Citation Nr: 0810141 Decision Date: 03/27/08 Archive Date: 04/09/08 DOCKET NO. 06-09 156 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Whether new and material evidence has been received to reopen a claim of service connection for a breast condition, to include breast cancer, including whether service connection can be granted. 2. Whether new and material evidence has been received to reopen a claim of service connection for allergic rhinitis and sinusitis, including whether service connection can be granted. REPRESENTATION Appellant represented by: Texas Veterans Commission WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Michael T. Osborne, Counsel INTRODUCTION The veteran had active service from October 1970 to November 1972, May 1973 to September 1978, October 1979 to October 1982, January to April 1991, and from December 1994 to March 1995, and additional U.S. Army Reserve service. This matter comes before the Board of Veterans' Appeals (Board) on appeal of an April 2005 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas, which denied the veteran's claim of service connection for breast cancer and her application to reopen previously denied claims of service connection for hypertension, a breast condition, and for allergic rhinitis and sinusitis. The veteran disagreed with this decision in June 2005. She perfected a timely appeal in March 2006. An RO hearing was held on the veteran's claims in March 2007. In a July 2007 rating decision, the RO granted the veteran's claim of service connection for hypertension, assigning a 10 percent rating effective November 1, 2004. There is no subsequent correspondence from the veteran expressing disagreement with the rating or effective date assigned. Accordingly, an issue relating to hypertension is no longer in appellate status. See Grantham v. Brown, 114 F .3d 1156 (1997). The Board observes that, in a September 1997 rating decision, the RO denied, in pertinent part, the veteran's claims of service connection for a breast condition and for allergic rhinitis and sinusitis. The veteran disagreed with this decision in August 1998. The RO then issued a Statement of the Case (SOC) to the veteran and her service representative in July 1999. The veteran did not perfect a timely appeal; thus, the September 1997 rating decision became final. See 38 U.S.C.A. § 7104 (West 2002). In an October 2004 letter, the veteran requested that her previously denied claims be reopened. In that letter, the veteran stated that she had been diagnosed with a breast condition (which she characterized as abnormal breast bleeding) during active service followed by a blood-filled lump in her breast that was subsequently diagnosed as breast cancer following service separation. It appears that the RO treated the veteran's October 2004 letter, in pertinent part, as a new claim of service connection for breast cancer and an application to reopen a previously denied service connection claim for a breast condition; however, the veteran's contentions relate to a single claim of service connection for a breast condition, to include breast cancer. As noted, the RO denied the veteran's service connection claim for breast cancer and also denied reopening of the service connection claim for a breast condition in the currently appealed rating decision issued in April 2005. The RO also reopened the veteran's previously denied service connection claim for allergic rhinitis and sinusitis in a July 2007 supplemental SOC and denied this claim on the merits. The Board does not have jurisdiction to consider a claim that has been previously adjudicated unless new and material evidence is presented. See Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). Therefore, although the RO has reviewed the veteran's service connection claims for a breast condition, to include breast cancer, and for allergic rhinitis and sinusitis on a de novo basis, these issues are as stated on the title page. Regardless of the RO's reopening of the claim for service connection for allergic rhinitis and sinusitis, the Board must make its own determination as to whether new and material evidence has been received to reopen this claim. That is, the Board has a jurisdictional responsibility to consider whether a claim should be reopened, regardless of the RO's finding. See Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's claims has been obtained. 2. In a September 22, 1997, rating decision, the RO denied the veteran's claims of service connection for a breast condition, to include breast cancer, and for allergic rhinitis and sinusitis; although the veteran disagreed with this decision, no appeal was perfected. 3. New and material evidence has been received since September 1997 in support of the veteran's claims of service connection for a breast condition, to include breast cancer, and for allergic rhinitis and sinusitis. 4. The veteran does not experience any current disability due to a breast condition, to include breast cancer, which could be attributable to active service. 5. The veteran's allergic rhinitis and sinusitis is not related to active service. CONCLUSIONS OF LAW 1. The September 1997 rating decision, which denied the veteran's claims of service connection for a breast condition, to include breast cancer, and for allergic rhinitis and sinusitis, is final. 38 U.S.C.A. § 7104 (West 2002); 38 C.F.R. § 3.104 (2007). 2. Evidence received since the September 1997 RO decision in support of the claim of service connection for a breast condition, to include breast cancer, is new and material; accordingly, this claim is reopened. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2007). 3. A breast condition, to include breast cancer, was not incurred in active service. 38 U.S.C.A. §§ 1101, 1110,1112, 1113, 1131, 1137, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309 (2007). 4. Evidence received since the September 1997 RO decision in support of the claim of service connection for allergic rhinitis and sinusitis is new and material; accordingly, this claim is reopened. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156 (2007). 5. Allergic rhinitis and sinusitis was not incurred in active service. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2007); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2007). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Before assessing the merits of the appeal, VA's duties under the Veterans Claims Assistance Act of 2000 (VCAA) must be examined. The VCAA provides that VA shall apprise a claimant of the evidence necessary to substantiate her claim for benefits and that VA shall make reasonable efforts to assist a claimant in obtaining evidence unless no reasonable possibility exists that such assistance will aid in substantiating the claim. In a December 2004 letter, VA notified the veteran of the information and evidence needed to substantiate and complete her claims, including what part of that evidence she was to provide and what part VA would attempt to obtain for her. See 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1); Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). The letter informed the veteran to submit medical evidence and noted other types of evidence the veteran could submit in support of her claims. In addition, the veteran was informed of when and where to send the evidence. After consideration of the contents of this letter, the Board finds that VA has substantially satisfied the requirement that the veteran be advised to submit any additional information in support of her claims. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). The December 2004 letter also defined new and material evidence, advised the veteran of the reasons for the prior denial of the claims of service connection for a breast condition, to include breast cancer, and for allergic rhinitis and sinusitis, and noted the evidence needed to substantiate the underlying claims of service connection. That correspondence satisfied the notice requirements as defined in Kent v. Nicholson, 20 Vet. App. 1 (2006). Additional notice of the five elements of a service- connection claim was provided in March 2006, as is now required by Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Thus, the Board finds that VA met its duty to notify the veteran of her rights and responsibilities under the VCAA. With respect to the timing of the notice, the Board points out that the Veterans Court held that a VCAA notice, as required by 38 U.S.C.A. § 5103(a), must be provided to a claimant before the initial unfavorable agency of original jurisdiction decision on a claim for VA benefits. See Pelegrini v. Principi, 18 Vet. App. 112 (2004). In this case, the December 2004 letter was issued before the April 2005 rating decision which denied the benefits sought on appeal; thus, the notice was timely. There has been no prejudice to the appellant, and any defect in the timing or content of the notices has not affected the fairness of the adjudication. See Mayfield, 444 F.3d at 1328. The Board also finds that VA has complied with the VCAA's duty to assist by aiding the veteran in obtaining evidence and affording her the opportunity to give testimony before the RO. It appears that all known and available records relevant to the issues here on appeal have been obtained and are associated with the veteran's claims file; the veteran does not contend otherwise. VA need not conduct an examination or obtain a medical opinion with respect to the issue of whether new and material evidence has been received to reopen a previously denied claim of entitlement to service connection because the duty under 38 C.F.R. § 3.159(c)(4) applies to a claim to reopen only if new and material evidence is presented or secured. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). As will be explained below in greater detail, new and material evidence has been presented or secured since September 1997 in support of the veteran's application to reopen a previously denied service connection claim for a breast condition, to include breast cancer. Because, however, there is no evidence that the veteran experiences any current disability due to a breast condition, to include breast cancer, VA is not required to provide the veteran with an examination as part of the development of this claim. New and material evidence also has been presented or secured since September 1997 in support of the veteran's application to reopen a previously denied service connection claim for allergic rhinitis and sinusitis. The RO already has provided the veteran with VA examinations as part of the development of this claim. Thus, the Board finds that VA has done everything reasonably possible to notify and to assist the veteran and that no further action is necessary to meet the requirements of the VCAA. The veteran contends that her previously denied service connection claims for a breast condition, to include breast cancer, and for allergic rhinitis and sinusitis should be reopened and, once reopened, a breast condition and her currently diagnosed allergic rhinitis and sinusitis were incurred during active service. In a September 1997 rating decision, the RO denied the veteran's claims of service connection for a breast condition, to include breast cancer, and for allergic rhinitis and sinusitis. A finally adjudicated claim is an application which has been allowed or disallowed by the agency of original jurisdiction, the action having become final by the expiration of one year after the date of notice of an award or disallowance, or by denial on appellate review, whichever is the earlier. 38 U.S.C.A. §§ 7104, 7105 (West 2002); 38 C.F.R. §§ 3.160(d), 20.302, 20.1103 (2007). As noted in the Introduction, the veteran disagreed with the September 1997 rating decision in August 1998. In response, the RO issued an SOC on these claims to the veteran and her service representative in July 1999; however, the veteran failed to perfect a timely appeal. Thus, the September 1997 rating decision became final. The claims of entitlement to service connection for a breast condition, to include breast cancer, and for allergic rhinitis and sinusitis may be reopened if new and material evidence is submitted. Manio v. Derwinski, 1 Vet. App. 140 (1991). The veteran filed this application to reopen her previously denied service connection claims for a breast condition, to include breast cancer, and for allergic rhinitis and sinusitis in October 2004. Under the applicable provisions, new evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with the previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether evidence is new and material, the credibility of the new evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The evidence before VA at the time of the prior final rating decision in September 1997 consisted of the veteran's service medical records and post-service private treatment records. The RO noted that the veteran was treated once during active service in December 1974 for several small breast nodules that were considered secondary to taking birth control pills. The RO also noted that, although the veteran's separation physical examination from 1978 was not of record, a subsequent U.S. Army Reserve physical examination in 1987 noted no breast condition or history of breast problems. The RO noted further that, although the veteran was treated for allergic rhinitis on several occasions during active service and although her separation physical examination was not of record, she denied any history of sinusitis on her U.S. Army Reserve physical examination in 1987. Thus, the claims were denied. The newly submitted evidence consists of additional VA clinical records and private treatment records. The newly submitted VA clinical records show that, in January 1998, a breast ultrasound showed a large cyst in the left breast. A March 1998 mammogram showed a cystic versus solid mass in the left breast. A November 1998 breast ultrasound showed a lobulated debris filled cyst measuring 3.5 centimeters in maximum diameter. The veteran received a left lumpectomy and lymph node dissection at a VA Medical Center in February 1999, followed by radiation therapy and chemotherapy. The surgical diagnosis was a 1.2 centimeter left sentinel lymph node dissection with completion axillary dissection. Following radiological consult in March 1999, the assessment was stage I adenocarcinoma of the left breast, status-post lumpectomy, and left axillary lymph node dissection. A June 2000 mammogram showed no obvious mammographic evidence of malignancy and the veteran was status-post left lumpectomy. A June 2000 breast ultrasound showed a palpable left breast lump which could be confirmed as being a cyst located within dense breast parenchyma that measured 3 x 4 millimeters. On VA outpatient treatment in February 2001, it was noted that the veteran was status-post left breast lumpectomy with left axillary lymph node dissection. The veteran denied any breast tenderness, pain, skin changes, lumps/masses, or nipple discharge. Physical examination of the veteran's breasts showed small pendulous breasts, nipples everted without dippling, retractions, skin changes, nipple discharge, tenderness, or masses. The veteran had a small dip in the upper quadrant of her left breast from her prior lumpectomy. Scar tissue was palpable along the left breast lumpectomy incision. The VA examiner concluded that the veteran was doing well without complaints. The impression was status-post left breast lumpectomy and axillary lymph node dissection. An April 2001 mammogram showed no suspicious mass, malignant type calcification, architecture distortion, or lymph node abnormality. The impressions were no mammographic evidence of malignancy and probable left upper outer quadrant scarring and deformity from prior surgery. Following a February 2002 mammogram, the impressions were status-post left lumpectomy with radiation therapy and chemotherapy and moderately heterogeneously dense breast parenchyma with no mammographic evidence of malignancy. On VA examination in April 2007, the veteran complained of a long history of symptoms of congestion and nasal drainage. The veteran reported that her allergic rhinitis symptoms occurred year-round. Physical examination showed normal external auditory canals and tympanic membranes, mild swelling of the inferior turbinates, more on the right than on the left side, a very patent nasal airway, no more than 20 percent nasal obstruction on the left side, no more than 30 percent nasal obstruction on the right side, a straight nasal septum, no mucopus present in the nose or nasopharynx, no nasal crusting, no nasal polyps, and an unremarkable mouth and oropharynx. The VA examiner stated that the veteran's nasal obstructions was caused mostly by mild swelling involving the inferior turbinates. The VA examiner commented that the veteran complained bitterly of symptoms related to sneezing, congestion, and post-nasal drainage, which seemed somewhat out of proportion to the physical findings. The diagnosis was allergic rhinitis. In a June 2007 addendum to this examination report, the VA examiner stated that he had reviewed the veteran's claims file, including her service medical records. From his review, the VA examiner stated that he was unable to find evidence that chronic allergic rhinitis had its onset or was aggravated during any period of active service. The VA examiner stated that the veteran's in-service outpatient treatment for allergic rhinitis "would not establish chronicity." The VA examiner opined that it was less likely than not that the veteran's current allergic rhinitis was manifested with findings of nasal drainage/allergies while on active service. The VA examiner also opined that the veteran currently had signs and symptoms only for allergic rhinitis and not for sinusitis. The newly submitted private medical records show that, following private outpatient treatment in April 1993, the impressions included a left breast mass. On private outpatient treatment in September 1996, physical examination showed an irregular mobile elliptical mass approximately 2 x 3 centimeters on the areolar edge of the left breast that had been present and unchanged for at least 5 years, no axillary adenopathy, nipple discharge, or suspicious masses, although the veteran had diffuse fibronodularity in both breasts. On private outpatient treatment in July 1998, the veteran complained of a left breast mass. Physical examination showed an obvious deformity from the mass in the upper aspect of the left breast that was multi-lobulated, firm, mobile, and quite irregular, no nipple discharge, and no axillary lymphadenopathy. The impressions included probable fibroadenoma of the left breast. On private outpatient treatment in July 2002, the veteran complained of a tender lump associated with unilateral nipple discharge on the left side for the past 5 days. Prior to noticing the tender lumpy area, the veteran stated that she had been hit by a forklift at work and initially presumed her tenderness and lump were secondary to that trauma. Physical examination showed a uniductal discharge on the left nipple, an ill-defined lumpiness beneath the areolar margin slightly medial to a prior lumpectomy scar, no otherwise dominant or suspicious masses to palpation of either breast, no axillary adenopathy, no nipple discharge in the right breast. The impression was rule-out recurrence of intraductal breast carcinoma. A private breast ultrasound in July 2002 showed palpable tenderness in the left breast, no dominant masses or speculated lesions, sonographic evidence of a mildly dilated duct in the left breast, and no evidence of a dilated duct or nipple discharge. Laboratory resulted dated in July 2002 were negative for malignant cells. At a private mammogram in July 2003, the veteran reported that her left breast tenderness and lumpiness had resolved. Physical examination showed a healed scar in the superior aspect of the left nipple with no skin thickening, nipple deformity, or palpable mass or nodule. The impressions were status-post lumpectomy of the left breast, benign-appearing calcifications in the left breast, and stable appearance of both breasts. With respect to the veteran's application to reopen a previously denied service connection claim for a breast condition, to include breast cancer, the evidence (service medical records and post-service private treatment records) that was of record in September 1997 showed no post-service treatment for a breast condition, to include breast cancer. The newly submitted evidence shows post-service treatment for stage I adenocarcinoma of the left breast which was surgically removed in February 1999, followed by post- surgical radiation therapy. Since the newly submitted VA clinical records and private medical records show post- service treatment for breast cancer, and raise a reasonable possibility that the veteran's breast cancer may be related to active service, the Board finds that this evidence is new and material. At the time of the September 1997 rating decision, there was no objective evidence of a breast condition, to include breast cancer, which could be related to active service. The new evidence was not previously considered by agency decision makers, is not cumulative or redundant, relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim of service connection for a breast condition, to include breast cancer. 38 C.F.R. § 3.303. With respect to the veteran's application to reopen a claim of service connection for allergic rhinitis and sinusitis, the evidence that was of record in September 1997 also did not show any post-service treatment for this claimed disability. The newly submitted evidence, which consists of the April 2007 VA examination report and June 2007 addendum, shows such treatment for allergic rhinitis and sinusitis. Since the newly submitted VA clinical records and private medical records show post-service treatment for allergic rhinitis and sinusitis, and raise a reasonable possibility that the veteran's allergic rhinitis and sinusitis may be related to active service, the Board finds that this evidence is new and material. At the time of the September 1997 rating decision, there was no objective evidence of allergic rhinitis and sinusitis which could be related to active service. The new evidence was not previously considered by agency decision makers, is not cumulative or redundant, relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim of service connection for allergic rhinitis and sinusitis. 38 C.F.R. § 3.303. New evidence is sufficient to reopen a claim if it contributes to a more complete picture of the circumstances surrounding the origin of a veteran's disability, even where it may not convince the Board to grant the claim. Hodge v. West, 155 F.3d 1356 (Fed. Cir. 1998). Accordingly, the claims for service connection for a breast condition, to include breast cancer, and for allergic rhinitis and sinusitis are reopened. Having determined that new and material evidence has been received to reopen the veteran's claims of service connection for a breast condition, to include breast cancer, and for allergic rhinitis and sinusitis, the Board must adjudicate these claims on the merits. Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Hickson v. West, 12 Vet. App. 247, 253 (1999). If there is no evidence of a chronic condition during service or an applicable presumptive period, then a showing of continuity of symptomatology after service may serve as an alternative method of establishing the second and/or third element of a service connection claim. See 38 C.F.R. § 3.303(b); Savage v. Gober, 10 Vet. App. 488 (1997). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of the same symptomatology and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Evidence of a chronic condition must be medical, unless it relates to a condition to which lay observation is competent. If service connection is established by continuity of symptomatology, there must be medical evidence that relates a current condition to that symptomatology. See Savage, 10 Vet. App. at 495-498. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. See 38 C.F.R. § 3.102. A review of the veteran's service medical records indicates that, following outpatient treatment in August 1972, the impression was allergic rhinitis. Following outpatient treatment in March 1973, the impression was sinusitis. In May 1973, the veteran complained of a long history of nasal congestion. Physical examination showed large amounts of mucous in the nose and swollen nasal turbinates. The impression was rhinorrhea. In July 1974, the veteran complained of pain in the right breast and stated that she had found a lump on a breast self- examination. Physical examination showed several small nodules in the upper quadrant of the right breast with no inflammation. The impression was symptomatic fibrocystic disease secondary to birth control pills. In February 1976, the veteran complained of nasal congestion, frontal headaches, and sleep problems due to nasal congestion. Physical examination showed hyperemic mucous membranes and glistening patches of nasal membrane passages. X-rays of the paranasal sinuses were normal. The impression was severe nasal allergies with possible nasal polyps. Following otorhinolayrngology follow-up in April 1976, the impression was rhinitis. In December 1976, the veteran complained of sneezing. Physical examination showed bilaterally swollen nasal turbinates, left greater than right. The impression was allergic rhinitis. On routine pelvic and breast examination in January 1981, physical examination showed no breast masses. On routine pelvic and breast examination in September 1981, physical examination showed non-tender breasts, normal nipples, no discharge, and a small fibrocystic lesion in each breast. On private outpatient treatment in February 1988, the veteran complained of a 4-year history of sinus problems which included pressure in her face and eyes, intermittent nasal drainage, and severe nasal congestion. Physical examination showed normal ears, oral cavity, and neck, a severe chronic rhinitis with pale boggy edematous nasal mucosa, and complete obstruction of the nasal airway. Sinus x-rays were essentially normal. The impression was severe chronic polypous rhinitis. On private outpatient treatment in January 1989, with H.L.S, M.D. (Dr. H.S.), physical examination showed severe nasal congestion with complete obstruction of the upper portion of the nose "with what looks like" polypoid change involving the middle turbinates bilaterally. The impression was suspected chronic ethmoid sinusitis. In a March 1989 letter, Dr. H.S. stated that a computerized tomography (CT) scan of the veteran's paranasal sinuses showed that they were "fairly normal." The nose was completely obstructed with hypertrophic turbinates. The veteran reported a medical history of chronic or frequent colds, sinusitis, hay fever, and cancer at a periodic U.S. Army Reserve physical examination in July 1990. The examiner noted that the veteran did not experience any current symptoms due to these reported problems. Clinical evaluation of the veteran's breasts and sinuses was normal. On U.S. Army Reserve gynecological examination in August 1990, small cysts in both breasts were noted. On in-service outpatient treatment in March 1995, a microcalcification in the left breast approximately 1 centimeter in density was noted. The calcification was round and appeared uniform. The in-service examiner stated that "this probably represen[ts] fibroadenoma." As noted above, the post-service medical evidence shows continuing treatment for breast cancer beginning in 1998. The veteran's stage I breast cancer was removed surgically in February 1999 followed by radiation therapy and chemotherapy. Following surgery, the veteran was doing well and had no complaints in February 2001. Mammography in April 2001 and February 2002 showed no breast malignancy. Private laboratory results in July 2002 also were negative for malignancy, despite the veteran's complaint of left breast tenderness. The veteran reported in July 2003 that her left breast tenderness was resolved. The private examiner noted benign calcifications in the left breast and determined that both breasts were stable. Also as noted above, following VA examination in April 2007, the VA examiner stated that, although the veteran complained bitterly of symptoms related to sneezing, congestion, and post-nasal drainage, these complaints seemed somewhat out of proportion to the physical findings of allergic rhinitis. In a June 2007 addendum to this examination report, this VA examiner concluded that there was no evidence in the veteran's service medical records that her chronic allergic rhinitis had its onset or was aggravated during any period of active service. This VA examiner stated that the veteran's in-service outpatient treatment for allergic rhinitis "would not establish chronicity." This VA examiner opined that it was less likely than not that the veteran's current allergic rhinitis was manifested with findings of nasal drainage/allergies while on active service. The Board finds that the preponderance of the evidence is against the veteran's claim of service connection for a breast condition, to include breast cancer. The service medical records show a small fibrocystic lesion in each breast in September 1981, small cysts in both breasts on U.S. Army Reserve gynecological examination in August 1990, and a microcalcification in the left breast approximately 1 centimeter in density in March 1995. However, the veteran was not treated for breast cancer at any time during active service. Following her final separation from service in March 1995, it appears that she was first treated for a breast condition in January 1998 when a breast ultrasound showed a large cyst in the left breast. As noted elsewhere, the veteran's subsequently diagnosed breast cancer was removed surgically in February 1999 and appears to have resolved. Subsequent testing and mammography has shown no recurrence of the veteran's breast cancer. It also appears that the veteran was last treated for a breast condition in July 2003, when the examiner concluded that both breasts were stable. A service connection claim must be accompanied by evidence which establishes that the claimant currently has a disability. Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Simply put, service connection is not warranted in the absence of proof of a present disability. Additional evidence in support of the veteran's service connection claim for a breast condition, to include breast cancer, is her own lay assertions and March 2007 RO hearing testimony. As a lay person, the veteran is not competent to opine on medical matters such as the etiology of medical disorders. The record does not show, nor does the veteran contend, that she has specialized education, training, or experience that would qualify her to provide an opinion on this matter. Accordingly, the veteran's lay statements are entitled to no probative value. See Bostain v. West, 11 Vet. App. 124, 127 (1998), citing Espiritu v. Derwinski, 2 Vet. App. 492 (1992). See also Routen v. Brown, 10 Vet. App. 183, 186 (1997). Absent evidence of a medical nexus between a breast condition, to include breast cancer, and active service, and without evidence of current disability, the Board finds that service connection for a breast condition, to include breast cancer, is not warranted. The Board also finds that the preponderance of the evidence is against the veteran's claim of service connection for allergic rhinitis and sinusitis. The veteran's service medical records show infrequent treatment for sinus congestion and allergic rhinitis; however, as the VA examiner concluded in June 2007, such treatment does not establish that the veteran incurred chronic allergic rhinitis and sinusitis during active service. It appears that the veteran was not treated for allergic rhinitis and sinusitis between her service separation in March 1995 and March 2007, when she received VA examination. After reviewing the complete claims file, the VA examiner concluded in June 2007 that it was less likely than not that the veteran's current allergic rhinitis manifested itself during active service. With respect to negative evidence, the fact that there was no record of any complaint, let alone treatment, involving the veteran's condition for many years is significant. See Maxson v. West, 12 Vet. App. 453, 459 (1999), affirmed sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that it was proper to consider the veteran's entire medical history, including a lengthy period of absence of complaints). The veteran has contended in lay statements and at her March 2007 RO hearing that she incurred allergic rhinitis and sinusitis during active service. However, as noted above, her lay statements are entitled to no probative value. See Bostain and Routen, both supra. Absent a medical nexus between the veteran's currently diagnosed allergic rhinitis and active service, and without evidence that the veteran incurred chronic allergic rhinitis and sinusitis during active service, the Board finds that service connection for allergic rhinitis and sinusitis is not warranted. As the preponderance of the evidence is against the veteran's claims, the benefit-of- the-doubt doctrine does not apply. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App 49, 55-57 (1990). (CONTINUED ON NEXT PAGE) ORDER As new and material evidence has been received, the claim of service connection for a breast condition, to include breast cancer, is reopened. To that extent only, the appeal is allowed. As new and material evidence has been received, the claim of service connection for allergic rhinitis and sinusitis is reopened. To that extent only, the appeal is allowed. Entitlement to service connection for a breast condition, to include breast cancer, is denied. Entitlement to service connection for allergic rhinitis and sinusitis is denied. ____________________________________________ JAMES L. MARCH Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs