Veteran's statements indicating he was exposed to fumes from paint and other chemicals while working in the paint locker during service and his statements reporting service in Sicily are consistent with the places, types, and circumstances of his service. 38 U.S.C. § 1154 (a); 38 C.F.R. § 3.303 (a). MPRs are consistent with other probative evidence showing the Veteran's sinusitis is related to service. MPRs constitute highly probative evidence weighing in favor of the claim.

VA treatment records show the Veteran experiences sinusitis. A March 2019 sinus series of x-rays did not reveal any remarkable findings, but records from between March 2018 and January 2020 acknowledge sinusitis as one of the Veteran's active conditions. See January 2019 CAPRI; July 2020 CAPRI. VA treatment records are consistent with other probative evidence demonstrating the Veteran's sinusitis is related to service. VA treatment records constitute highly probative evidence weighing in favor of the claim.

A March 2019 VA examiner did not diagnose the Veteran with sinusitis. See March 2019 VA Examination. The examination is inadequate because the examiner did not address the Veteran's lay statements reporting continued sinus infections after service or the VA treatment records reflecting sinusitis as one of the Veteran's active conditions between March 2018 and January 2020. See Nieves-Rodriguez, 22 Vet. App. at 304; Stefl, 21 Vet. App. at 124. The VA "miscellaneous" examination acknowledges STRs reflect a history of acute and transient sinusitis but emphasized post-service records do not suggest the Veteran experienced chronic sinusitis. See March 2019 VA Examination. The examination is not consistent with the probative evidence demonstrating the Veteran's sinusitis is related to service. The March 2019 VA examination is not probative.

A February 2025 private examiner diagnosed the Veteran with sinusitis and opined the Veteran's sinusitis is at least as likely as not related to in-service exposures. See February 2025 Medical Treatment Record. The opinion is adequate because the rationale was based on a consideration of the Veteran's history and lay statements, a review of the Veteran's STRs, MPRs, and VA treatment records, and an analysis of relevant medical literature. See Nieves-Rodriguez, 22 Vet. App. at 304; Stefl, 21 Vet. App. at 124. The rationale explained the Veteran did not experience asthma, seasonal allergies, or chronic sinus conditions prior to service, his MOS as deck seaman required him to manage the paint locker and exposed him to strong chemical fumes from volatile organic compounds found in industrial paints, solvents, and degreasers, STRs show the Veteran frequently sought treatment for persistent nausea, dizziness, sinus pressure, headaches, ear pain, pharyngitis, and nasal congestion treated by multiple rounds of antibiotics and nasal sprays to manage sinus-related infections in 2005, and the Veteran's sinus symptoms continued and worsened after service. See February 2025 Medical Treatment Record. The rationale also indicated the Veteran's symptoms were exacerbated by his exposure to mold, contaminants in floodwaters, toxic compounds, soot, and fungal spores when he burned flood-damaged files without adequate personal protective equipment (PPE) in a confined space over a four-day period. Id. The opinion is consistent with the other probative evidence demonstrating the Veteran's sinusitis is related to service. The February 2025 private medical opinion constitutes highly probative evidence weighing in favor of the claim.

In sum, the probative evidence weighs in favor of the claim. Service connection for sinusitis is granted.

REASONS FOR REMAND

Under the AMA, the Board shall remand a claim to correct an error by the AOJ to satisfy its duty to assist the claimant under 38 U.S.C. § 5103A if the error occurred prior to the AOJ decision on appeal. 38 U.S.C. § 5103A (f)(2)(A); 38 C.F.R. § 20.802 (a).

The Board may also remand a claim to correct any other AOJ error "in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substant
probative evidence weighs in favor of the claim. Service connection for sinusitis is granted.

REASONS FOR REMAND

3. Service connection for a skin disability, claimed as pseudofolliculitis barbae (PFB).

The Veteran seeks entitlement to service connection for PFB. See July 2021 VA Form 10182. The AOJ found the Veteran experienced a qualifying in-service event, as he was treated for PFB. See July 2020 Rating Decision. This favorable finding is binding on the Board. See 38 C.F.R. § 3.104(c).

Remand is necessary to correct a pre-decisional duty to assist error. 38 U.S.C. § 5103A (f)(2)(A); 38 C.F.R. § 20.802(a). The AOJ provided the Veteran with a March 2019 VA examination, but the examination is inadequate. An opinion based on the absence of treatment records without consideration of a Veteran's competent reports is inadequate. Dalton v. Nicholson, 21 Vet. App. 23, 48-49 (2007). The March 2019 VA examiner did not diagnose the Veteran with PFB and emphasized that post-service records do not show treatment for PFB in longer than 8 years, but the examiner did not address the Veteran's lay statements indicating he currently has discolored, irritated, and itchy bumps underneath his beard and did not opine as to whether the Veteran's current skin inflammation is related to his PFB during service. See January 2025 Hearing Transcript; March 2019 VA Examination. The examination is also inadequate because it is unclear whether the examiner conducted a physical examination of the skin underneath the beard. See Nieves-Rodriguez, 22 Vet. App. at 304; Stefl, 21 Vet. App. at 124. The Veteran indicated the examiner wanted him to shave his beard so that the examiner could observe the Veteran's razor bumps underneath his beard, but the Veteran refused to shave because shaving causes a painful process of fresh irritated, itchy, and discolored bumps. See January 2025 Hearing Transcript. The examiner did not document a request to have the Veteran shave and did not state whether a physical examination of the Veteran's skin underneath his beard was performed. See March 2019 VA Examination. For these reasons, the March 2019 VA examination is inadequate.

Thus, the AOJ committed pre-decisional error in obtaining, and relying upon, an inadequate medical examination. Consequently, remand is necessary to remedy the pre-decisional error.

The matters are REMANDED for the following action:

1. After associating all additional records relevant to the Veteran's claim for service connection for pseudofolliculitis barbae (PFB), schedule the Veteran for an examination to determine the nature and etiology of the Veteran's skin disability, claimed as pseudofolliculitis barbae (PFB).

Following a review of the claims file, the examiner must respond to the following:

(a.) Conduct a physical examination of the Veteran's skin underneath his beard hair. Diagnose any current dermatological disabilities and provide a medical opinion determining the nature and etiology of any resulting diagnoses.

(b.) Address the Veteran's lay statements indicating he currently has discolored, irritated, and itchy bumps underneath his beard.

(c.) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's skin disability, claimed as pseudofolliculitis barbae (PFB), was incurred in or is otherwise related to his active service? Why or why not?

Consider service treatment records (STRs) showing the Veteran was treated for pseudofolliculitis barbae (PFB) multiple times during service.

2. Provide a rationale to support all opinions. In providing the requested opinions, consider the Veteran's lay statements describing in-service and post-service symptoms.

If there is any medical reason to accept or reject the proposition that the Veteran's reported symptoms in service and thereafter represented the onset

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