Citation Nr: 18142690 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 15-08 655 DATE: October 17, 2018 ORDER Entitlement to service connection for headaches is denied. Entitlement to service connection for a lumbar spine disability is denied. Entitlement to service connection for a neurological disability of the lower extremities, claimed as sciatica, is denied. Entitlement to service connection for a cervical spine disability is denied. Entitlement to service connection for a neurological disability of the upper extremities, claimed as carpal tunnel syndrome, is denied. Entitlement to service connection for a left shoulder disability is denied. Entitlement to service connection for a right shoulder disability is denied. Entitlement to service connection for a left elbow disability is denied. Entitlement to service connection for a right elbow disability is denied. Entitlement to an increased evaluation of 30 percent, but not in excess thereof, for residuals of non-displaced fracture of the nose is granted. Entitlement to an increased evaluation in excess of 10 percent for maxillary sinusitis with retention cyst is denied. Entitlement to nonservice-connected pension benefits is denied. FINDINGS OF FACT 1. The headaches the Veteran experienced during active service are a symptom of his service-connected sinusitis and are specifically contemplated by the rating criteria for sinusitis; and he has not been diagnosed with a separate vascular headaches (migraine) disability. 2. The preponderance of the evidence is against finding that the current lumbar spine disability was incurred in service, is otherwise related to service, or manifested within one year of service separation. 3. The preponderance of the evidence is against finding that the current neurological disability of the lower extremities was incurred in service, is otherwise related to service, or manifested within one year of service separation. 4. The preponderance of the evidence is against finding that the current neck spine disability was incurred in service, is otherwise related to service, or manifested within one year of service separation. 5. The preponderance of the evidence is against finding that the current neurological disability of the upper extremities, to include carpal tunnel syndrome, was incurred in service, is otherwise related to service, or manifested within one year of service separation. 6. The preponderance of the evidence is against finding that the Veteran has a current disability of the shoulders that began during active service or is otherwise related to an in-service injury, event, or disease. 7. The preponderance of the evidence is against finding that the Veteran’s bilateral elbow disabilities began during active service, or are otherwise related to an in-service injury, event, or disease. 8. Throughout the appeal period, the Veteran’s service-connected residuals of non-displaced fracture of the nose have not been productive of any loss of part of the nose or scars, rhinitis, or any other symptoms or pathology involving the throat. 9. Throughout the appeal period, the Veteran’s maxillary sinusitis with retention cyst has been productive of more than 6 non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and crusting. 10. Throughout the appeal period, the Veteran maxillary sinusitis with retention cyst has not been productive of radical surgery with chronic osteomyelitis, or when there is near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. 11. The Veteran’s countable income exceeds the relevant maximum allowable pension rate (MAPR) for purposes of entitlement to nonservice-connected pension benefits. CONCLUSIONS OF LAW 1. The criteria for service connection for headaches have not been met. 38 U.S.C. §§ 101, 1101, 1110, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2017). 2. The criteria for service connection for a lumbar spine disability are not met. 38 U.S.C. §§ 1110, 1112, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 3. The criteria for service connection for a neurological disability of the lower extremities are not met. 38 U.S.C. §§ 1110, 1112, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 4. The criteria for service connection for a cervical spine disability are not met. 38 U.S.C. §§ 1110, 1112, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 5. The criteria for service connection for a neurological disability of the upper extremities are not met. 38 U.S.C. §§ 1110, 1112, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 6. The criteria for service connection for a left shoulder disability are not met. 38 U.S.C. §§ 1110, 1112, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 7. The criteria for service connection for a right shoulder disability are not met. 38 U.S.C. §§ 1110, 1112, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 8. The criteria for service connection for a left elbow disability are not met. 38 U.S.C. §§ 1110, 1112, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 9. The criteria for service connection for a right elbow disability are not met. 38 U.S.C. §§ 1110, 1112, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 10. For the entire appeal period, the criteria for an evaluation in excess of 10 percent for residuals of non-displaced fracture of the nose have not been met. 38 U.S.C. §§ 1155 (West 2014); 38 C.F.R. § 4.97, Diagnostic Code 6502 (2017). 11. Resolving reasonable doubt in the Veteran’s favor, the criteria for an evaluation of 30 percent, and not in excess thereof, for maxillary sinusitis with retention cyst have been met for the entire rating period on appeal. 38 U.S.C. §§ 1155, 5107, (West 2014); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.97, Diagnostic Code 6513 (2017). 12. The Veteran’s annual countable income is excessive for the purposes of establishing his eligibility for nonservice-connected pension benefits. 38 U.S.C. §§ 101, 501, 1503, 1521 (West 2014); 38 C.F.R. §§ 3.2, 3.3, 3.23, 3.271, 3.272, 3.273, 3.274, 3.275, 3.350 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1972 to January 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a March 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) located in Jackson, Mississippi. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Federal law specifically limits entitlement for service-connected disease or injury to cases where such incidents result in a disability. It is not enough for a claimant to seek some sort of benefit simply because he had a disease or injury on active duty. In the absence of proof of a current disability, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Degmetich v. Brown, 104 F.3d 1328, 1333 (1997) (upholds Court of Appeals for Veterans Claims decision to require a current existing disability). Service connection is also warranted for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(b). For certain chronic diseases, including arthritis and organic diseases of the nervous system, a presumption of service connection arises if the disease is manifested to a degree of 10 percent within one year following discharge from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). When a chronic disease is not shown to have manifested to a compensable degree within one year after service, under 38 C.F.R. § 3.303 (b) for the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. When the fact of chronicity in service is not adequately supported, a showing of continuity after discharge is required to support a claim for such diseases; however, such continuity of symptomatology may only support a claim for those chronic diseases listed under 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. The Board has reviewed all the evidence in the Veteran’s claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by a veteran or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). 1. Headaches The Veteran seeks service connection for headaches. He asserts that his headaches started in service. The record reflects that the Veteran has a current headaches disability. For the reasons set forth below, the Board finds that the Veteran’s headaches are a symptom of his service-connected sinusitis and are contemplated by the rating criteria for his sinusitis; therefore, he is already being compensated for his headaches. See 38 C.F.R. § 4.97, Diagnostic Code (DC) 6513. The Veteran’s service treatment records show no complaints of, treatment for, or diagnosis of headaches. However, the Veteran submitted lay statements by the Veteran’s father, mother, wife, ex-wife, and work colleague, all of whom supported the Veteran’s assertions that his headaches began in service. The February 2011 VA examination report noted the Veteran’s headaches as a symptom of his sinusitis. Similarly, an August 2016 disability benefits questionnaire (DBQ), completed by Dr. H.S., shows a diagnosis of tension headaches. Dr. H.S. opined that the Veteran’s tension headaches are caused by his sinusitis and depressive disorder. To the extent that the headaches are a symptom of the service-connected sinusitis, the Board has fully considered the Veteran’s headaches in awarding a higher 30 percent evaluation for the Veteran’s sinusitis, as discussed below. See 38 C.F.R. § 4.97, DC 6513; see also Mittleider v. West, 11 Vet. App. 181, 182 (1998) (per curiam), citing Mitchem v. Brown, 9 Vet. App. 136, 140 (1996) (the Board is precluded from differentiating between symptomatology attributed to a non-service-connected disability and a service-connected disability in the absence of medical evidence that does so, although the Board may not ignore such distinctions where they appear in the medical record). To the extent that the headaches are caused by the Veteran’s depressive disorder, the Veteran is not service connected for a depressive disorder. Therefore, any headaches related to the Veteran’s depressive disorder are not subject to service connection because the primary disability (depressive disorder) is not service connected. 38 C.F.R. § 3.310. The does not show that the Veteran has been diagnosed with migraine headaches, so as to warrant a separate rating under 38 C.F.R. § 4.124a, DC 8100 (2017). The August 2016 DBQ, which was submitted by the Veteran, noted a diagnosis of tension headaches, which are defined as a primary headache brought on by prolonged overwork or emotional strain, or both, affecting especially the occipital region. See Dorland’s Illustrated Medical Dictionary 824 (32nd ed. 2012). However, migraine headaches are defined as an often-familial symptom complex of periodic attacks of vascular headaches, usually temporal and unilateral in onset, commonly associated with irritability, nausea, vomiting, constipation or diarrhea, and often photophobia. Id. at 1166. The record does not show that the Veteran has been diagnosed with migraine headaches, or that his headaches had a vascular etiology or were associated with irritability, nausea, vomiting, constipation or diarrhea, or photophobia. In sum, the preponderance of the evidence demonstrates that the Veteran does not have a diagnosis of vascular headaches (migraine), and that the headaches that began during active service are a symptom of his service-connected sinusitis and, therefore, he is already receiving compensation for the headaches as a part of the rating criteria for sinusitis. Assignment of a separate rating for the same headaches would constitute impermissible pyramiding. See 38 C.F.R. §§ 4.14 (2017); Esteban v. Brown, 6 Vet. App. 259, 261- 62 (1994). The Board acknowledges the Veteran’s belief that his current headaches are a disability distinct from his sinusitis that began during active service. However, his statements alone do not establish a diagnosis or medical nexus. Indeed, while the Veteran is competent to provide evidence regarding matters that can be perceived by the senses, he is not shown to be competent to render medical opinions. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology). As such, as a lay person, he is without the appropriate medical training and expertise to offer an opinion on a medical matter, including the etiology or causation of a specific disability. The question of causation, in this case, involves a complex medical issue that the Veteran is not competent to address. Jandreau. The February 2011 VA examiner and Dr. H.S. have expertise, education, and training that the Veteran is not shown to have. As such, their etiology opinions are afforded more weight. They are adequate opinions and the most probative evidence of record. Notably, there are no contrary competent medical opinions of record. Based on the foregoing, the weight of the competent evidence demonstrates that the headaches the Veteran experienced during active service are related to his service-connected sinusitis, and that a separate grant of service connection is not warranted, as the rating schedule for sinusitis specifically contemplates headaches. Moreover, the weight of the evidence demonstrates that the Veteran does not have a separately-diagnosed vascular headaches disability. Therefore, the Board finds that a preponderance of the lay and medical evidence that is of record weighs against the claim for service connection for headaches. For these reasons, the claim for service connection for headaches must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Low back disability 3. Neurological disability of lower extremities The Veteran seeks service connection for a low back disability, as well as a neurological disability of the lower extremities. He asserts that, while leading troops through an obstacle course in service, he fell from a height of more than 12 feet and landed on his back and felt pain in the back. See, e.g., March 2011 VA Form 21-4138. The record reflects that the Veteran has a current low back disability. See, e.g., June 2010 VA treatment record (a Magnetic resonance imaging (MRI) of the lumbar spine showed diagnoses of forminal disc bulges causing moderate bilateral neural forminal stenosis); see also November 2006 private treatment record (showing a diagnosis of degenerative joint disease and compression of the first lumbar vertebra). With respect to the claimed neurological disability of the lower extremities, a July 2007 private treatment record showed complaints of low back pain with pain and burning sensation in the lower extremities. In a March 2011 statement, J.R., an office manager at a doctor’s office, noted that the Veteran was seen at the practice in 2003, in pertinent part, with complaints of pain in the lower back and legs, and noted that the Veteran had pinched nerves which were causing pain in his lower back. Accordingly, and resolving reasonable doubt in favor of the Veteran on this question, the Board finds that he has a current neurological disability of the lower extremities. However, for the reasons set forth below, the Board finds that the evidence weighs against that the Veteran’s low back disability and neurological disability of the lower extremities were incurred in service, or are otherwise related to service. Service treatment records show no complaints of, treatment for, or diagnosis of a low back condition or a neurological condition of the upper extremities. The January 1974 service separation examination report shows a normal clinical evaluation of the spine, lower extremities, and neurologic system. The concurrent report of medical history shows that the Veteran denied current symptoms and a history of recurrent back pain, swollen or painful joints, arthritis, bone, joint, or other deformity, and neuritis or paralysis. In this regard, the Board is not relying on the absence of evidence, but rather on the contemporaneous, affirmative lay reports of symptoms and history by the Veteran, as well as contemporaneous clinical assessment of the spine, lower extremities, and neurologic system. While not dispositive, the post-service evidence does not reflect any complaints or treatment pertaining to the low back or lower extremities for many years following separation from active service. The first post-service evidence of a low back condition is in a November 2006 private treatment record which noted a diagnosis of degenerative joint disease and compression of the first lumbar vertebra. The first-post-service evidence of a neurological condition of the lower extremities is a July 2007 private treatment record that showed that the Veteran complained of low back pain with pain and burning sensation in the lower extremities. The Board emphasizes that the multi-year gap between discharge from active duty service to when the Veteran sought medical care for his low back and bilateral low extremity neurological disability is a factor that weighs against in-service incurrence of these disabilities. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (lengthy period of absence of medical complaints for condition can be considered as a factor in resolving claim); see also Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (affirming Board’s denial of service connection where veteran failed to account for lengthy time period between service and initial symptoms of disability); Kahana v. Shinseki, 24 Vet. App. 428, 440 (2011) (the silence in a medical record can be weighed against lay testimony if the alleged injury, disease, or related symptoms would ordinarily have been recorded in the medical record being evaluated by the fact finder). Moreover, to the extent that the Veteran now claims that he has had back pain or bilateral lower extremity neurological symptoms since service, the Board finds that such assertions are not credible because they are contradicted and outweighed by more contemporaneous evidence, including the Veteran’s own reports of no history of low back symptoms or neurological symptoms of the lower extremities at service separation and for many years after service, which indicates that the Veteran’s low back and bilateral lower extremity neurological symptoms did not start until years after service separation. The Veteran has not otherwise submitted any medical evidence that his current low back disability or neurological disability of the lower extremities may be related to service, other than his general assertions that these disabilities are related to service. Although lay persons are competent to report low back or lower extremity neurological symptoms experienced at any time, as well as provide opinions on some medical issues, the specific disabilities in this case, lumbar spine degenerative joint disease, forminal disc bulges with neural forminal stenosis, and neurological disability of the lower extremities, fall outside the realm of common knowledge of a lay person. Kahana, 24 Vet. App. 428; Jandreau, 492 F.3d 1372. Thus, the Veteran statements purporting to link the current low back disability and neurological disability of the lower extremities to service are assigned no probative value. Finally, as the Veteran’s arthritis of the lumbar spine and neurological disability of the lower extremities have not been shown to have manifested within one year of service separation, the presumptive service connection provisions of 38 C.F.R. §§ 3.307 and 3.309(a) are not applicable in this case. For these reasons, the Board finds that a preponderance of the evidence is against a finding that the Veteran’s lumbar spine disability and neurological disability of the lower extremities were incurred in service, or are otherwise related to service. Accordingly, service connection for a lumbar spine disability and a neurological disability of the lower extremities must be denied. As the preponderance of the evidence is against the claims, the benefit of the doubt rule does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 4. Cervical spine disability 5. Neurological disability of the upper extremities The Veteran seeks service connection for a cervical spine disability, as well as a neurological disability of the upper extremities, claimed as carpal tunnel syndrome. He asserts that, while leading troops through an obstacle course in service, he fell from a height of more than 12 feet and felt pain in the neck. See, e.g., March 2011 VA Form 21-4138. The record reflects that the Veteran has a current cervical spine disability, as well as a current neurological disability of the upper extremities. See, e.g., June 2010 VA treatment record (MRI of the neck showed a diagnosis of moderate degenerative disc disease); November 2010 VA treatment record (an electromyography showed bilateral median neuropathy at or distal to the wrists); April 2018 VA treatment record (showing a diagnosis of bilateral carpal tunnel syndrome). As such, the first criterion necessary for service connection has been met. However, for the reasons set forth below, the Board finds that the evidence weighs against that the Veteran’s cervical spine disability and neurological disability of the upper extremities were incurred in service, or are otherwise related to service. Service treatment records show no complaints of, treatment for, or diagnosis of a cervical spine condition or a neurological condition of the upper extremities. The January 1974 service separation examination report shows a normal clinical evaluation of the spine, upper extremities, and neurologic system. The concurrent report of medical history shows that the Veteran denied current symptoms and a history of swollen or painful joints, arthritis, bone, joint, or other deformity, and neuritis and paralysis. In this regard, the Board is not relying on the absence of evidence, but rather on the contemporaneous, affirmative lay reports of symptoms and history by the Veteran, as well as contemporaneous clinical assessment of the spine, upper extremities, and neurologic system. While not dispositive, the post-service evidence does not reflect any complaints or treatment pertaining to the neck or upper extremities for many years following separation from active service. An October 2010 VA treatment record reflects that the Veteran reported neck pain radiating down the arms for 15 years, which indicates post-service onset of cervical spine and upper extremity neurological symptoms in 1995, decades after service separation. The Board emphasizes that the multi-year gap between discharge from active duty service to when the Veteran sought medical care for his cervical spine and bilateral upper extremity neurological disabilities is a factor that weighs against in-service incurrence of these disabilities. See Maxson, 230 F.3d at 1333; see also Mense, 1 Vet. App. at 356; Kahana, at 440. Moreover, to the extent that the Veteran now claims that he has had neck pain and bilateral upper extremity neurological symptoms since service, the Board finds that such assertions are not credible because they are contradicted and outweighed by more contemporaneous evidence, including the Veteran’s own reports of no history of elbow symptoms at service separation and for many years after service, which indicate that the Veteran’s cervical spine and bilateral upper neurological extremity symptoms did not start until years after service separation. The Veteran has not otherwise submitted any medical evidence that his current cervical spine disability or neurological disability of the upper extremities may be related to service, other than his general assertions that these disabilities are related to service. Although lay persons are competent to report neck or upper extremity neurological symptoms experienced at any time, as well as provide opinions on some medical issues, the specific disabilities in this case, cervical spine degenerative disc disease, bilateral upper extremity neuropathy, and bilateral carpal tunnel syndrome, fall outside the realm of common knowledge of a lay person. Kahana, 24 Vet. App. 428; Jandreau, 492 F.3d 1372. Thus, the Veteran statements purporting to link the current cervical spine disability and neurological disability of the upper extremities to service are assigned no probative value. Finally, as the Veteran’s arthritis of the cervical spine, bilateral upper extremity neuropathy, and bilateral carpal tunnel syndrome have not been shown to have manifested within one year of service separation, the presumptive service connection provisions of 38 C.F.R. §§ 3.307 and 3.309(a) are not applicable in this case. For these reasons, the Board finds that a preponderance of the evidence is against a finding that the Veteran’s cervical spine disability and neurological disability of the upper extremities were incurred in service, or are otherwise related to service. Accordingly, service connection for a cervical spine disability and a neurological disability of the upper extremities must be denied. As the preponderance of the evidence is against the claims, the benefit of the doubt rule does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 6. Left shoulder disability 7. Right shoulder disability The Veteran seeks service connection for left and right shoulder disabilities. For the reasons set forth below, the Board finds that the evidence weighs against finding that the Veteran has a current disability of the shoulders that began during service or is at least as likely as not related to an in-service injury, event, or disease. First addressing the current disability requirement, the Board notes that, under applicable regulation, the term “disability” means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Allen v. Brown, 7 Vet. App. 439 (1995): Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991). The United States Court of Appeals for Veterans Claims (Court) has held that a symptom such as pain, without a diagnosed or identifiable underlying malady or condition, does not, in and of itself, constitute a ‘disability’ for which service connection may be granted. See Sanchez-Benitez v. West, 13 Vet. App. 282 (1999). The Federal Circuit recently held, however, that the term “disability” as used in 38 U.S.C. 1110 “refers to the functional impairment of earning capacity, not the underlying cause of said disability,” and held that “pain alone can serve as a functional impairment and therefore qualify as a disability.” Saunders v. Wilkie, No. 2017-1466, 2018 U.S. App. LEXIS 8467, at 17 (Fed. Cir. Apr. 3, 2018). In this case, the record contains no complaints of, treatment for, or diagnosis of a left shoulder disability. While the Veteran’s medical records show some complaints of right shoulder pain, there is no record of a diagnosis of a right shoulder disability. See, e.g., August 2015 and January 2016 VA treatment records (MRI studies conducted after Veteran’s complains of right shoulder pain showed that the Veteran’s right shoulder was normal). Moreover, there is no indication that the Veteran’s right shoulder pain reached the level of a functional impairment of earning capacity necessary to establish the presence of a disability. Id. Where the evidence does not support a finding of current disability upon which to predicate a grant of service connection, there can be no valid claim for that benefit. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer, 3 Vet. App. at 225. As such, the Board finds that the evidence weighs against a finding of a current disability of the shoulders, and service connection for the claimed left and right shoulder disabilities is not warranted. Even if the Veteran is found to have current left or right shoulder disabilities, the Board finds that the evidence weighs against a finding of an in-service injury, disease, or event pertaining to the shoulders to which a current disability of the shoulders may be related. Service treatment records show no complaints of, treatment for, or diagnosis of a left or right shoulder disability. The January 1974 service separation examination report shows a normal clinical evaluation of the upper extremities, and the concurrent report of medical history shows that the Veteran denied current symptoms and a history of swollen or painful joints, arthritis, bone, joint, or other deformity, and painful or trick shoulder. In this regard, the Board is not relying on the absence of evidence, but rather on the contemporaneous, affirmative lay reports of symptoms and history by the Veteran, as well as contemporaneous clinical assessment of the upper extremities. As noted above, the record contains no complaints of or treatment for a left shoulder condition. While not dispositive, the record reflects that the first post-service evidence of a potential right shoulder condition was in a December 2006 private treatment record which noted a potential separated right shoulder in 2003. A July 2015 VA treatment record shows that the Veteran reported injuring his right shoulder on July 18, 2015 at a water park while trying to stop himself from falling. Based on the foregoing, the evidence weighs in favor of a post-service injury to the right shoulder. Finally, as the Veteran is not shown to have been diagnosed with bilateral shoulder arthritis, the presumptive service connection provisions of 38 C.F.R. §§ 3.307 and 3.309(a) are not applicable in this case. For these reasons, the Board finds that weight of the evidence demonstrates that the Veteran does not have a current disability of the shoulders, that the Veteran did not sustain an injury, disease, or event pertaining to the shoulders in service, and that the Veteran had post-service injury to the right shoulder. As such, the Board finds that service connection for the claimed left and right shoulder disabilities must be denied. As the preponderance of the evidence is against the claims, the benefit of the doubt rule does not apply. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 8. Left elbow disability 9. Right elbow disability The Veteran seeks service connection for left and right elbow disabilities. The record reflects that the Veteran has a current disability of the left and right elbows. See, e.g., October 2010 VA treatment record (showing a diagnosis of bilateral elbow medial epicondyles). As such, the first criterion necessary for service connection has been met. However, for the reasons set forth below, the Board finds that the evidence weighs against that the Veteran’s bilateral elbow disability was incurred in service, is otherwise related to service. Service treatment records show no complaints of, treatment for, or diagnosis of left or right elbow disabilities. The January 1974 service separation examination report shows a normal clinical evaluation of the upper extremities, and the concurrent report of medical history shows that the Veteran denied current symptoms and a history of swollen or painful joints, arthritis, bone, joint, or other deformity, and painful or trick elbow. In this regard, the Board is not relying on the absence of evidence, but rather on the contemporaneous, affirmative lay reports of symptoms and history by the Veteran, as well as contemporaneous clinical assessment of the upper extremities. While not dispositive, the post-service evidence does not reflect any left or right complaints or treatment for at least 19 years following separation from active service. A July 2010 private treatment record shows that the Veteran reported bilateral elbow pain. An October 2010 VA treatment record reflects that the Veteran reported bilateral elbow pain for one year. The Board emphasizes that the multi-year gap between discharge from active duty service to when the Veteran sought medical care for his bilateral elbow disability is a factor that weighs against in-service incurrence of these disabilities. See Maxson, at 1333; see also Mense, at 356; Kahana, 24 Vet. App. at 440. Moreover, to the extent that the Veteran now claims that he has had bilateral elbow pain since service, the Board finds that such assertions are not credible because they are contradicted and outweighed by more contemporaneous evidence, including the Veteran’s own reports of no history of elbow symptoms at service separation and for many years after service, which indicate that the Veteran’s bilateral elbow disability did not start until years after service separation. The Veteran has not otherwise submitted any medical evidence that his current bilateral elbow disability may be related to service, other than his general assertions that his bilateral elbow disability is related to service. Although lay persons are competent to report right symptoms experienced at any time, as well as provide opinions on some medical issues, the specific disability in this case, bilateral elbow medial epicondyles, falls outside the realm of common knowledge of a lay person. Kahana, 24 Vet. App. 428; Jandreau, 492 F.3d 1372. Thus, the Veteran statements purporting to link the current bilateral elbow disability to service are assigned no probative value. Finally, as the Veteran is not shown to have been diagnosed with bilateral elbow arthritis, the presumptive service connection provisions of 38 C.F.R. §§ 3.307 and 3.309(a) are not applicable in this case. For these reasons, the Board finds that a preponderance of the evidence is against a finding that the Veteran’s left and right elbow disabilities are related to service. Accordingly, service connection for left and right elbow disabilities must be denied. As the preponderance of the evidence is against the claims, the benefit of the doubt rule does not apply. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Increased Rating Disability ratings 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 or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. Staged ratings are appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). 10. Residuals of non-displaced nose fracture The Veteran seeks a higher evaluation for the service-connected residuals of a nose fracture. For the entire appeal period, the Veteran has been in receipt of a 10 percent evaluation for the service-connected residuals of a nose fracture under 38 C.F.R. § 4.97, Diagnostic Code (DC) 6502. DC 6502 provides for a maximum 10 percent disability rating when there is a 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side of the nose. Id. Because the Veteran is already in receipt of the maximum revaluation under DC 6502, a higher rating is not assignable under this Diagnostic Code. The Board finds that the Veteran’s service-connected residuals of a nose fracture are most appropriately rated under DC 6502, the only code available which would allow a compensable rating for this condition. The evidence of record relevant to this appeal does not support the assignment of a diagnostic code other than 6502, as the Veteran’s service-connected residuals of a nose fracture are not shown to involve any other factor that would warrant evaluation of the disability under any other provisions of the rating schedule. Crucially, his current residuals of a nose fracture do not include any loss of part of the nose or scars (DC 6504), rhinitis (DCs 6522 to 6524), or any other symptoms or pathology involving the throat (DCs 6515 to 6524). Moreover, the Veteran is already in receipt of a 10 percent rating for sinusitis under DC 6513, as discussed below. Accordingly, a disability rating in excess of 10 percent for the Veteran’s service-connected residuals of a nose fracture is not warranted for the entire rating period on appeal. 38 C.F.R. §§ 4.3, 4.7, 4.97. The claim for a higher evaluation for residuals of a nose fracture is therefore denied. 11. Maxillary sinusitis with retention cyst The Veteran seeks a higher evaluation for the service-connected maxillary sinusitis with retention cyst. For the entire appeal period, the Veteran has been in receipt of a 10 percent evaluation for the service-connected maxillary sinusitis under 38 C.F.R. § 4.97, DC 6513. Under DC 6513 for chronic maxillary sinusitis, found in the General Rating Formula for Sinusitis, a noncompensable or zero percent rating is assigned where sinusitis is detected by X-ray only. A 10 percent evaluation is assigned where there are 1 or 2 incapacitating episodes per year of sinusitis requiring prolonged (lasting 4 to 6 weeks) antibiotic treatment, or 3 to 6 non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent evaluation is assigned where there are 3 or more incapacitating episodes per year of sinusitis requiring prolonged (lasting 4 to 6 weeks) antibiotic treatment, or more than 6 non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. Finally, a 50 percent evaluation is assigned following radical surgery with chronic osteomyelitis, or when there is near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. The regulation defines an incapacitating episode as one that requires bed rest and treatment by a physician. 38 C.F.R. § 4.97. The Veteran underwent a VA examination in February 2011. He reported six sinus episodes per year, each of which lasting for three days. The Veteran described headaches with his sinus episodes. Antibiotic treatment was needed for his sinus problem, but the treatment did not last for four to six weeks. Upon examination, the examiner noted subjective factors of interference with breathing through the nose, hoarseness, crusting, and pain, with chronic sinusitis and headaches. The objective factors were noted as tender maxillary and frontal sinuses and radiologic findings. A November 2012 VA examination report noted that frontal sinuses, ethmoid air cells, maxillary sinuses, mastoid air cells, and sphenoid sinuses appeared clear. At a December 2014 VA examination, the Veteran reported sinusitis, with frontal headaches, watery and itchy eyes, and post-nasal drip. The Veteran denied current use of antibiotics but stated that he had used antibiotics in the past for breathing problems. Based on the foregoing, the Board finds that the evidence is in equipoise as to whether the Veteran’s service-connected maxillary sinusitis with retention cyst more nearly approximates the criteria for a disability rating of 30 percent throughout the appeal period. The evidence indicates that the sinusitis has not been productive of three or more incapacitating episodes per year of prolonged antibiotic treatment. However, given the frequency and severity of the Veteran’s headaches, the Board finds that the evidence is at least in equipoise that the sinusitis has been productive of six or more non-incapacitating episodes per year characterized by headaches, pain, and crusting. The February 2011 VA examination report noted headaches, pain, and crusting associated with the sinusitis disability. See also September 2015, February 2016, and April 2016 VA treatment records. The Veteran also submitted an August 2016 DBQ, which purports to link the Veteran’s headaches, in part, to his sinusitis. In granting the higher 30 percent evaluation, the Board has fully accounted for all of the Veteran’s reported symptoms, to include the frequency and severity of his headaches. The Board finds that an evaluation in excess of 30 percent is not warranted for the Veteran’s maxillary sinusitis with retention cyst. A higher rating under DC 6513 is assigned following radical surgery with chronic osteomyelitis, or when there is near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. The evidence weighs against such manifestations. The record does not show that the Veteran underwent any surgeries for his sinusitis disability. Therefore, the Board finds that the Veteran’s maxillary sinusitis symptoms are consistent with the 30 percent rating criteria rather than the higher 50 percent rating criteria under DC 6513. See 38 C.F.R. § 4.97. Accordingly, a disability rating in excess of 30 percent for the Veteran’s maxillary sinusitis is not warranted for the entire rating period on appeal. 38 C.F.R. §§ 4.3, 4.7, 4.97. 12. Entitlement to nonservice-connected pension benefits The Veteran seeks nonservice-connected pension benefits. Pursuant to 38 U.S.C. § 1521(a), nonservice-connected disability pension is a benefit payable to a veteran of a period of war who is permanently and totally disabled from nonservice-connected disability not the result of his own willful misconduct. A veteran is entitled to such benefits if two criteria are met. First, the veteran had qualifying wartime service as defined in 38 C.F.R. § 3.3(a)(3)(i), (ii), and (iii). Second, the veteran’s income is not in excess of the applicable MAPR, and specified at 38 C.F.R. § 3.23, as changed periodically, and reported in the Federal Register. See 38 U.S.C. § 1521. The maximum rates for a veteran’s pension is reduced dollar for dollar by the amount of the countable income of a veteran, his spouse, and any dependent. 38 U.S.C. § 1521; 38 C.F.R. § 3.23(d). VA presently recognizes the following as periods of war: January 1, 1817 through December 31, 1898, inclusive; April 21, 1898 through July 4, 1902, inclusive; May 9, 1916 through April 5, 1917; April 6, 1917 through November 11, 1918, inclusive; December 7, 1941 through December 31, 1946, inclusive; June 27, 1950 through January 31, 1955, inclusive; August 5, 1964 through May 7, 1975, inclusive; and August 2, 1990 through a date to be prescribed by Presidential proclamation or law. 38 U.S.C. § 101; 38 C.F.R. § 3.2. In determining income for this purpose, payments of any kind from any source are counted as income during the 12-month annualization period in which received unless specifically excluded. 38 U.S.C. § 1503; 38 C.F.R. § 3.271. The MAPRs are specified in 38 U.S.C. § 1521, as increased from time to time under 38 U.S.C. § 5312. At the time of the Veteran’s claim in January 2011, for nonservice-connected pension purposes, the MAPR for a Veteran with one dependent was $15,493. See Pension Rate Tables, effective December 1, 2009, available at https://www.benefits.va.gov/PENSION/rates_veteran_pen09.asp (accessed on September 18, 2018). The MAPR was increased to $16,051, effective December 1, 2011; $16,324, effective December 1, 2012; $16,569, effective December 1, 2013; $16,851, effective December 1, 2014; $16,902, effective December 1, 2016; and $17,241, effective December 1, 2017. Unreimbursed medical expenses reduce countable income for VA pension purposes. Unreimbursed medical expenses in excess of five percent of the maximum annual pension rate, which have been paid by the appellant, may be excluded from an individual’s income for the same 12-month annualization period to the extent they were paid. 38 C.F.R. § 3.272(g)(1)(iii). Other expenses that may be excluded from countable income include: welfare; maintenance (including nursing home and home care fees); VA pension benefits; payments under Chapter 15 of Title 38, United States Code, including accrued pension benefits; reimbursements for casualty loss; profit from sale of property; and joint accounts (accounts and joints accounts in banks and similar institutions acquired by reason of death of the other joint owner). 38 C.F.R. § 3.272. In this case, the record reflects that the Veteran meets the qualifying service criteria as defined in § 3.3(a)(3)(i) based on more than 90 days of active service during the war period from August 5, 1964 through May 7, 1975. As for the income threshold requirement, the record reflects that, for the initial and subsequent annualization periods starting in January 2011, the Veteran has been in receipt of monthly pages of at least $1,300 ($15,600 per year), and that the Veteran’s spouse has been in receipt of at least $1,700 ($20,400 per year). See January 2011 VA Form 21-526. The Veteran has not otherwise reported any additional income or net worth information, and has not provided any evidence of eligible unreimbursed medical expenses or any other expenses that may be deducted from his income for purposes of calculating his countable income for nonservice-connected pension purposes. Based on the foregoing, the Board finds that, for the initial and subsequent annualization periods pertinent to this appeal, the Veteran’s countable income has exceeded the relevant MAPR. Accordingly, the Veteran does not meet the annual income requirement set forth in 38 C.F.R. § 3.3, and nonservice-connected pension is, therefore, not warranted. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Ragheb, Counsel