Citation Nr: 18153910 Decision Date: 11/29/18 Archive Date: 11/28/18 DOCKET NO. 16-53 228A DATE: November 29, 2018 ORDER Entitlement to service connection for a chronic sinus condition, to include rhinitis and sinusitis is denied. FINDINGS OF FACT 1. The evidence of record is against a finding that the Veteran has a current rhinitis disability; rather his rhinitis is a symptom associated with cluster headaches, without separate and distinct pathology. 2. The evidence of record is against a finding that the Veteran’s current symptoms otherwise related to nasal and sinus obstruction were caused by or incurred in service. CONCLUSION OF LAW The criteria for entitlement to service connection for a chronic nasal condition, to include rhinitis and sinusitis have not been satisfied. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. 3.102, 3.303, 3.310 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from November 1973 to December 1976. Entitlement to service connection for a chronic nasal condition, to include rhinitis and sinusitis Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303, 3.304. Service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Walker v. Shinseki, 701 F.3d 1331 (Fed. Cir. 2013). Notwithstanding the lack of evidence of disease or injury during service, service connection may still be granted if all of the evidence, including that pertinent to service, establishes that the disability was incurred in service. See 38 U.S.C. § 1113(b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503 (1992). The Veteran initially filed a claim of entitlement to service connection for “sinus/nose problems” in February 2015. In an April 2015 rating decision, the AOJ denied the claim, noting that, although the Veteran’s service treatment records documented complaints of upper respiratory symptoms, there was no finding of continuity of symptoms after service. Furthermore, more recent medical evidence showed a diagnosis of sinus congestion related to deviated nasal septum and turbinate hypertrophy. The Veteran filed an additional claim in May 2015, stating that he was claiming entitlement to service connection for “rhinitis/sinusitis.” As the Veteran’s record documented in-service complaints associated with sinus congestion, VA scheduled him for an examination in July 2015. At that time, the examiner reported current diagnoses of a deviated nasal septum and cluster headaches. According to the Veteran’s reported history, he was treated for three or four episodes of sinusitis and allergic rhinitis during service. Post-service, from 1976 to 2008, he had no treatment for a sinus condition and was unable to give a history for that period. Subsequent to his enrollment with VA Medical Centers in 2007, the Veteran was diagnosed with cluster headaches and a deviated nasal septum. He underwent nasal septal repair in November 2012, which improved his symptoms, but did not prevent total recurrence. The examiner also reported the existence of rhinitis. The examiner opined that it was less likely than not that the Veteran’s current nasal and sinus conditions were caused by or incurred in service. By way of rationale, the examiner explained that the Veteran did not have a rhinitis disability with separate and distinct pathology. Rather, his rhinitis was a symptom of his currently service-connected headache disability. With respect to sinusitis, the examiner acknowledged complaints of sinus problems in service, but noted that the Veteran’s March 1976 sinus x-rays showed no evidence of sinusitis. The Veteran’s post-service record showed no evidence of a chronic sinus condition until at least 2008, when the Veteran began receiving treatment for new complaints of nasal congestion. The examiner noted that when the Veteran first sought treatment with VA, his ear nose and throat (ENT) examination was normal, and no history of sinusitis was mentioned or identified. Similarly, a July 15, 2008 ENT examination was “normal.” The VA examiner concluded that the Veteran’s recent complaints of nasal problems were related to the diagnosed deviated septum as well as enlarged nasal turbinates, both of which did not develop until after the Veteran began treatment with VA. Furthermore, the Veteran’s deviated septum was not due to trauma. Indeed, the examiner’s findings are supported by the record. Service treatment records document occasions in which the Veteran was treated for nasal symptoms, but where the primary complaint was headaches. On his separation examination, the Veteran checked ‘Yes’ to a history of headaches, but ‘No’ to a history of sinusitis and no sinus conditions were noted on separation. When the Veteran first began treatment at the Atlanta VA Medical Center in November 2007 there were no sinus symptoms or history of sinus symptoms noted. VA treatment records first show reduced nasal patency in September 2009. Sinus symptoms were further identified in January 2010, with a mild nasal obstruction noted in August 2010. Symptoms continued until September 2012 when a CT scan identified a deviated septum and nasal obstruction turbinate hypertrophy, ultimately leading to surgery. Based on the foregoing, the preponderance of the evidence is against a finding that current symptoms of a nasal or sinus condition were caused by or incurred in service. The July 2015 examiner’s opinion was based on a full review of the medical and lay evidence and was supported by adequate medical rationale explaining why the Veteran’s chronic rhinitis symptoms were part of his headache disorder rather than a separate pathology, and why nasal and sinus obstruction were recently-developed symptoms that were unrelated to service. That opinion is therefore probative. The Board notes that the Veteran, in his substantive appeal, asserted that his current problems relating to sinuses and rhinitis began in service. Although competent to attest to observable symptoms, he is not competent to state that the symptoms experienced in service were manifestations of stand-alone chronic disabilities. To the extent that he asserts he has had nasal symptoms continuously since service, the Board finds such assertions to be not credible, as he denied sinusitis upon separation from service, and did not report a history of nasal problems when he was assessed upon initiation of care with VA in 2007. Indeed, as noted above, his ENT examination at the time was normal. The Veteran has had ample opportunity to secure and submit a medical opinion in favor of his assertions, and against the reasoned medical opinion of the July 2015 VA examiner, but he has not done so. (Continued on Next Page) There is no other competent evidence to support the claim that current sinus and nasal symptoms were caused by or incurred in service. As the preponderance of the evidence is against this finding, the “benefit of the doubt” rule is not applicable and the Board must deny the claim. See 38. U.S.C. §5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Giaquinto, Associate Counsel