Citation Nr: 19124303 Decision Date: 04/01/19 Archive Date: 04/01/19 DOCKET NO. 12-34 466 DATE: April 1, 2019 ORDER Entitlement to service connection for residuals of a fractured nose is granted. FINDING OF FACT Residuals of a fractured nose were incurred in active service. CONCLUSION OF LAW The criteria for service connection for residuals of a fractured nose have been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 5103, 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service with the U.S. Air Force from August 1966 to May 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2009 rating decision from the Department of Veterans Affairs (VA) Regional Office in Cleveland, Ohio (RO). In November 2016, the Veteran testified before the undersigned Veterans Law Judge in a videoconference hearing. A copy of the hearing transcript has been associated with the record. The appeal was previously before the Board and was remanded in August 2017 for additional development and a VA examination. The Board finds that the RO ordered the requested record development and the Veteran was afforded a VA examination in November 2018, which substantially complied with remand directives. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998), where the Board’s remand instructions were substantially complied with), aff’d, Dyment v. Principi, 287 F.3d 1377 (Fed. Cir. 2002). The appeal is now back before the Board for further appellate proceedings. Neither the Veteran nor his representative have raised any issues with the duty to notify or duty to assist. See Scott v McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument).. Entitlement to service connection for residuals of a nose fracture Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303 (2017). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (2017). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). In rendering a decision on appeal, the Board must analyze the credibility and probative value of all medical and lay evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. 38 U.S.C. § 1154 (a) (2012); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). The standard of proof to be applied in decisions on claims for veterans’ benefits is set forth in 38 U.S.C. § 5107. A veteran is entitled to the benefit of the doubt when there is an approximate balance of evidence for and against the claim. See 38 C.F.R. § 3.102 (2017). When a veteran seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert, 1 Vet. App. 49. The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). The Veteran, within a July 2011 notice of disagreement, contends that he currently is experiencing residuals of a broken nose, to include sinus problems, related to a motor vehicle accident in July 1969 while in service. He reports that after spending a month for treatment in a civilian hospital, he returned to service and experienced breathing difficulties. The Veteran indicated that in May 1970, six months after discharge, he saw a private physician who diagnosed him with a broken nose, and performed corrective surgery on his nose in June 1970. Military personnel records show that the Veteran was admitted under duty to a civilian hospital in July 1969. Service treatment records include a July 1969 note which shows the Veteran had been admitted to a civilian hospital for medical services. A May 1970 separation examination shows a normal nose clinical evaluation, but does show abnormal head, face, neck and scalp as showing small surgical scars. The separation physician noted the Veteran’s July 1969 auto accident in which the Veteran was hospitalized for six days with full recovery, no complication and no sequelae. On the report of medical history at separation, the Veteran denoted ear, nose or throat trouble. An August 1969 letter from the Veteran’s treating Air Force physician while in-service, shows the Veteran had been under the physician’s care since July 1969 following an automobile accident. The Veteran, following the accident, was treated for multiple lacerations of the scalp, face, and right knee; multiple, deep third-degree abrasions of shoulders, back, hands, and arms; and partial amputation of the right ear. Repair of lacerations of face, right knee, and right ear; and derm abrasion debridement of gravel of the skin were performed. The Veteran was discharged from the hospital six days later. The Air Force physician reported seeing the Veteran on several occasions following his discharge from the hospital, at the end of July 1969, in which the wounds appeared to be well healed and he was released from his care to return to base in August 1969. An October 2018 buddy statement from the Veteran’s Air Force roommate shows that in July 1969, he remembered that the Veteran had sustained a broken nose and a concussion from an auto accident, and was placed on light duty for a while afterwards. A November 2018 VA examination shows that the Veteran reported a history of a deviated nasal septum in 1971 while in service. The Veteran stated that he was involved in a motor vehicle accident in 1969, in which he was diagnosed with a concussion, laceration of the right ear, and abrasions on the right jaw. After the accident, the Veteran reported that he self-treated on-going nose bleeds and nasal congestion until six months after separation, when he sought treatment from an ENT specialist, and was told he had a broken nose. The Veteran had gone under surgical repair of his broken nose, and reported that ever since, he has had intermittent difficulty with breathing through the left side of his nose. During examination of the Veteran, the VA examiner noted a traumatic deviated septum, with other nose, throat, larynx or pharynx conditions. The VA examiner did not have any other pertinent findings, or any scars related to the conditions listed. X-rays of the nasal bones showed no fracture, dislocation with clear sinus and normal bone density. The report showed a normal nasal bone x-ray. The VA examiner, based on examination and interview with the Veteran, and review of the Veteran’s claims file, opined that a nose disability was less likely than not related to active service, to include the documented July 1969 motor vehicle accident. The VA examiner reasoned that the reported history of traumatic nasal fracture/deviated septum due to the in-service motor vehicle accident was resolved in surgery in 1971 without current evidence of residuals by examination or review of medical records, to include sinus and breathing problems. A December 2018 private medical record shows the Veteran complained of nose issues, to include trouble breathing through his nose, to see if the physician could “verify that he broke his nose in the past for VA.” The private physician, on physical evaluation of the nose, noted osteotomies, a fairly straight septum, and that modified cottle maneuvers revealed significant improvement bilaterally. The private physician noted a history of fracture of the nasal bone, nasal valve collapse and deviated septum, and opined that the nasal obstruction was secondary to nasal valve collapse most likely due to the history of prior trauma and nasal surgery in 1971. Upon review of the lay and medical evidence of record, the Board finds that the evidence is evenly balanced as to whether the Veteran has residuals of a fractured nose which was incurred in service. Both examiners appear to concede that the Veteran had in-service MVA and sustained numerous residuals. A November 2017 VA medical opinion shows that based on examination, the Veteran did not have any residual disability. Conversely, a December 2018 opinion indicates that the Veteran did indeed have residual nasal obstruction which was secondary to a prior traumatic fracture. (Continued on the next page)   Accordingly, service connection is granted. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. R. Woodarek, Associate Counsel