Citation Nr: 1322565 Decision Date: 07/16/13 Archive Date: 07/24/13 DOCKET NO. 09-03 458 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to a compensable disability rating for left frontal and maxillary antral sinusitis prior to April 3, 2012 and a rating in excess of 30 percent thereafter. 2. Entitlement to a compensable disability rating for allergic rhinitis. 3. Entitlement to a compensable disability rating for history of near-drowning accident with history of acute and moderate organic brain syndrome secondary to anoxia. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Amanda Christensen, Associate Counsel INTRODUCTION The Veteran had active military service from June 1974 to January 1976. This appeal comes to the Board of Veterans' Appeals (Board) from a June 2008 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida and an October 2008 rating decision by the RO in Montgomery, Alabama. In a February 2013 supplemental statement of the case, the Veteran was awarded an increased rating of 30 percent effective April 3, 2012 for his service-connected sinusitis. The increased rating constitutes a partial grant of benefits, such that the issue remains on appeal and is for consideration by the Board. A Board hearing was scheduled for June 2013 and the Veteran notified, but the Veteran did not appear for the hearing. The Board has not only reviewed the Veteran's physical claims file but also the Veteran's file on the "Virtual VA" system to insure a total review of the evidence. FINDINGS OF FACT 1. Prior to April 3, 2012 the Veteran experienced three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. 2. As of April 3, 2012 the Veteran has experienced more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. 3. The Veteran's allergic rhinitis involves nasal obstruction no greater than 50 percent on each side, without polyps. 4. The Veteran's symptoms of organic brain syndrome secondary to anoxia include primarily memory problems not severe enough either to interfere with occupational and social functioning or to require continuous medication. CONCLUSIONS OF LAW 1. The criteria for a 10 percent evaluation, but no higher, for sinusitis prior to April 3, 2012 have been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102 and 4.97, Diagnostic Code 6513. 2. The criteria for a rating in excess of 30 percent for sinusitis as of April 3, 2012 have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102 and 4.97, Diagnostic Code 6513. 3. The criteria for a compensable rating for allergic rhinitis have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102 and 4.97, Diagnostic Code 6522 (2012). 4. The criteria for a compensable rating for history of near-drowning accident with history of acute and moderate organic brain syndrome secondary to anoxia have not been met. 38 U.S.C.A. §§ 1155, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102 and 4.130, Diagnostic Code 9300. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.1 (2012). Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14 (2012). In its evaluation, the Board shall consider all information and lay and medical evidence of record. 38 U.S.C.A. § 5107(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, including the degree of disability, the Board shall give the benefit of the doubt to the veteran. Id., 38 C.F.R. §§ 3.102, 4.3. Stated another way, VA has an equipoise standard akin to the rule in baseball that "the tie goes to the runner." Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Notably, the benefit of the doubt doctrine is not applicable based on pure speculation or remote possibility. See 38 C.F.R. § 3.102. Where, as here, entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, staged ratings are appropriate for an increased rating claim if the factual findings show distinct time periods where the service-connected disability exhibited symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The following discussion addresses the Veteran's level of disability from the time the increased rating claim for sinusitis was filed in December 2007 and the time the increased rating claim for organic brain syndrome was filed in December 2009. A. Sinusitis Diagnostic Code 6513 pertains to chronic maxillary sinusitis and Diagnostic Code 6512 pertains to chronic frontal sinusitis. Both are rated according to the General Rating Formula for Sinusitis (General Rating Formula). Under the General Rating Formula, a noncompensable evaluation is warranted for sinusitis detected by x-ray only. A 10 percent evaluation is warranted for one or two incapacitating episodes per year of sinusitis 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. An incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. 38 C.F.R. § 4.97 (2012). A 30 percent evaluation is warranted for 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. Id. Finally, a 50 percent evaluation is warranted for chronic sinusitis following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain and tenderness of the affected sinus, and purulent discharge or crusting after repeated surgeries. Id. Service treatment records reflect that the Veteran was first diagnosed with chronic sinusitis in 1976. VA treatment records show that in April 2007 the Veteran reported having severe sinus pain, yellow nasal drainage, and a productive cough. In June 2007 he was seen again complaining of sinus congestion for about two weeks. He stated he was experiencing hoarseness, an occasional productive cough, headache, and nasal drainage. He was diagnosed with sinusitis and prescribed an antibiotic and allergy medicine. The Veteran was afforded a VA examination in February 2008. He reported he gets a sinus infection about every two months for three weeks. He finds that antibiotics do help. The examiner stated that the Veteran does not have a history of incapacitating episodes but does have six non-incapacitating episodes per year of less than 14 days consisting of purulent drainage and sinus pain. The Veteran reported the following rhinitis symptoms: nasal congestion, excess nasal mucous, itchy nose, watery eyes, sneezing. He reported the following sinus symptoms: purulent nasal discharge, headaches, sinus pain, and sinus tenderness. He also reported one to six headaches per week. The Veteran also reported frequent breathing difficulty. The examiner found tenderness in the frontal and maxillary sinuses. The Veteran was found to have 50 percent right and left nasal obstruction. A CT scan showed a small amount of fluid in the right maxillary sinus without evidence of abnormality. The examiner diagnosed the Veteran with chronic rhinosinusitis with associated sinusitis. In September 2008 the Veteran was seen at the VA complaining of sinus problems for the past two weeks, including headaches and nasal drainage, and was prescribed antibiotics. In a February 2010 statement, the Veteran said when he lays down on one side he has sinus drainage to that side that prevents him from breathing out of the nostril on that side. He stated that if he sleeps sitting in a recliner then the drainage goes down his throat and causes him to cough. He reported the drainage is thick and yellowish when he coughs it up. He reported that taking an antibiotic will clear up the drainage for a day or two but then it comes back. He also reported sharp pains in his temples and forehead and swelling under his eyes. The Veteran underwent another VA examination in August 2010. X-rays showed no evidence of sinusitis and the Veteran reported his last sinus infection was six months ago. The Veteran said he has had problems with chronic congestion since his near-drowning experience. He complained of some interference with breathing though his nose. The examiner noted some clear drainage. The examiner diagnosed perennial rhinitis with no evidence of left frontal or maxillary antral sinusitis by x-ray currently and no evidence of purulent drainage, as well as headaches and acute and moderate organic brain syndrome secondary to anoxia. An April 2011 note by the Veteran's VA doctor states that he has maxillary mucosal thickening on x-ray and will be treated with nasal spray, antibiotic, and allergy medicine. In May 2011 the Veteran was seen at the VA and noted to have sinus pressure with no infection. He was seen again in June complaining of sinus pressure and a cough, at which time an x-ray was taken and he was prescribed an antibiotic and nasal spray. The Veteran underwent another VA examination in April 2012. The examiner noted that the Veteran had had two episodes of sinusitis so far in 2012, both times treated with antibiotics. The examiner stated that the Veteran had experienced seven or more non-incapacitating episodes of sinusitis characterized by headaches, pain, and purulent discharge or crusting in the past 12 months. He had not experienced any incapacitating episodes requiring prolonged antibiotic treatment. The examiner stated that the Veteran experiences maxillary sinusitis that manifests with headaches, pain and tenderness of the affected sinus, and purulent discharge or crusting. With regard to rhinitis, the examiner stated that the Veteran does not have greater than 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side. He also does not have permanent hypertrophy of the nasal turbinates or nasal polyps. The examiner noted the Veteran's June 2011 MRI suggested mild mucosal thickening involving both maxillary sinuses. A December 2012 private hospital record reflects that the Veteran was seen for a nosebleed and sinusitis and prescribed an antibiotic for 10 days, antihistamine, and saline nasal spray. The Veteran currently has a noncompensable rating prior to April 3, 2012 and a 30 percent rating thereafter for sinusitis. The Board finds that the Veteran is entitled to a 10 percent rating prior to April 3, 2012 but is not entitled to a rating in excess of 30 percent thereafter. At the Veteran's February 2008 VA examination, the examiner noted that the Veteran reported he has six sinus infections per year. At his August 2010 VA examination he reported his last sinus infection was six months prior, but did not indicate whether that was an unusually long time to go without one or how many he usually has in a year. Although records do not reflect the Veteran was diagnosed with sinus infections at the VA at least three times a year, the records do reflect regular reports of sinus problems and periodic diagnoses of sinusitis and the prescription of antibiotics from 2007 to 2012. Notably, in April 2012 the Veteran reported at his VA examination that he experiences more than seven sinus infections per year, including two so far in 2012. The evidence reflects that none of the Veteran's episodes of sinusitis can be characterized as incapacitating as they did not require bed rest or antibiotic treatment of four to six weeks. Crediting the Veteran's February 2008 contention that at that time he was experiencing six sinus infections per year, the Board finds that giving the Veteran the benefit of the doubt, he is entitled to a 10 percent evaluation for sinusitis prior to April 3, 2012 as the evidence suggests that he was having at least three, but not more than six, non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. The Veteran is not entitled to the next higher rating for that time period as the evidence does not show that he was having three or more incapacitating episodes per year of sinusitis requiring prolonged antibiotic treatment, or more than six non-incapacitating episodes per year of sinusitis. It is important for the Veteran to recognize that it is only by finding his statements as to the frequency of his sinus infections credible and giving him the benefit of the doubt that he is entitled to a 10 percent rating for that period, as his VA treatment records reflect he sought treatment for fewer sinus infections than he claimed to have had and no private treatment records showing treatment for sinus infections are of record. With regard to the period from April 3, 2012 forward, the Board finds the Veteran is not entitled to a rating in excess of 30 percent. To be entitled to the next higher rating, the evidence must show the Veteran has chronic sinusitis following radical surgery with chronic osteomyelitis, or near constant sinusitis characterized by headaches, pain and tenderness of the affected sinus, and purulent discharge or crusting after repeated surgeries. The April 2012 VA examiner stated that the Veteran experiences "episodes of sinusitis," not "near constant sinusitis." The Veteran's treatment records also do not reflect complaints of near constant sinusitis, only episodes of sinusitis. Further, the record does not reflect that the Veteran has chronic sinusitis following radical surgery with chronic osteomyelitis or any surgery at all. As a preponderance of the evidence is against the Veteran's claim for an increased rating as of April 3, 2012, the benefit of the doubt doctrine does not apply and his claim is denied. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. The Board has also considered whether referral for consideration of an extraschedular rating is warranted, noting that if an exceptional case arises where ratings based on the statutory schedules are found to be inadequate, consideration of an "extra-schedular" evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities will be made. 38 C.F.R. § 3.321(b)(1). The Court has held that the determination of whether a claimant is entitled to an extraschedular rating under § 3.321(b) is a three-step inquiry, the responsibility for which may be shared among the RO, the Board, and the Under Secretary for Benefits or the Director, Compensation and Pension Service. Thun v. Peake, 22 Vet. App. 111 (2008). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. This means that initially there must be a comparison between the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the rating schedule for that disability. If the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the rating schedule, the assigned schedular evaluation is adequate, and no referral is required. If the criteria do not reasonably describe the claimant's disability level and symptomatology, a determination must be made whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as "governing norms." 38 C.F.R. § 3.321(b)(1) (related factors include "marked interference with employment" and "frequent periods of hospitalization"). See id. However, in this case, the medical evidence fails to show anything unique or unusual about the Veteran's service connected sinusitis that would render the schedular criteria inadequate. The Veteran's symptoms, including headaches, pain and tenderness of the affected sinus, and purulent discharge, are contemplated in the rating assigned. As such, it would not be found that his disability met the "governing norms" of an extraschedular rating. Accordingly, referral for consideration of an extraschedular rating is not warranted. Moreover, even if it were argued that the schedular rating criteria were inadequate, the Board finds no reason to refer the case to the Compensation and Pension Service to consider whether an extra-schedular rating is warranted. In this case, there is no evidence of any hospitalization associated with the Veteran's sinusitis. In addition, the Board finds the record does not reflect that the Veteran's sinusitis markedly interferes with his ability to work. See 38 C.F.R. § 4.1 (indicating that generally, the degrees of disability specified in the Rating Schedule are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability). The manifestations of the Veteran's disability are considered by the schedular rating. Based on the foregoing, the Board finds the schedular evaluation is adequate, and referral is not required. 38 C.F.R. § 3.321; Thun, 22 Vet. App. 111. B. Rhinitis Under Diagnostic Code 6522, a 10 percent disability evaluation is warranted for allergic or vasomotor rhinitis without polyps, but with greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side. A 30 percent evaluation is warranted for allergic or vasomotor rhinitis with polyps. 38 C.F.R. § 4.97 (2012). The February 2008 VA examiner stated that the Veteran has 50 percent obstruction of the right and left nasal passages and no polyps. The April 2012 VA examiner stated that the Veteran does not have greater than 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side. He found the Veteran does not have nasal polyps. No medical records suggest that the Veteran has greater than 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side or nasal polyps. Based on the forgoing, the Board finds the Veteran is not entitled to a compensable rating for his service-connected rhinitis. There are no other diagnostic criteria under which the Veteran's service-connected allergic rhinitis would be more appropriately evaluated. Rhinitis is specifically addressed in Diagnostic Code 6522, and therefore, any other diagnostic codes, including those to evaluate sinusitis are not applicable. 38 C.F.R. § 4.97, Diagnostic Codes 6510-6514 (2012). The Board also finds an extraschedular rating is not warranted as the evidence does not show that the Veteran's disability picture is so unusual or exceptional in nature as to render the current rating inadequate. The rhinitis symptoms reported by the Veteran, including nasal congestion, excess nasal mucous, itchy nose, watery eyes, and sneezing, are contemplated by the rating criteria. Further, there is no evidence of record that would warrant a compensable evaluation for the Veteran's service-connected allergic rhinitis at any time during the period pertinent to this appeal. See Francisco, 7 Vet. App. 55; Hart, 21 Vet. App. 505. Finally, in reaching this decision the Board considered the doctrine of reasonable doubt. However, as the preponderance of the evidence is against the Veteran's claim for an initial compensable evaluation for allergic rhinitis, the doctrine is not for application. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. C. Organic Brain Syndrome The Veteran currently has a noncompensable rating for his history of a near-drowning accident with history of acute and moderate organic brain syndrome secondary to anoxia. He is rated under Diagnostic Code 9300 for delirium, which is evaluated under the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130. Under the General Rating Formula for Mental Disorders, a mental condition that has been formally diagnosed but with symptoms not severe enough either to interfere with occupational and social functioning or to require continuous medication is rated as noncompensable. A 10 percent evaluation is warranted for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication. A 30 percent evaluation is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events). In October 2009 the Veteran was afforded an examination for post-traumatic stress disorder that included some mental testing. The examiner noted the Veteran's speech was unremarkable, his attention was intact, and thought process and content unremarkable. The Veteran's recent and remote memory tested normal, although the Veteran reported having memory problems, including forgetting intended activities at times. The Veteran also reported balance problems, dizzy spells, and sharp head pain at times since his near-drowning experience. In September 2010 the Veteran underwent a VA brain and spinal cord examination. The Veteran told the examiner he experiences memory problems and usually makes a list of things to do. However, the examiner noted the Veteran had a normal cognitive screening examination. The examiner noted the Veteran retired in 2006 due to a heart attack. The examiner opined that the Veteran's near-drowning with anoxic brain injury has no effect on his usual occupation or daily activities. At an April 2012 VA examination, the Veteran was found to have mild cognitive impairment with testing. He scored 4 out of 5 on delayed recall, although the Veteran stated that he has problems with his short term memory. The examiner stated that the Veteran did not have a traumatic brain injury but rather a metabolic injury secondary to anoxia from the near drowning accident. At a November 2012 VA mental health examination memory testing suggested significant cognitive impairments, but the examiner questioned the level of effort the Veteran put into the testing. The examiner also noted the Veteran did not spontaneously report having significant problems with his memory. The examiner further stated that the Veteran did not appear to be experiencing any mental health condition related to his near-drowning experience. The Veteran's treatment records do not reflect he is on any medication for his diagnosed organic brain syndrome. Further, his VA treatment records do not reflect complaints related to the condition or any treatment for the condition. The Veteran has subjectively reported memory problems in statements related to his claim and VA examinations, but the October 2009 VA examiner found the Veteran's memory to be normal when tested and the November 2012 VA examiner questioned the validity of memory testing that showed a deficiency. In April 2012 the Veteran scored a 4 out of 5 on a delayed recall test during a VA examination. The Veteran also had a normal cognitive screening examination in September 2010. Further, the November 2012 examiner noted that the Veteran did not volunteer that he experiences memory difficulties. The Veteran has also reported intermittent episodes of balance problems and dizziness he attributes to his near-drowning experience. However, to the extent that the Veteran experiences such symptoms, the evidence does not show they are related to his organic brain syndrome. The September 2010 VA examiner opined that the Veteran's reported balance problems are not related to his anoxic brain injury. Although the Veteran is competent to report such symptoms, he is not competent as a lay person to opine as to their etiology. The September 2010 examiner also opined that the Veteran's condition has no effect on his usual occupation or daily activities. Based on the forgoing, the Board finds a preponderance of the evidence reflects that the Veteran's symptoms, to the extent that they are present, are not severe enough to interfere with his occupational and social functioning, thus a compensable rating under the General Rating Formula for Mental Disorders is not warranted. The Board has also considered whether other diagnostic codes could be applicable, but finds there is not a more appropriate code. With regard to Diagnostic Code 8045 for residuals of traumatic brain injury (TBI), the Board finds it is not applicable as the Veteran has been found not to have TBI. Specifically, the April 2012 VA examiner stated that the Veteran did not have TBI but instead a metabolic injury secondary to anoxia. Also, the November 2012 examiner found the Veteran did not have a mental health condition related to his organic brain syndrome. As the preponderance of the evidence is against this claim for an increased rating, the benefit of the doubt doctrine does not apply, and the claim for a compensable evaluation must be denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. Further, there is no evidence of record that would warrant a compensable evaluation for the Veteran's condition at any time during the period pertinent to this appeal. See Francisco, 7 Vet. App. 55; Hart, 21 Vet. App. 505. The Board also finds an extraschedular rating is not warranted as the evidence does not show that the Veteran's disability picture is so unusual or exceptional in nature as to render the current rating inadequate. The Veteran's primary symptom complained of is memory problems, which are contemplated by the rating criteria. Duties to Notify and Assist As provided for by the Veterans Claims Assistance Act of 2000 (VCAA), VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA 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; and (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b)(1). Such notice should also address VA's practices in assigning disability evaluations and effective dates for those evaluations. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). While the required notice should be furnished prior to the issuance of the appealed rating decision, any initial errors of notice will not be prejudicial if: 1) corrective actions (e.g., issuance of a post-adjudication notice letter containing the required information) are taken, and 2) the appeal is readjudicated (e.g., in a Supplemental Statement of the Case). See Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007). Here, the VCAA duty to notify was satisfied by way of a letters sent to the Veteran in February 2008 and February 2010. In the letters, the RO informed the Veteran of the Veteran's and VA's respective duties for obtaining evidence and how VA assigns disability ratings and effective dates. VA also has a duty to assist the Veteran with the development of facts pertinent to the appeal. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). This duty includes the obtaining of "relevant" records in the custody of a federal department or agency under 38 C.F.R. § 3.159(c)(2), as well as records not in federal custody (e.g., private medical records) under 38 C.F.R. § 3.159(c)(1). VA will also provide a medical examination if such examination is determined to be "necessary" to decide the claim. 38 C.F.R. § 3.159(c)(4). The Board finds that all necessary development has been accomplished. The RO has obtained the Veteran's service treatment records, VA treatment records, and private treatment records identified by the Veteran. The Veteran also submitted personal statements. Neither the Veteran nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. The Veteran was afforded VA medical examinations in February 2008, October 2009, August 2010, September 2010, April 2012, and November 2012 for both his diagnosed sinusitis/rhinitis and organic brain syndrome. The examiners, medical professionals, obtained an accurate history and listened to the Veteran's assertions. The examiners provided the Board with sufficient information to rate the Veteran's disabilities. Therefore, the Board finds that the examinations are adequate and contain sufficient information to decide the issues on appeal. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Hence, no further notice or assistance to the Veteran is required to fulfill VA's duty to assist in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio, 16 Vet. App. 183. [Continued on Next Page] ORDER A 10 percent rating, but no higher, is granted for left frontal and maxillary antral sinusitis prior to April 3, 2012, subject to the laws and regulations controlling the disbursement of monetary benefits. A rating in excess of 30 percent for left frontal and maxillary antral sinusitis as of April 3, 2012 is denied. A compensable rating for allergic rhinitis is denied. A compensable rating for history of near-drowning accident with history of acute and moderate organic brain syndrome secondary to anoxia is denied. ____________________________________________ MICHELLE L. KANE Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs