Citation Nr: 18157363 Decision Date: 12/13/18 Archive Date: 12/12/18 DOCKET NO. 16-52 969 DATE: December 13, 2018 ORDER Entitlement to service connection for rhinitis is granted. FINDING OF FACT Resolving all reasonable doubt in favor of the Veteran, allergic rhinitis was aggravated during active service. CONCLUSION OF LAW Resolving all reasonable doubt in favor of the Veteran, the criteria for service connection for allergic rhinitis have been met. 38 U.S.C. §§ 1110, 5107 (2017); 38 C.F.R. §§ 3.102, 3.303 (2016). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1995 to February 2009. This appeal comes before the Board of Veterans’ Appeals (Board) from a September 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), in Waco, Texas. In May 2018, the Veteran appeared at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. SERVICE CONNECTION The Board notes that it has reviewed all the evidence in the record. Although the Board has an obligation to provide adequate reasons and bases supporting its decision, there is no requirement that the Board discuss every piece of evidence in the record. The Board will summarize the relevant evidence, as deemed appropriate, and the Board's analysis will focus on what the evidence shows, or fails to show, as to the claim. See Gonzalez v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). When determining service connection, a presumption of soundness ordinarily applies. 38 C.F.R. § 3.304(b). Pursuant to such presumption, a Veteran will be considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by such service. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Horn v. Shinseki, 25 Vet. App. 231, 234 (2012). Aggravation may not be conceded where the disability underwent no increase in severity during service on the basis of all the evidence of record pertaining to the manifestations of the disability prior to, during, and subsequent to service. See 38 U.S.C. § 1153; 38 C.F.R. §§ 3.304, 3.306(b). A pre-existing disease or injury is considered to have been aggravated by service only if the evidence shows that the underlying disability underwent an increase in severity; the occurrence of symptoms, in the absence of an increase in the underlying severity, does not constitute aggravation of the disability. See Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002); 38 C.F.R. § 3.306 (a). Furthermore, temporary or intermittent flare-ups of a pre-existing condition during service are not sufficient to be considered aggravation of the condition, unless the underlying condition, as contrasted to symptoms, worsens. See Jensen v. Brown, 4 Vet. App. 304, 306-07 (1993); Hunt v. Derwinski, 1 Vet. App. 292 (1991). In evaluating a claim, the Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a); Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis if (1) the medical issue is within the competence of a layperson, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Kahana v. Shinseki, 24 Vet. App. 428, 433 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). If the evidence is competent, the Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, the Board may properly consider internal inconsistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995). A Veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. See Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (2009); see also Walker v. Shinseki, 708 F.3d 1331, 1334 (Fed. Cir. 2013). In making its ultimate determination, the Board must give a veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. See Fagan, 573 F.3d at 1287 (quoting 38 U.S.C. § 5107(b)). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 1. Entitlement to service connection for rhinitis The Veteran contends that he incurred allergic rhinitis in active service and service connection is warranted, in the alternative, he contends that the condition pre-existed service and has been worsened due to his in-service exposure to environmental hazards. The Board finds that the competent and credible evidence is in equipoise as to whether the Veteran’s allergic rhinitis was aggravated beyond the normal progression of the disease during service. Review of the record shows upon enlistment examination in January 1999, the Veteran reported “yes” when asked if he had sinusitis or hay fever. Examination of the nose and sinuses was normal. The entrance physical notes that the Veteran reported taking sinus tabs and had a history of non-incapacitating hay fever. The Veteran’s service treatment records show that the Veteran sought medical treatment for allergic rhinitis in September 1998 and May 2002. It was noted that the Veteran had allergic rhinitis. The assessment was allergic rhinitis and upper respiratory infection with reactive airways disease. On both occasions, he was prescribed medication. A May 2008 service treatment record indicates that the Veteran had increased allergy complaints since returning from Iraq. In his May 2018 Board testimony, the Veteran testified that he had hay fever prior to entering military service. The Veteran further testified that he treated the condition with sudafed, an over-the-counter medication. He also stated that his symptoms had increased in severity after his deployment to Southeast Asia. There is competent and credible evidence of a diagnosis of allergic rhinitis while in service and soon after service separation. In a June 2016 VA examination, the examiner diagnosed the Veteran with chronic sinusitis and allergic rhinitis. The examiner opined that these conditions were more likely than not related to the Veteran’s military service. The examiner also noted that the Veteran had chronic occupational exposure to chemical irritants which caused the conditions, and that the Veteran’s symptoms progressed from “acute onset nasal sinus, frontal sinus and bilateral irritation of the conjunctiva” to “current chronic sinusitis, allergic rhinitis, and sinus-associated pressure headaches.” The Board finds that the competent and credible evidence is in equipoise as to whether the Veteran's allergic rhinitis was aggravated by service. The Board finds the service treatment records and the post service treatment records demonstrate in-service symptoms and recurrent symptoms since service separation, including a report of increased allergy complaints when returning from Iraq. There is treatment for allergic rhinitis while in service and following service separation. There is evidence that weighs against the claim for service connection. The July 2014 VA examination report indicates that the VA examiner opined that the Veteran had allergic rhinitis that had not been aggravated beyond the normal progression of the disease. The examiner opined that the Veteran's allergic rhinitis is less likely as not caused by or a result of active duty. However, the examiner did not address evidence of increased treatment with medication or the issue of exposure to environmental hazards. Based on a careful review of the entire record, the Board finds that the evidence is in equipoise as to whether the current allergic rhinitis was aggravated by service. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). In resolving all reasonable doubt in the Veteran's favor, service connection for allergic rhinitis is granted. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Michael J. O'Connor