Citation Nr: 0809868 Decision Date: 03/25/08 Archive Date: 04/09/08 DOCKET NO. 96-05 033 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, California THE ISSUES 1. Entitlement to an initial evaluation in excess of 10 percent for sinusitis prior to February 8, 1995. 2. Entitlement to an initial evaluation in excess of 30 percent for sinusitis prior to June 12, 2004. ATTORNEY FOR THE BOARD Christopher Maynard, Counsel INTRODUCTION The veteran had active service from January 1979 to January 1982. This matter initially came before the Board of Veterans' Appeals (Board) on appeal from an April 1994 decision by the RO which, in part, granted service connection for sinusitis and assigned a 10 percent evaluation, effective from April 19, 1993, the date of receipt of claim. In June 2000, the Board, in part, denied an initial evaluation in excess of 10 percent prior to February 8, 1995, and assigned an increased rating to 30 percent from February 8, 1995, and the veteran appealed to the United States Court of Appeals for Veterans Claims (hereinafter, "the Court"). In May 2001, the Court granted a Joint Motion for Remand of the June 2000 Board decision. The Board remanded the appeal for additional development in September 2003. In August 2005, the Board denied an initial evaluation in excess of 10 percent prior to February 8, 1995, and in excess of 30 percent from February 8, 1995 to June 12, 2004, and assigned an increased evaluation to 50 percent from June 12, 2004, and the veteran appealed the decision to the Court. In July 2007, the Court vacated the August 2005 Board decision with respect to the 10- and 30-percent evaluations assigned prior to June 12, 2004, and remanded for further development. The veteran appointed a private attorney to represent him in his appeal before the Court only. FINDINGS OF FACT 1. All evidence necessary for adjudication of this claim have been obtained by VA. 2. From April 19, 1993 to February 7, 1995, the veteran's symptoms of sinusitis were manifested by chronic headaches and left maxillary sinus tenderness; severe sinusitis with frequently incapacitating recurrences and purulent discharge or crusting reflecting purulence were not demonstrated. 3. From February 8, 1995 to April 15, 2003, the veteran's symptoms were manifested by chronic headaches and left maxillary sinus tenderness without purulent discharge; severe symptoms of sinusitis, or near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting were not demonstrated. 4. From April 16, 2003, the veteran's manifestations of sinusitis more nearly approximated the criteria contemplated by a 50 percent schedular rating under the revised rating criteria for sinusitis. 5. The criteria for rating sinusitis in effect from October 7, 1996, is more favorable to the veteran. CONCLUSIONS OF LAW 1. The criteria for an initial evaluation in excess of 10 percent for sinusitis from April 19, 1993 to February 7, 1995, have not been met. 38 U.S.C.A. §§ 1155, 5100, 5102, 5103, 5103A, 5106, 5107 (West 2002); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.97, Part 4, Diagnostic Code 6513 (effective prior to October 7, 1996). 2. The criteria for an evaluation in excess of 30 for sinusitis from February 8, 1995 to April 15, 2003 have not been met. 38 U.S.C.A. §§ 1155, 5100, 5102, 5103, 5103A, 5106, 5107 (West 2002); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.97, Part 4, Diagnostic Code 6513 (effective prior to and from October 7, 1996). 3. The criteria for an increased evaluation to 50 percent for sinusitis from April 16, 2003 have been met. 38 U.S.C.A. §§ 1155, 5100, 5102, 5103, 5103A, 5106, 5107 (West 2002); 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.97, Part 4, Diagnostic Code 6513 (effective from October 7, 1996). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2006); 38 C.F.R §§ 3.102, 3.156(a), 3.159, 3.326(a) (2007). Proper VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must ask the claimant to provide any evidence in her or his possession that pertains to the claim. 38 U.S.C.A. § 5103(a) (West 2002); C.F.R. § 3.159(b)(1) (2007). VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). Regarding the veteran's claim for a higher initial rating for sinusitis, once service connection is established, the claim is substantiated and further VCAA notice with regard to downstream issues, such as the initial evaluation, is unnecessary. See Dingess v. Nicholson, 19 Vet. App. 473 (2006), aff'd sub nom, Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). As noted in the Court's July 2007 Memorandum Decision, this appeal arises from the RO's initial assignment of a disability rating upon awarding service connection for sinusitis in 1994, and thus, at the time of the VCAA's enactment, VA no longer had any further duty to notify the veteran on how to substantiate his sinusitis claim because his claim was substantiated in April 1994. Nonetheless, a letter dated in May 2005, fully satisfied the duty to notify provisions of VCAA. 38 U.S.C.A. § 5103; 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). Further, as to the duty to assist, the veteran's service medical records and all VA and available private medical records identified by him have been obtained and associated with the claims file. The veteran was examined by VA multiple times during the pendency of this appeal and was afforded an opportunity for a personal hearing, but declined. Based on a review of the claims file, the Board finds that there is no indication in the record that any additional evidence relevant to the issues to be decided herein is available and not part of the claims file. See Mayfield III. Law and Regulations As noted above, this appeal arises from an original claim for compensation benefits and an April 1994 rating decision which, in part, granted service connection for sinusitis and assigned a 10 percent evaluation. The veteran was subsequently assigned an increased rating to 30 percent, effective from February 8, 1995, and to 50 percent from June 12, 2004. As held in AB v. Brown, 6 Vet. App. 35, 38 (1993), where the claim arises from an original rating, the claimant will generally be presumed to be seeking the maximum benefit allowed by law and regulation. See also Fenderson v. West, 12 Vet. App. 119 (1999), which held that at the time of an initial rating, separate [staged] ratings may be assigned for separate periods of time based on the facts found. Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R., Part 4. The percentage ratings in VA's Schedule for Rating Disabilities (Schedule) represent as far as can practicably be determined the average impairment in earning capacity resulting from such disabilities and their residual conditions in civil occupations. 38 C.F.R. § 4.1 (2007). During the pendency of this appeal, the rating criteria for evaluating disabilities of the respiratory system were amended, effective from October 7, 1996. The Board is required to consider the claim in light of both the former and revised schedular rating criteria to determine whether an increased evaluation for the veteran's sinusitis is warranted. VA's Office of General Counsel has determined that the amended rating criteria, if favorable to the claim, can be applied only for periods from and after the effective date of the regulatory change. However, the veteran does get the benefit of having both the old regulation and the new regulation considered for the period after the change was made. See VAOPGCPREC 3-00. That guidance is consistent with longstanding statutory law, to the effect that an increase in benefits cannot be awarded earlier than the effective date of the change in law pursuant to which the award is made. See 38 U.S.C.A. § 5110(g) (West 2002). The question presented on appeal is whether the veteran is entitled to a rating in excess of 10 percent from the date of the grant of service connection to February 7, 1995, and to a rating in excess of 30 percent from February 8, 1995 to June 11, 2004, including whether an evaluation in excess of 30 percent under the revised rating criteria may be assigned from October 7, 1996. The veteran's sinusitis is evaluated under 38 C.F.R. § 4.97, Diagnostic Code (DC) 6513 under the old and the revised rating schedule. Prior to October 7, 1996, DC 6513 provided for a noncompensable (zero percent) rating with x-ray manifestations only or symptoms mild or occasional sinusitis. A 10 percent rating was assigned for moderate sinusitis with discharge or crusting or scabbing, infrequent headaches. A 30 percent rating was assigned with severe sinusitis with frequently incapacitating recurrences, severe and frequent headaches, purulent discharge or crusting reflecting purulence. A 50 percent rating was assigned for postoperative sinusitis, following radical operation, with chronic osteomyelitis requiring repeated curettage, or severe symptoms after repeated operations. The revised rating criteria for sinusitis effective from October 7, 1996, provides for a 10 percent rating when there are one or two incapacitating episodes of sinusitis per year requiring prolonged (lasting four to six weeks) antibiotic treatment, or three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent rating is warranted when there are 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 headaches, pain, and purulent discharge or crusting. A 50 percent rating is warranted 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. Note: An incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. Evaluation In Excess of 10 Percent Prior to February 7, 1995. In the July 2007 decision, the Court indicated, in part, that the Board appeared to have relied on the findings from the two VA examinations in May 1993 and February 1995, in reaching its decision that the veteran was not entitled to a rating higher than 10 percent prior to February 1995, and that it did not offer any discussion or analysis as to the veteran's chronic complaints of headaches or the VA outpatient records during that period of time. The medical evidence from the date of the veteran's original claim in April 1993 to February 1995, included two VA examinations (May 1993 and February 1995) and numerous VA outpatient notes. The findings from the two VA examinations were not materially different and showed mild tenderness to palpation over the maxillary sinuses. In May 1993, there was some inferior turbinate hypertrophy and generalized mucosal edema, but no mucopus (purulent discharge). The diagnoses included history of clear allergic rhinitis and secondary sinusitis. When examined by VA in February 1995, the examiner noted that the veteran required emergency room therapy for asthmatic symptoms on at least five occasions since 1994. On examination, however, other than mild tenderness on the left maxillary sinus, there were no signs or symptoms of sinusitis. X-ray studies showed the left maxillary sinus was smaller and more opaque than the right, and the remainder of the paranasal sinuses were clear. The diagnoses included allergic rhinitis, sinusitis, and bronchial asthma. The examiner commented that sinusitis and bronchial asthma were not related, but were usually related to a common denominator, i.e., an allergic background. The VA outpatient notes from April 1993 to February 1995 showed that the veteran was seen on numerous occasions, often with complaints of sinusitis. On most occasions, including when seen for problems unrelated to his sinuses, the veteran complained of chronic headaches. However, the records between May 1993 and February 1995, rarely revealed any objective findings of sinusitis other than mild to moderate tenderness on the left side of his face, primarily on the left maxillary sinus, and the veteran was place on antibiotics twice for sinusitis. Although the reports are replete with complaints of headaches, sometimes described as severe, they do not show any objective evidence of severe sinusitis with frequently incapacitating recurrences and purulent discharge or crusting reflecting purulence. Beginning in June 1994, in addition to chronic headaches, the veteran's complaints included shortness of breath, wheezing, and chest pains. X-ray studies showed a soft tissue density in the left maxillary but no air fluid level. The other paranasal sinuses were well developed and aerated. At that time, the examiner indicated that the soft tissue density was consistent with sinusitis, and the veteran was given antibiotics. When seen four days later, the veteran's sinuses were clear. The diagnosis was resolving sinusitis. When seen in July 1994, the veteran complained of headaches and abdominal cramping. No specific findings were noted and the diagnosis was acute sinusitis and gastroenteritis. When seen in September, October, and November 1994, the veteran complained of chronic headaches and congestion. However, other than maxillary sinus tenderness, there were no objective findings of sinusitis or purulent discharge or crusting reflecting purulence. In September, the impression included sinusitis and hypertension. In October the impressions include rhinitis and asthma. A CT scan in October revealed a small amount of fluid in the left maxillary sinus compatible with mild sinusitis. The remainder of the sinuses were clear. In November, the only objective finding was hypoplastic left maxillary sinus and the examiner noted that there was no evidence of any sinus disease. When seen in December 1994, the veteran complained of severe headaches and chest pains for the previous two months. However, on examination, there were no acute symptoms of sinusitis. A CT scan showed the same mucosal thickening along the posterior medial aspect of the left maxillary sinus which was present on the earlier scan in October 1994, but no fluid. The assessment was allergic asthma. When seen in February 1995, there was boggy mucosa over the meati and turbinates, mild tenderness over the maxillary sinus area, and mild airflow obstruction through both nostrils. Inspiratory and expiratory wheezing was also noted. X-ray studies showed no change in the appearance of the sinuses. The diagnoses included bronchial asthma and status post left Caldwell-Luc procedure for chronic sinusitis. In this case, the objective findings on the two VA examinations and the numerous VA outpatient notes from April 1993 to February 1995 failed to reveal any objective evidence of more than mild symptoms of sinusitis. Moreover, there were no objective findings of severe sinusitis with frequently incapacitating recurrences and purulent discharge or crusting reflecting purulence so as to warrant the next higher rating of 30 percent. While the veteran was seen on numerous occasions from April 1993 to February 1995, the lack of any objective or chronic findings of sinusitis, other than some maxillary tenderness, does not equate to an "incapacitating episode." That is, merely being seen by medical personnel for complaints which the veteran believed were manifestations of sinusitis, but without any objective findings of sinusitis, does not constitute treatment under the definition for an "incapacitating episode." In fact, in later reports, at least one neurologist opined that that while the exact etiology of his headaches was not clear, they did not appear to be related to his allergies. Given the lack of any objective findings of even moderate sinusitis with discharge, crusting, or scabbing, the Board finds no basis for the assignment of a rating in excess of 10 percent prior to February 1995. Evaluation In Excess of 30 Percent From February 8, 1995 to June 12, 2004. At this point, it should be noted that the veteran's sinusitis must be rated under the old criteria for the period from February 8, 1995 to October 7, 1996. From October 1996, the veteran has the benefit of being rated under both the old and the revised rating criteria. From February 1995 to October 1996, the medical evidence showed that the veteran was seen on numerous occasions for headaches and sinus problems. Although the veteran complained of chronic sinusitis most of the time, the records showed that he actually was found to have additional respiratory problems unrelated to sinusitis, including asthma and allergic rhinitis. In fact, the records showed treatment primarily for allergies and asthma, and did show any specific findings for sinusitis. An outpatient note in late February 1995, indicated that the veteran was scheduled to be seen at the allergy clinic but came in with complaints of chronic sinusitis. Although there was no evidence of purulent discharge or any other objective manifestations of sinusitis found on physical examination, the impression was "chronic sinusitis with CT evidence of left nasal sinus mucosa thickening." It is significant to note that the most recent CT scan of record in February 1995 was a December 1994 study which showed essentially the same findings as on the October 1994 scan. However, in October 1994, the veteran also had a small amount of fluid in the left maxillary sinus, which the examiner indicated was compatible with "mild sinusitis." Based on the objective findings, the diagnostic studies actually showed improvement from October to December 1994. In any event, the veteran was not shown to have any purulent discharge in February 1995. Even assuming that the impression on the February 1995 report was correct, the medical evidence did not support a finding of more than mild sinusitis. Similarly, when seen in April and May 1995, the veteran's complaints and the objective findings were unchanged. However, the assessment now included allergic rhinitis. The May report indicated that the veteran was "highly allergic" to all trees, weeds, grasses, pets, and dust mites and was minimally allergic to molds. The assessment was severe asthma. The examiner indicated that the veteran's medications should be adjusted to account for his allergies "to everything." The clinical findings on VA examination in June 1995, were not materially different from the February 1995 examination and showed mild tenderness on the left maxillary sinus, but no visible abnormalities, and all sinuses transilluminated well. X-ray studies showed the left maxillary sinus was smaller than the right and diffusely opaque with no air fluid level. The remainder of the paranasal sinuses were clear. A September 1995 VA outpatient note indicated that the veteran's allergic rhinitis was poorly controlled, and that he was not taking his medications properly. There were no objective findings of purulent discharge or crusting. A VA outpatient note in October 1995 showed essentially normal sinuses with no evidence of purulent discharge. The impression was no evidence of sinus disease. A private allergy consultation report in November 1995 indicated that the veteran had significant positive reactions to a wide variety of common aeroallergens, including pollens, house dust mites, cockroach and, to a less extent, animals. His history appeared to be one of perennial allergic rhinoconjunctivitis with sinusitis. The examiner also noted that the veteran's CT scans had been unremarkable in terms of a persistent sinus disease and recommended treatment to get better control of his allergies. A private otolaryngology report dated in February 1996, showed some enlarged turbinates but no purulent discharge. The examiner indicated that CT and MRI scans brought by the veteran showed some very mild, possibly left maxillary sinus disease and possibly some very mild ethmoid disease. The examiner commented that most of the veteran's complaints seemed to be allergy related. A private report from the Mayo Clinic dated in February 1996, indicated that there was no evidence of purulent infection on nasal examination. When seen by VA for headaches and sinus/facial pain in September, October, and November 1996, and January and March 1997, there were no reported findings of purulent discharge or any other manifestations of sinusitis. Other than tenderness over the maxillary sinus, there were no objective findings of purulent discharge or other manifestations of sinusitis on VA examination in April 1997. In August 1997, the veteran was noted to have some mucopurulent stranding in the left maxillary sinus. The impression was probable recurrent left sinusitis. A VA ENT note in February 1998, indicated that the veteran was seen for a 20 year history of headaches, which he believed was related to his sinuses. A CT scan showed slight post inferior left maxillary sinus stranding and a midline brain parenchyma calcific body. The examiner indicated that the evaluation was unchanged and noted that he talked with the veteran for over 75 minutes concerning his headaches. He explained to the veteran that the nature of headaches (constant, severe, etc.) and the lack of CT or examination evidence of a sinus etiology made other [etiological] causes most likely in his case. He noted that issues of narcotic dependence, seeing "thousands" of physicians, etc., made the management of his disorder more difficult. The impression was vascular versus specific nerve etiology for headaches. VA outpatient notes from January 2000 to August 2002 showed that the veteran was seen periodically for complaints of headaches and facial/sinus pain. Although the veteran sometimes reported chronic sinus discharge, the objective findings on every single progress note failed to reveal any evidence of purulent discharge or crusting or any objective manifestations of active sinusitis. When examined by VA in March 2003, the veteran complained of chronic left sided facial pain, but denied any complaints of sinus type pain or pressure. On examination, there was some of dried mucosa, but no evidence of purulence or sinus pain on palpation. The impression included no current evidence of sinus disease. The examiner noted that a review of past examinations showed minimal soft tissue thickening of the maxillary sinus, but that there was no evidence of any current active or chronic sinus disease. The examiner also opined that it was unlikely that the veteran's facial pain was related to sinus disease. He indicated that lancinating pain is very unusual in sinus disease and was more consistent with a diagnosis of tic douloureux or possibly migraine headaches. A VA CT scan in April 2003 showed minimal increase in mucosal thickening within the right posterior ethmoid and left ethmoid sinuses, and stable mucosal disease in the left maxillary and frontal sinuses. When examined by VA in June 2004, the veteran reported that he had been on at antibiotics approximately ten times over the past year. Parenthetically, the Board notes that a review of the medical records does not show antibiotic treatment more than twice. On examination, the veteran's nasal cavity and turbinates were within normal limits and there was no evidence of crusting or mucopurulence. There was significant pain on the left cheek, forehead and maxillary sinuses, more so on the left side. Based on a review of the April 2003 VA CT report, the examiner opined that the findings were more consistent with a chronic near- constant sinusitis rather than a chronic osteomyelitis. Based on the June 2004 VA opinion, the Board assigned an increased rating to 50 percent for the service-connected sinusitis; effective from June 12, 2004, the date of the VA examination report. In the July 2007 decision, the Court noted that the Board assigned the 50 percent evaluation effective from the date of the June 2004 VA examination report which, in turn, was based on a review of an April 2003 VA CT scan. The Court raised the question of whether the evidence prior to the June 2004 VA examination showed "near constant sinusitis" so as to warrant the assignment of a 50 percent evaluation prior that date. In this regard, the Board notes that the objective evidence of record failed to show more than mild manifestations of sinusitis at any time since the initial filing of the veteran's original claim in 1993. While the veteran was seen on numerous occasions for chronic headaches, sinus pressure, and occasionally reported a history of mucus, the objective findings on physical examinations showed evidence of active sinusitis only three or four times since 1993, and only once was there diagnostic confirmation of active sinusitis, which was characterized as "mild." As to the veteran's chronic headaches, the medical records show that he was evaluated on numerous occasions, but no specific etiology was ever identified. While it may be reasonable to assume that some of his headaches may have been related to sinusitis, the fact that there was only one confirmed report of active sinusitis would seem to suggest that the veteran's headaches were, for the most part, not a manifestation of sinusitis. In fact, at least two physicians opined that his headaches were not related to sinusitis. As noted above, one VA physician in 1998, indicated that the lack of any diagnostic or clinical evidence of sinus disease made it more likely that his headaches were of some other etiology. It should also be noted that none of the medical reports opined or otherwise attributed the veteran's headaches to active sinusitis. A VA psychiatric evaluation to determine a possible etiology of his headaches in September 2001, indicated that the psychological testing suggested malingering. In any event, the rating criteria for an evaluation of 30 percent or greater for sinusitis prior to and from October 1997, requires, in part, evidence of purulent discharge or crusting reflecting purulence. Although the veteran reported such history numerous times, he was not shown to have any purulent discharge or evidence reflecting purulence on nearly every occasion that he was seen by VA or by private doctors. After an exhaustive review of all the VA outpatient reports and private medical records from February 1995 to October 7, 1996, the evidence did not show any manifestations of sinusitis which would warrant a rating in excess of 30 percent under the old rating criteria for sinusitis. That is, there was no objective evidence of osteomyelitis requiring repeated curettage or severe symptoms of sinusitis. Applying the old and the revised criteria, from October 1996 to June 2004, the Board has found no evidence of severe symptoms of sinusitis or near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting. The Board notes that it appears that the July 2004 VA examiner did not have the actual CT images to review as the VA facility apparently did not have the computer capability to store them, and the veteran's copies had been given to the Mayo Clinic. Thus, it appears that his opinion was based, in part, on a review of the CT report rather than on the actual images. Though the examiner indicated that he had reviewed the veteran's "charts," the only specific reference he made to any particular record was the April 2003 CT report, the rest of his narrative appears to have been based primarily on the veteran's self-described history. The examiner's recommendations for additional neurological evaluation for the veteran's facial pain due to dental extraction is further evidence that his review of the record was limited, as the records showed that the veteran was evaluated on several prior occasions for that very reason. Moreover, the examiner did not offer any discussion of the March 2003 VA examination report which showed no clinical findings of active sinusitis or any of the other VA or private medical reports prior to March 2003 which were likewise conspicuously absent of any objective findings of chronic sinusitis. The limited scope of the June 2004 medical opinion notwithstanding, the Board is not competent to render its own medical opinion. Therefore, based on the June 2004 VA opinion that the findings from the April 2003 CT report was "more consistent with a chronic near-constant sinusitis rather than a chronic osteomyelitis[,]" the Board finds that a 50 percent evaluation should be assigned from April 16, 2003, the date of the CT report. As discussed above, the objective findings prior to April 2003, do not show severe symptoms of sinusitis or near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries, so as to warrant an evaluation in excess of 30 percent prior to April 2003. Finally, the Board must address the veteran's ability to provide probative information concerning his symptoms of sinusitis. While the veteran is competent to offer evidence as to the visible symptoms or manifestations of a disease or disability, his belief as to its current severity under pertinent rating criteria or the nature of the service- connected pathology is not probative evidence. Only someone qualified by knowledge, training, expertise, skill, or education, which the veteran is not shown by the record to possess, may provide evidence requiring medical knowledge. Layno v. Brown, 6 Vet. App. 465, 470 (1994); Grottveit v. Brown, 5 Vet. App. 91, 92-93 (1993); Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). In this case, while the veteran believes that all of his symptoms were all related to sinusitis, the clinical and diagnostic findings since 1993 failed to show a severity of sinusitis to such extent so as to warrant a rating in excess of the evaluations assigned for the appropriate periods discussed above. Applying the appropriate diagnostic codes to the facts of this case, the Board finds that a rating in excess of 10 percent for sinusitis prior to February 8, 1995, or for an evaluation in excess of 30 percent prior to April 16, 2003 is not warranted. From April 16, 2003, the veteran's disability picture for sinusitis more closely approximated the criteria for a 50 percent schedular rating. ORDER An evaluation in excess of 10 for sinusitis prior to February 8, 1995, is denied. An evaluation in excess of 30 for sinusitis from February 8, 1995 to April 15, 2003, is denied. An evaluation of 50 percent for sinusitis from April 16, 2003 is granted, subject to VA laws and regulation concerning payment of monetary benefits. S. L. Kennedy Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs