Citation Nr: 21002692 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 17-50 329A DATE: January 14, 2021 ORDER Entitlement to service connection for high cholesterol is denied. Entitlement to service connection for a bilateral eye disability, including as due to a disability manifested by high cholesterol, is denied. Entitlement to service connection for a lumbosacral spine disability is denied. Entitlement to an initial 10 percent rating for allergic rhinitis is granted. FINDINGS OF FACT 1. The record evidence shows that the Veteran has high cholesterol; this is considered a laboratory finding and not a disability for VA compensation purposes. 2. The record evidence shows that the Veteran’s current bilateral eye disability and lumbosacral spine disability are not related to active service. 3. The record evidence shows that the Veteran’s service-connected allergic rhinitis is manifested by, at worst, 90 percent obstruction of the bilateral nasal passages. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for high cholesterol have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304 (2019). 2. The criteria for entitlement to service connection for a bilateral eye disability, including as due to high cholesterol, have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304 (2019). 3. The criteria for entitlement to service connection for a lumbosacral spine disability have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304 (2019). 4. The criteria for an initial 10 percent rating for allergic rhinitis have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.97, Diagnostic Code (DC) 6522 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 1974 to December 1978 and from February 1982 to July 1997. A videoconference Office Board hearing was held in January 2020 before the undersigned Veterans Law Judge and a copy of the hearing transcript has been added to the record. Service Connection 1. Entitlement to service connection for high cholesterol The Board finds that the preponderance of the evidence is against granting the Veteran’s claim of service connection for high cholesterol. The Veteran essentially contends that he experiences high cholesterol which is related to active service. The record evidence does not support these assertions. It shows instead that, although the Veteran’s laboratory results indicate that he has high cholesterol, this is a laboratory finding, and is not considered a disability for VA adjudication purposes. The voluminous medical evidence, to include service treatment records and post-service VA and private outpatient treatment records, show that he has high cholesterol (also known as hyperlipidemia). He was placed on a diet and exercise program while on active service in January 1986 as a result of his ongoing history of high cholesterol. The Board notes in this regard that hyperlipidemia is “a general term for elevated concentrations of any or all of the lipids in the plasma, including hypertriglyceridemia, hypercholesterolemia, etc.” See DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 852 (29th ed. 2000). The Board next notes that hyperlipidemia or high cholesterol is a laboratory finding and is not a disability for which VA compensation is available. See 61 Fed. Reg. 20,440, 20,445 (May 7, 1996) (finding laboratory results of hyperlipidemia or high cholesterol not disabilities subject to VA rating schedule). The Court has held that term “disability” refers to impairment of earning capacity. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). The record evidence does not suggest that the Veteran’s high cholesterol causes any impairment of earning capacity. The Board acknowledges that, although high cholesterol may be evidence of underlying disability or subsequently may cause disability, service connection may not be granted for a laboratory finding of high cholesterol alone. A service connection claim must be accompanied by evidence which establishes that the claimant currently has a disability. Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is not warranted in the absence of proof of current disability. The Board has considered whether the Veteran experienced a disability as a result of his acknowledged high cholesterol at any time during the pendency of this appeal. Service connection may be granted if there is a disability at some point during the claim even if it later resolves or becomes asymptomatic. McClain v. Nicholson, 21 Vet. App. 319 (2007). There is no evidence – other than the Veteran’s unsupported lay assertions and Board hearing testimony – that he experiences current disability as a result of his high cholesterol which could be attributed to active service. The medical records reflect that there is no disability related to high cholesterol, and those records are more probative than the Veteran’s lay assertions. Thus, the Board finds that service connection for high cholesterol is not warranted. 2. Entitlement to service connection for a bilateral eye disability, including as due to high cholesterol The Board next finds that the preponderance of the evidence is against granting the Veteran’s claim of service connection for a bilateral eye disability, including as due to high cholesterol. The Veteran essentially contends that he incurred a bilateral eye disability during active service and experienced continuous post-service disability. He alternatively contends that his high cholesterol caused or aggravated (permanently worsened) his bilateral eye disability. The Board observes that, although the Veteran has a history of high cholesterol, this is a laboratory finding and is not a disability for which service connection is available (as discussed above). The voluminous record evidence also does not support the lay assertions and hearing testimony of an etiological link between the Veteran’s non-service-connected high cholesterol and any current bilateral eye disability. The Board observes that, in an August 2013 opinion, a VA clinician stated that the medical evidence “documented a small branch retinal artery occlusion which has since resolved without any residuals. There was no evidence of this on his current exam. High cholesterol is an associated risk factor for these types of occlusions.” The Veteran otherwise has not identified or submitted any evidence demonstrating an etiological link between a bilateral eye disability and high cholesterol. In summary, the Board finds that service connection for a bilateral eye disability as due to high cholesterol is not warranted. The Veteran also is not entitled to service connection for a bilateral eye disability on a direct service connection basis. See 38 C.F.R. §§ 3.303, 3.304. Contrary to his lay assertions and hearing testimony, the record evidence shows that his current bilateral eye disability (diagnosed as a benign choroidal nevus and bilateral cataracts) is not related to active service. The voluminous service treatment records show that, at a pre-enlistment physical examination in March 1974, prior to his entry on to active service in May 1974, clinical evaluation was within normal limits, his bilateral vision was 20/20, and he denied any relevant pre-service medical history. The Veteran’s medical history and clinical evaluation were unchanged at his separation physical examination in November 1978, prior to his first separation from service in December 1978. At his second enlistment physical examination in January 1982, prior to his re-entry on to active service in February 1982, clinical evaluation was within normal limits and his bilateral vision was 20/20. The Veteran reported a pre-service medical history of an eye injury in 1980 although the clinical significance of this report is unclear because the in-service examiner did not discuss it in reviewing the medical history. Subsequent periodic physical examinations in January 1986 and in February 1991 showed no relevant changes. On outpatient treatment in May 1992, the Veteran’s complaints included blurred vision. Physical examination showed pupils equal, round, and reactive to light and accommodation, full extraocular movements, 20/20 vision in the right eye and 20/25 vision in the left eye. The diagnosis was suspect serous macular elevation in the left eye. In March 1993, the Veteran’s complaints included blurry, heavy, and tired eyes. He reported a history of retinal detachment in April 1992 with a loss of vision which came back subsequently. His bilateral visual acuity was 20/20. The assessment was possibly latent hyperopia. The Veteran’s voluminous post-service VA and private outpatient treatment records show ongoing complaints of and treatment for a variety of bilateral eye disabilities. This evidence does not show that a bilateral eye disability is related to active service, however. For example, on outpatient treatment in April 2000, his complaints included blurry vision in the left eye and “aching” eye pain in both eyes. He denied any history of trauma or decreased visual acuity. His visual acuity was 20/20 in the right eye and 20/30 in the left eye. Physical examination showed pupils equal, round, and reactive to light and accommodation, intact extraocular movements, and mildly injected conjunctiva. The diagnosis was blurry vision in the left eye. On VA eye conditions Disability Benefits Questionnaire (DBQ) in May 2013, the Veteran’s complaints included “a fluttering in his vision at times.” The VA examiner reviewed the Veteran’s electronic claims file, including his service treatment records and post-service VA treatment records. The Veteran’s uncorrected distance vision was 20/40 corrected to 20/40 or better in both eyes. His uncorrected near vision was 20/100 corrected to 20/40 or better in both eyes. Physical examination showed pupils equal, round, and reactive to light and accommodation, no afferent pupillary defect, inferior nevus and inferonasal mild scarring along vessel in the right eye, preoperative bilateral cataracts, and a benign neoplasm. The VA examiner stated that the Veteran had a history of central serous retinopathy in the left eye which “has resolved and not resulted in any decrease in vision.” This examiner next stated that the Veteran had a benign choroidal nevus in the left which was not related to his prior central serous retinopathy and a “mildly constricted” visual field in the right eye “which is unrelated to any diagnosis.” The diagnoses were central serous retinopathy, cataract, and choroidal nevus. In a September 2013 addendum opinion to the August 2013 VA eye conditions DBQ, the VA examiner opined that it was less likely than not that any of the Veteran’s bilateral eye disabilities were related to active service. The rationale for this opinion was based on a review of the claims file. The rationale also was that the Veteran’s previous central serous retinopathy had resolved without any current residuals. The rationale further was that the Veteran’s cataracts “are normal aging changes…[and] were not present during his service.” Contrary to the Veteran’s lay assertions and hearing testimony, the record evidence shows that his current bilateral eye disability (diagnosed as central serous retinopathy, cataract, and choroidal nevus) is not related to active service. The August 2013 VA eye conditions DBQ examiner specifically opined in a September 2013 addendum opinion that the Veteran’s bilateral eye disability is not related to active service. This opinion was fully supported. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that a medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). The Veteran otherwise has not identified or submitted any evidence demonstrating his entitlement to service connection for a bilateral eye disability. In summary, the Board finds that service connection for a bilateral eye disability is not warranted. 3. Entitlement to service connection for a lumbosacral spine disability The Board next finds that the preponderance of the evidence is against granting the Veteran’s claim of service connection for a lumbosacral spine disability. The Veteran essentially contends that he incurred a lumbosacral spine disability during active service. Contrary to his lay assertions and Board hearing testimony, the record evidence does not support finding an etiological link between a current lumbosacral spine disability and active service. The available service treatment records show that, on outpatient treatment in October 1974, the Veteran’s complaints included low back pain. He denied any injury or urinary problems. The in-service clinician stated that the Veteran “seems to be uncomfortable.” The diagnosis was possible back muscle strain. In December 1977, the Veteran’s complaints included low back pain “after lifting 2 small boxes.” He also complained of difficulty breathing and maneuvering his neck. Objective examination showed no palpable tenderness over the spine but he moved with guarding. The diagnosis was acute thoraco-lumbar strain. The post-service evidence also does not support granting service connection for a lumbosacral spine disability. It shows instead that, although the Veteran has complained of and sought treatment for a lumbosacral spine disability since his service separation, it is not related to active service or any incident of service. The Veteran’s voluminous post-service VA and private outpatient treatment records show ongoing complaints of and treatment for a lumbosacral spine disability. This evidence also shows that he had spinal fusion surgery in approximately September 2012. On VA back (thoracolumbar spine) conditions DBQ in May 2013, the Veteran’s complaints included constant low back pain which waxed and waned. A history of low back pain since active service was reported. The VA examiner reviewed the Veteran’s electronic claims file, including his service treatment records and post-service VA treatment records. The Veteran experienced flare-ups of low back pain which caused him to miss 5 days of work in the previous 6 months. Physical examination showed pain on movement, less movement than normal, no guarding or muscle spasm, 5/5 muscle strength, no muscle atrophy, normal reflexes and sensation, negative straight leg raising bilaterally, mild constant pain of the right lower extremity, and moderate constant pain of the left lower extremity. X-rays showed no arthritis. An magnetic resonance imaging (MRI) scan dated in February 2013 showed status-post fusion L5-S1. The VA examiner concluded, “The Veteran has lower back pain with degenerative disc disease [status-post] discectomy and fusion.” This examiner noted that the Veteran had been seen while on active service for upper mid back pain diagnosed as muscle spasms which resolved. This examiner opined that it was less likely than not that the Veteran’s current lumbosacral spine disability is related to active service. The rationale for this opinion was that the Veteran’s current low back pain was in a different area of the spine than his in-service muscle spasms and “was reported as being due to different causes.” The rationale also was that there had been no progression of the Veteran’s in-service low back pain since it was treated and resolved. The diagnosis was lumbar radiculopathy. In an August 2013 addendum opinion to the May 2013 VA back DBQ, the VA examiner stated that he had reviewed additional service treatment records for the Veteran. This examiner concluded that the additional records reviewed showed complaints “not in the lower back (current complaint) and would not be evidence of a chronic back disability or continuation of a disability. No changes need to be made to the previous medical opinion.” In a December 2013 letter, S. E. R., M.D., opined that, after reviewing certain of the Veteran’s service treatment records and his reported medical history, it was at least as likely as not that the current lumbar radiculopathy “is the continuation/residual result of the complaints of lower back pain noted in his service records.” Contrary to the Veteran’s lay assertions and Board hearing testimony, the record evidence shows that his current lumbosacral spine disability is not related to active service. The Board acknowledges here that the Veteran complained of and sought treatment for possible back muscle strain and acute thoraco-lumbar strain during active service. As the VA examiner stated in May 2013, the Veteran’s in-service complaints pertained to a different area of the spine than his current post-service complaints and appeared to be have treated successfully and resolved during service. More importantly, this examiner opined that it was less likely than not that the Veteran’s current lumbosacral spine disability is related to active service. This opinion was fully supported. See Stefl, 21 Vet. App. at 124. The Veteran relies heavily on the December 2013 letter from Dr. S. E. R. as support for his assertion that the current lumbosacral spine disability is related to active service. The Court has held that the Board is free to assess medical evidence and is not compelled to accept a physician's opinion. Wilson v. Derwinski, 2 Vet. App. 614 (1992). A medical opinion based upon an inaccurate factual premise is not probative. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). A bare conclusion, even one reached by a medical professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). A bare transcription of lay history, unenhanced by additional comment by the transcriber, does not become competent medical evidence merely because the transcriber is a medical professional. LeShore v. Brown, 8 Vet. App. 406, 409 (1995). The Court also has held that the value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion." Bloom v. West, 12 Vet. App. 185, 187 (1999). Thus, a medical opinion is inadequate when it is unsupported by clinical evidence. Black v. Brown, 5 Vet. App. 177, 180 (1995). It appears that the opinion from Dr. S. E. R. is based almost entirely on what the Veteran reported to him concerning his medical history although this physician did not disclose what, in fact, the Veteran reported to him. This physician also did not address the fact that the Veteran’s in-service complaints related to a different area of the spine than his post-service complaints (as the VA examiner noted in his May 2013 opinion). This persuasively suggests that the opinion from Dr. S. E. R. is based on an inaccurate factual premise (i.e., that the in-service and post-service complaints pertain to the same area of the spine). Having reviewed the December 2013 opinion from Dr. S. E. R., the Board finds that it is not probative on the issue of whether the current lumbosacral spine disability is related to active service. The Veteran otherwise has not identified or submitted any evidence demonstrating his entitlement to service connection for a lumbosacral spine disability. In summary, the Board finds that service connection for a lumbosacral spine disability is not warranted. 4. Entitlement to an initial compensable rating for allergic rhinitis The Board finds that the evidence supports assigning an initial 10 percent for the Veteran’s service-connected allergic rhinitis. Consistent with his lay assertions and hearing testimony, the record evidence shows that this disability is manifested by, at worst, greater than 50 percent obstruction of the nasal passage on both sides (i.e., a 10% rating under DC 6522). See 38 C.F.R. § 4.97, DC 6522 (2019). The Veteran’s voluminous post-service VA and private outpatient treatment records show ongoing complaints of and treatment for allergic rhinitis. For example, on private outpatient treatment in November 2013, the Veteran’s complaints include chronic sinus infections and difficulty breathing through his nose. His “lifelong history of difficulty breathing through his nose and chronic sinus infections” had been treated with “multiple rounds of antibiotics, multiple nose sprays, and multiple decongestants.” He rated his pain from allergic rhinitis as 6/10 on a pain scale (with 10/10 being the worst imaginable pain). “He has some difficulty with smell and nasal stuffiness. He says he has trouble breathing out of both sides of his nose.” Nasal endoscopy showed severe bidirectional septal deviation with 90 percent obstruction of both nasal passages, moderate turbinate hypertrophy, and significant mucosal inflammation in the “remainder of the nose.” A computerized tomography (CT) scan showed septal deviation and chronic mucosal inflammatory disease in all paranasal sinuses. The diagnoses included chronic sinusitis and nasal septal deviation with 90 percent obstruction bilaterally. On VA sinusitis DBQ in August 2017, the Veteran’s complaints included daily sneezing, watery eyes, and a runny nose. The VA examiner reviewed the Veteran’s electronic claims file, including his service treatment records and post-service VA treatment records. The Veteran used a daily nasal spray and intermittently used Allegra to treat his symptoms. Physical examination showed traumatic deviated nasal septum with at least 50 percent obstruction of the nasal passage on both sides. A CT scan showed septal deviation and chronic mucosal inflammatory disease in all paranasal sinuses. Nasal endoscopy showed severe bidirectional septal deviation with 90 percent obstruction bilaterally, moderate turbinate hypertrophy, and “the remainder of the nose show[s] significant mucosal inflammation.” The diagnoses included allergic rhinitis. The Veteran essentially contends that his service-connected allergic rhinitis is more disabling than currently (and initially) evaluated. Consistent with these assertions, the record evidence shows that this disability is manifested by greater than 50 percent obstruction of nasal passage on both sides (i.e., a 10 percent rating under DC 6522). This consistent physical examination finding following private nasal endoscopy in November 2013 and VA nasal endoscopy in August 2017 support the assignment of an initial 10 percent rating for the Veteran’s service-connected allergic rhinitis throughout the appeal period. See 38 C.F.R. § 4.97, DC 6522 (2019). There is no indication, however, that the Veteran experiences nasal polyps as is required for an initial rating greater than 10 percent for his service-connected allergic rhinitis. Id. In summary, and after resolving any reasonable doubt in the Veteran’s favor, the Board finds that the criteria for an initial 10 percent rating for allergic rhinitis have been met. See also 38 C.F.R. § 3.102 (2019). R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael T. Osborne, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.