Citation Nr: 0126540 Decision Date: 11/20/01 Archive Date: 11/27/01 DOCKET NO. 94-28-117 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Houston, Texas THE ISSUES 1. Entitlement to service connection for a chronic lung disorder, to include as secondary to herbicide or radiation exposure. 2. Entitlement to an increased evaluation for sinusitis with allergic rhinitis, currently evaluated as 30 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Carolyn Wiggins, Counsel INTRODUCTION A Statement of Service, dated in August 1976, verifies the veteran entered the United States Naval Reserves in November 1952. He had active duty for training from July 26, 1953 to August 8, 1953. He was on active duty with the United States Marine Corp from October 1953 to September 1956. He was on active duty for training from August 31, 1959 to September 25, 1959. The veteran also had continuous active service from July 1964 to September 1981. This appeal arises from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas, which denied service connection for a pulmonary disability, to include bronchial asthma, and a rating in excess of 30 percent for sinusitis with allergic rhinitis. FINDINGS OF FACT 1. The veteran's chronic lung disease began during active service. 2. The veteran's service-connected sinusitis with allergic rhinitis, with a history of a bilateral revision transnasal endoscopic partial ethmoidectomy, right middle meatus maxillary antrostomy, and pansinusitis with mastoid bone appearance suggestive of prior infection, are manifested by near constant active sinusitis with headaches, pain and tenderness of the affected sinus, and purulent discharge after repeated surgeries. CONCLUSIONS OF LAW 1. A chronic lung disorder was incurred in active military service. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 1991 & Supp. 2001); 38 C.F.R. §§ 3.303, 3.304 (2001); 66 Fed. Reg. 45620-45632 (August 29, 2001) (codified as amended at 38 C.F.R. § 3.159); Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, 114 Stat. 2096 (2000). 2. The criteria for 50 percent rating for sinusitis with allergic rhinitis have been met. 38 U.S.C.A. §§ 1155, 5103, 5103A, 5107 (West 1991 & Supp. 2001); 66 Fed. Reg. 45620- 45632 (August 29, 2001) (codified as amended at 38 C.F.R. § 3.159); Veterans Claims Assistance Act of 2000, Pub. L. No. 106-475, 114 Stat. 2096 (2000); 38 C.F.R. § 4.97, Diagnostic Codes 6511, 6513, 6522 (2001). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Preliminary Matters. As an initial matter the Board notes that there has been a significant change in the law during the pendency of this appeal. On November 9, 2000, the VCAA became law. VA has also revised the provisions of 38 C.F.R. § 3.159 effective November 9, 2000, in view of the new statutory changes. See 66 Fed. Reg. 45620-45632 (August 29, 2001). This law redefined the obligations of VA with respect to the duty to assist and included an enhanced duty to notify a claimant as to the information and evidence necessary to substantiate a claim for VA benefits. This law also eliminated the concept of a well-grounded claim and superseded the decision of the Court in Morton v. West, 12 Vet. App. 477 (1999), withdrawn sub nom. Morton v. Gober, No. 96-1517 (U.S. Vet. App. Nov. 6, 2000) (per curiam order), which had held that VA could not assist in the development of a claim that was not well grounded. This change in the law is applicable to all claims filed on or after the date of enactment of the VCAA, or filed before the date of enactment and not yet final as of that date. VCAA, § 7(a), 114 Stat. at 2099-2100; see also Karnas v. Derwinski, 1 Vet. App. 308 (1991). For the reasons stated below, the Board finds that the duty to assist and duty to notify provisions of the VCAA have been fulfilled, to include the implementing regulatory provisions of 38 C.F.R. § 3.159, and that no additional assistance to the veteran is required based on the facts of the instant case. The claims folder contains the records of treatment of the veteran at the service medical clinics and private facilities identified by the veteran. There is no indication of any additional relevant evidence that has not been obtained by the RO. The veteran has been afforded adequate VA examinations, and the Statement and Supplemental Statements of the Case issued during this appeal, which contained a summary of all of the relevant evidence and applicable law and regulations, adequately informed the veteran of what evidence was needed to support his claims. The Board finds that VA has met its duty to assist the veteran develop his claims. Factual Background. There is no service medical evidence of a lung disorder, sinusitis or rhinitis dated during the veteran's period of active duty and active duty for training during the 1950s. The service medical records relating to the veteran's continuous period of active service from July 1964 to September 1981 include notations that chest X-rays in June 1964 and August 1964 were normal. In November 1968 the veteran was diagnosed with bronchitis. He underwent a septoplasty in February 1975 and, in March 1979, he was treated for possible pneumonia. He was told at that time that he had had bronchitis in Korea. Following further evaluation, the diagnosis was fever of undetermined origin. Shortly after his separation from service, the veteran submitted a statement in January 1982 asserting he served in areas in Vietnam where Agent Orange had been sprayed. A January 1986 service facility chest X-ray revealed a patchy density in the left base at the left costophrenic angle. The report stated it could represent minimal infiltrate or atelectasis. No other abnormality was noted. May 1987 medical records reveal a diagnosis of nasal obstruction. A partial inferior turbinectomy with cryosurgery was performed. January 1988 medical records include a chest X-ray that revealed a poor degree of inspiration and a small linear density in the left costophrenic angle, which was present on a study of January 1986 and was consistent with scarring. There was no evidence of focal or alveolar infiltrate or other significant abnormality. The treatment record included a notation of a history of chronic bronchitis, with the veteran giving a history of episodes of bronchitis occurring during the three previous winters. On a June 1988 VA examination coversheet the veteran wrote that he was treated from August 1985 to August 1988 at Fort Campbell for acute bronchitis, asthma and pneumonia. He indicated he had nasal polyps removed in May 1987. Service medical facility records from Ft. Campbell Kentucky show that the veteran was followed in the Allergy Clinic during 1982 for chronic allergic rhinitis. January 1985 medical evidence includes records of treatment for bronchitis. January 1986 records noted post viral pneumonitis with an asthmatic component, and pulmonary function tests showed mild obstruction. Physical examination revealed atelectasis at the left base. February 1986 pulmonary function test results were consistent with a reversible obstructive airway disease or asthma. February 1986 records include an assessment of viral pneumonitis. June 1986 service medical facility records include an assessment of viral pneumonitis with an observation to consider other interstitial pulmonary disease or connective tissue disease. July 1991 records from Lourdes Hospital show that the veteran was admitted for treatment of asthmatic bronchitis and pneumonia. A VA chest X-ray of the veteran in April 1993 was normal. The veteran submitted a claim for service connection for bronchial asthma in May 1993. He asserted that he was exposed to nuclear radiation from January 1966 to February 1968. He was stationed with the U.S. Marine Detachment with the USS Simon Lake-AS 33 at Holy Loch, Scotland, United Kingdom. His Marine detachment provided security during weapons (nuclear) handling and nuclear affluent spills, which included fluid from the submarine reactors. No protection was provided. In July 1993 the veteran wrote a letter about his chronic bronchial asthma. He asserted that his exposure to radiation in service had an impact on his chronic bronchial asthma. In March 1993 the veteran submitted a statement from his physician. The physician, Dr. L C M, was Chief of the Allergy/Immunology Service at the Blanchfield Army Community Hospital. He wrote the following: (The veteran) is known to the Allergy service of Blanchfield Army Community Hospital for significant perennial allergic rhinitis and bronchial asthma. Symptoms (were) initially noted in August 1971. Despite conservative treatment, his condition eventually required extensive surgical repair of his tympanic membranes. (The veteran) came under my care in 1988. He was noted to have monthly episodes of sinopulmonary infractions requiring courses of antibiotics and oral steroids. In 1990, (the veteran) was placed on inhalant immunotherapy, but despite this treatment, he continues to have deterioration of his symptoms that may be adversely affected by environmental conditions. Due to the propensity for adverse environments to aggravate his conditions as well as the chronicity of his sinopulmonary problems, I recommend that reevaluations of his disability be considered. Upon a VA examination in April 1993, the veteran reported that his respiratory difficulties began in 1968. He indicated that he had had recurrent bronchitis since 1968. He did not appear short of breath. A diagnosis of history of chronic recurrent bronchitis was recorded. His chest X-rays were noted to be normal. Records from the University of Washington Medical Center, dated in December 1993, show that the veteran underwent two procedures for treatment of recurrent sinusitis. Specifically, a bilateral complete endoscopic ethmoidectomy and a right middle meatus maxillary antrostomy were performed. In April 1994 the RO denied the veteran's claim for service connection for a bronchial/pulmonary disorder, claimed as asthma/bronchitis, including as due to herbicide and radiation exposure. The veteran filed his notice of disagreement with the RO determination in April 1994. The veteran wrote that the infected mucous draining into his lungs from his sinuses was causing his bronchitis. A statement of the case was issued in July 1994. The veteran submitted his substantive appeal in July 1994. In a statement accompanying his appeal the veteran asserted he had been exposed to asbestos in service. He indicated that, during his service with the ships company USS Simon Lake from January 1966 to February 1968, he was required to visit the working areas of the ship and the nuclear submarines alongside where asbestos was being installed. He contended that he was breathing asbestos fibers daily for two years. The veteran filed a claim for an increased ratings for his service connected disabilities in August 1994. A VA examination was performed in September 1994. Chronic recurrent bronchitis of undetermined etiology was diagnosed. Pulmonary Function tests revealed mild obstructive airway disease with a mild restrictive component. It was noted that improvement had occurred since April 1993. The VA examiner added that there were no specific factors noted in the physical examination to attribute the disease process to any specific cause (i.e., exposure to Agent Orange, asbestos). In an October 1994 letter the veteran stated that spray records indicated that he was in areas where the highest concentrations of Agent Orange were applied in Vietnam. During his tour he was an infantry officer and lived in the bush. The RO received a copy of an Administrative Decision of the Social Security Administration in July 1995. Also submitted was a copy of a psychological intake report dated in July and August 1994. Tests scores suggested that the veteran was channeling some of his psychological feelings into somatic complaints and symptoms. The psychologist opined that the veteran's reported breathing difficulties might have both a physical and psychosomatic component to them. The diagnoses were post-traumatic stress disorder and psychological factors affecting physical condition. In his recommendations the psychologist wrote that exposure to Agent Orange cannot be ruled out as a contributing factor to the veteran's presenting symptoms. It was noted that spraying records for 1968 and 1969 for Agent Orange indicate significant amounts of the chemical were sprayed in the Corp area while the veteran was there. Records from the Bay Area Medical Center include a January 1997 Computed tomography (CT) examination of the sinuses. It revealed pansinusitis, and the existence of surgical changes with a retention cyst or polyp. The examination also revealed that the mastoid bone was poorly aerated on either side with a sclerotic appearance suggestive of prior infection. A history and physical examination report includes a history of a the development of bronchitis while the veteran was in Vietnam. The veteran indicated that he had had intermittent bronchitis, with several episodes in the 1960s, followed by more frequent episodes in the 1970s. In 1986 he began having increasingly frequent episodes of bronchitis. In the plan for treatment section of the report the physician wrote that the veteran has "perhaps lung interstitial lung disease." It was noted that his chest X- ray actually looked more like asbestosis with accompanying paralysis of the right diaphragm. In February 1997 the same physician reviewed old X-ray reports and opined that they suggested the veteran had a fibrotic lung condition going back probably twenty years. June 1997 service medical facility records include an X-ray report that noted findings of linear densities at both pulmonary bases, which were believed to possibly represent discoid atelectasis. There was no evidence of pneumonia. A VA examination was performed in October 1998. The veteran reported having frequent pneumonias, almost on a yearly basis. He had had bronchitis at least twice a year up until 1995. The VA examiner's impression was the veteran had advanced chronic obstructive pulmonary disease secondary to asthma and allergic rhinitis with sinusitis. An X-ray report revealed minimal fibrotic changes in the lower lungs. A pulmonary function test was interpreted as showing minimal restrictive lung disease. An addendum was added to the VA examination report in February 1999. The addendum reads in part as follows: Any time he (the veteran) gets a sinus infection which are recurring, he will get an exacerbation of his asthma and COPD at that time. Sinusitis aggravates his breathing but not to the point where he needs to increased his inhalation. However it is well known that any time that he gets any type of infection in his system, whether in his sinus, or whether in pneumonia or bronchitis, he will get an exacerbation of his respiratory system. Records from the veteran's private internist show treatment for sinusitis and asthma during 1999 and 2000. A May 2000 chest X-ray revealed some basilar atelectasis in the right lung base. The impression was right lung infiltrate. May 2000 X-rays of the sinuses revealed findings consistent with bilateral maxillary sinusitis. A second May 2000 chest X-ray revealed subsegmental atelectasis of the right lower lobe. A third X-ray in May 2000 revealed atelectatic changes involving the right lung base that appears to be more prominent than with the previous examination. The possibility of a small zone of pneumonic infiltrate involving the first infrahilar region could not be excluded. Service Connection for Bronchial/Pulmonary Disability Pertinent Laws and Regulations. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131 (West 1991); 38 C.F.R. § 3.303(a) (2001). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b) (2001). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Id. Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2001). Further, VA regulations provide that a "disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition." 38 C.F.R. § 3.310 (2000); see Anderson v. West, 12 Vet. App. 491, 495 (1999); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). With regard to a claim for secondary service connection, a claimant must provide competent evidence that the secondary condition was caused by the service-connected condition. See Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516- 17 (1995). If a veteran was exposed to an herbicide agent during active military, naval, or air service, the following diseases shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, provided that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied: chloracne or other acneform disease consistent with chloracne; Hodgkin's disease; multiple myeloma; non- Hodgkin's lymphoma; porphyria cutanea tarda; respiratory cancers; and soft-tissue sarcoma. 38 C.F.R. § 3.309(e). A veteran who has had active service in the Republic of Vietnam during the Vietnam era shall be presumed to have been exposed during such service to an herbicide agent containing dioxin, such as AO, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6). The presumption of exposure requires both service in Vietnam during the designated time period and the establishment of one of the listed diseases in order for the presumption of inservice exposure to an herbicide to apply. McCartt v. West, 12 Vet. App. 164, 168-69 (1999). The Secretary of Veterans Affairs (Secretary) has determined that there is no positive association between exposure to herbicides and any other condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See 59 Fed. Reg. 341-46 (1994); see also 61 Fed. Reg. 41,422-449 (1996). 38 C.F.R. § 3.304 (2001) says that satisfactory lay or other evidence that an injury or disease was incurred or aggravated in combat will be accepted as sufficient proof of service connection if the evidence is consistent with the circumstances, conditions or hardships of such service even though there is no official record of such incurrence or aggravation. 38 U.S.C.A. § 1154 (West 1991). Service connection may be granted for disability due to exposure to ionizing radiation in service. 38 U.S.C.A. § 1112(c); 38 C.F.R. §§ 3.309, 3.311. The diseases considered to be "radiogenic" are listed in 38 C.F.R. § 3.309. If a claim is based on a disease other than one of those listed at 38 C.F.R. § 3.311, VA shall nevertheless consider the claim under the provisions of this section provided that the claimant has cited or submitted competent scientific or medical evidence that the claimed condition is a radiogenic disease. 38 C.F.R. § 3.311 (2001). Diseases of allergic etiology, including bronchial asthma and urticaria, may not be disposed of routinely for compensation purposes as constitutional or developmental abnormalities. Service connection must be determined on the evidence as to existence prior to enlistment and, if so existent, a comparative study must be made of its severity at enlistment and subsequently. Increase in the degree of disability during service may not be disposed of routinely as natural progress nor as due to the inherent nature of the disease. Seasonal and other acute allergic manifestations subsiding on the absence of or removal of the allergen are generally to be regarded as acute diseases, healing without residuals. The determination as to service incurrence or aggravation must be on the whole evidentiary showing. 38 C.F.R. § 3.380. Analysis. The contends, in essence, that his chronic lung disease began during service, which he attributes, in part, to his exposure to radiation, Agent Orange and asbestosis during that time. While there is no medical evidence of a presumptive disease found in the regulations pertaining to veteran's exposed to herbicides or radiation, or of a nexus between a current lung disorder and the alleged exposures, the Board does not find it necessary to address the issue of any relationship between those claimed exposures and his current disability since the evidence supports service connection for chronic lung disease based on either a direct incurrence or secondary basis. The service medical records show that the veteran was treated for bronchitis and suspected pneumonia during service. Post- service medical records show variously diagnosed lung disorders, to include bronchitis, asthma, and chronic obstructive lung disease. In reviewing the record, the Board finds that the picture that emerges is one of chronic recurrent bronchitis and asthmatic bronchitis beginning during service and aggravated over the years by chronic recurrent sinusitis, and eventual diagnoses include chronic obstructive lung disease. A physician who reviewed the veteran's old chest X-rays opined in February 1997 that the veteran's fibrotic lung condition probably dated back twenty years, which would indicate an onset date of 1977, which was while he was on active duty and approximately 4 years prior to the veteran's retirement from the service in 1981. This opinion is consistent with the medical evidence in the claims file, to include the veteran's medical histories obtained on numerous examinations over the years since service, and entirely consistent with the veteran's statements and testimony presented since he filed his claim in 1994. A VA physician also recently suggested that the veteran's current diagnosis of chronic obstructive pulmonary disease was aggravated by his service-connected sinusitis, which would lend support for a grant of secondary service connection on an aggravation basis. See 38 C.F.R. § 3.310(a); Allen, supra. In any event, it is the Board's judgment that the medical evidence of record supports the conclusion that the veteran current chronic obstructive pulmonary disease is of service origin. Accordingly, service connection for a chronic lung disorder is warranted on a direct incurrence basis. Increased Evaluation for Sinusitis with Allergic Rhinitis Disability evaluations are determined by the application of a schedule of ratings that is based on average impairment of earning capacity. 38 U.S.C.A. § 1155. Percentage evaluations are determined by comparing the manifestations of a particular disorder with the requirements contained in the VA Schedule for Rating Disabilities, 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2000). In evaluating the severity of a particular disability, it is essential to consider its history. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. §§ 4.1 and 4.2 (1997). During the pendency of this appeal the diagnostic codes for evaluating disability related to diseases of the nose and throat have been amended. The amendments were published at 61 Fed. Reg. 46720 (1996). The amendments became effective October 7, 1996. Prior to October 7, 1996 sinusitis, ethmoid, pansinusitis and ethmoid, were rated as 50 percent disabling with postoperative following radical operation, with chronic osteomyelitis, requiring repeated curettage, or severe symptoms after repeated operations. 38 C.F.R. § 4.97, Diagnostic Code 6510-6514 (1986). Chronic atrophic rhinitis with definite atrophy of intranasal structure, and moderate secretion was rated as 10 percent disabling. Rhinitis with moderate crusting and ozena, atrophic changes was rated as 30 percent disabling. Rhinitis with massive crusting and marked ozena, with anosmia was rated as 50 percent disabling. 38 C.F.R. § 4.97, Diagnostic Code 6501 (2000). Effective October 7, 1996, the General Rating Formula for sinusitis for diagnostic codes 6510 through 6514 is as follows: Following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries is rated as 50 percent disabling. Three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by head aches, pain, and purulent discharge or crusting is rated as 30 percent disabling. 38 C.F.R. § 4.97, Diagnostic Codes 6511, 6513 (2000). The modified rating schedule eliminated Diagnostic Code 6501, and a new diagnostic code was added for allergic or vasomotor rhinitis. Allergic or vasomotor rhinitis with polyps is rated as 30 percent disabling. Without polyps, but with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side. 38 C.F.R. § 4.97, Diagnostic Codes 6522 (2000). Analysis. When a law or regulation changes after a claim has been filed but before the administrative appeal process has been concluded, VA must apply the regulatory version that is more favorable to the veteran. Karnas v. Derwinski, 1 Vet. App. 308, 312-13 (1991). Therefore, the Board must evaluate the veteran's claim for a higher rating under both the old criteria in the VA Schedule for Rating Disabilities and the current regulations in order to ascertain which version is most favorable to his claim, if indeed one is more favorable than the other. Also see VAOPGCPREC 3-2000 (May 30, 2000). The Board has reviewed both the old and new regulations and determined that the new regulations are move favorable to the veteran. As was noted in the Federal Register the new regulations of rating sinusitis are more specific in listing the symptoms to be considered when rating disability related to sinusitis. The medical evidence supports a grant of an increased rating to 50 percent for sinusitis with allergic rhinitis. The claims folder contains evidence of repeated surgeries for treatment of sinusitis and allergic rhinitis. A septoplasty was performed in February 1975 for treatment of allergic rhinitis and sinusitis in service. May 1987 service medical facility records include records of an inferior turbinectomy with cryosurgery. December 1993 records from the University of Washington Medical Center show that the veteran underwent endoscopic ethmoidectomy and a right middle meatus maxillary antrostomy. Subsequent to those surgical procedures a CT scan in January 1997 revealed sclerosis of the mastoid bone, noted to be evidence of prior infection of the bone. A 50 percent rating requires either radical surgery with chronic osteomyelitis or near constant sinusitis with symptoms after repeated surgeries. The medical record shows the veteran has had several significant surgical procedures involving his sinuses and nasal passages. There is evidence of old infection of the bone. There is no reference to chronic recurrent or recent acute infection or inflammation of the bone but there is medical evidence of near constant sinusitis with purulent discharge after repeated surgeries. Under these circumstances, an increased rating to 50 percent for sinusitis and allergic rhinitis is warranted. 38 C.F.R. § 4.97, Diagnostic Codes 6511, 6513 (2000). The Board considered whether the veteran's sinusitis and allergic rhinitis should be evaluated separately. The United States Court of Appeals for Veterans Claims (Court) has held the determination of whether the correct diagnostic code was selected by the VA in a particular case is neither a pure factual question nor a pure legal one; rather, it is a mixed question involving the application of law -- here, one or more regulations -- to a particular set of facts -- in this case, one or more disabilities affecting appellant. Butts v. Brown, 5 Vet. App. 532, 538 (1993) (en banc). In this case the Board has concluded that the symptoms manifested by the veteran more closely follow the criteria for rating sinusitis. In addition, the symptoms of allergic rhinitis and sinusitis overlap and are almost indistinguishable. The pain, purulent discharge and blockage of the nasal passages represent the same disease process and symptoms. The Board notes that evaluation of the same "disability" or the same "manifestations" under various diagnoses is not allowed. 38 C.F.R. § 4.14. A claimant may not be compensated twice for the same symptomatology as "such a result would overcompensate the claimant for the actual impairment of his earning capacity." Brady v. Brown, 4 Vet. App. 203, 206 (1993) (interpreting 38 U.S.C.A. § 1155). This would result in pyramiding, contrary to the provisions of 38 C.F.R. § 4.14. However, a claimant may have separate and distinct manifestations attributable to the same injury and should be compensated under different diagnostic codes. Fanning v. Brown, 4 Vet. App. 225, 230 (1993). In this instance the veteran's symptoms of sinusitis and allergic rhinitis are not separate and distinct. For that reason a separate evaluation for allergic rhinitis is not proper. ORDER Service connection for chronic lung disease is granted. An increased rating for sinusitis and allergic rhinitis to 50 percent is granted, subject to regulations governing the award of monetary benefits. R. F. Williams Member, Board of Veterans' Appeals