Citation Nr: 21062988 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 14-19 276 DATE: October 12, 2021 ORDER Entitlement to service connection for sinusitis is denied. FINDING OF FACT At no time during the pendency of the claim has the Veteran been diagnosed with sinusitis. CONCLUSION OF LAW The criteria for service connection for sinusitis have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1988 to August 1995. In August 2018, the Veteran testified at a video conference hearing (hearing) before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. This matter was previously remanded by the Board of Veterans' Appeals (Board) in March 2019 and most recently in April 2021 for additional development. It now returns for further appellate review. During remand, the Regional Office (RO) granted service connection for gastroesophageal reflux disease (GERD) in a July 2021 rating decision. Thus, the service connection claim for GERD is no longer before the Board because a grant of service connection constitutes a full grant of benefits on appeal. Grantham v. Brown, 111 F.3d 1156 (Fed. Cir. 1997). Service Connection The Veteran contends that he has sinusitis, which was incurred in or caused by service. See August 2018 Board Hearing Transcript. Specifically, the Veteran testified that he was treated for sinusitis during active duty and was currently receiving treatment for sinusitis. Id. Legal Criteria Service connection may be granted for any current disability that is the result of a disease contracted or an injury sustained in the line of duty during active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for a disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). Relevant Facts and Analysis The March 2011 VA examiner concluded that the Veteran did not have a diagnosis of sinusitis based on a negative X-ray report taken in connection with the VA examination. See March 2011 VA Compensation and Pension (C&P) Examination Report for Nose, Sinus, Larynx, and Pharynx. Notably, the X-ray reported showed sinus were well aerated and normally developed. Id. The examiner diagnosed the Veteran with allergic rhinitis. Similarly, while the Veteran reported sinus issues during October 2014 VA examination, the examiner diagnosed him with allergic rhinitis. See October 2014 VA Sinusitis, Rhinitis, and Other Conditions Disability Benefits Questionnaire (DBQ). The Board found that this examination was inadequate because it failed to address whether the Veteran had a diagnosis of sinusitis. See March 2019 Board Remand. The Veteran was also provided a VA examination in April 2016. See April 2016 Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx and Pharynx DBQ. The examiner diagnosed the Veteran with allergic rhinitis and sinusitis. Id. The Veteran reported that he experienced constant post nasal drip, as well as "sore throats, headaches, swelling of his sinus cavities, [and] exacerbations that require steroids to open his passages back up." Id. The examiner also found the Veteran had symptoms consistent with sinusitis. In her remarks, the examiner stated the Veteran's allergic rhinitis had progressed and stated, "evidence of sinusitis present." However, the examiner did not provide a nexus opinion regarding the etiology of his sinusitis, as such the opinion was deemed inadequate. See March 2019 Board Remand. The Veteran also provided a letter from his private physician Dr. L.L. in October 2018. See September 2018 Letter from Dr. L.L. She noted that the Veteran has a history of recurrent sinusitis as well as a "history of sinusitis during his military career." However, this opinion does not specifically address whether the Veteran has a current diagnosis of sinusitis. As noted above, the Board remanded the claim in March 2019 to clarify whether the Veteran had a current diagnosis of sinusitis. Accordingly, a VA examination was conducted in January 2020. The January 2020 VA examiner opined that the Veteran did not have a diagnosis of chronic sinusitis. See January 2020 Sinusitis, Rhinitis, and Other Conditions Disability Benefits Questionnaire (DBQ). Instead, the examiner found that the Veteran had acute rhinosinusitis (ARS) based on a review of the record. Id. However, the examiner did not specifically address the prior diagnosis of sinusitis in the claims file and her basis for disagreeing with the prior findings. See April 2016 VA Sinusitis /Rhinitis and Other Conditions DBQ (diagnosed Veteran with sinusitis); see also September 2018 Letter from Dr. L.S.L. (confirming Veteran has history of recurrent sinusitis). The Board remanded the claim again in April 2021 to obtain additional clarification on whether the Veteran had a diagnosis of sinusitis, and to determine the etiology of the Veteran's ARS. Consequently, VA obtained a medical opinion in July 2021. See July 2021 VA Medical Opinion DBQ. The examiner noted that he reviewed the medical articles submitted by the Veteran in addition to the relevant medical evidence of record including prior VA examinations. Id. The examiner sated that the Veteran "has a current diagnosis of allergic rhinitis. The Veteran does not have sinusitis and/or acute rhinosinusitis (ARS)." Id. He explained that the ARS "is defined as symptomatic inflammation of the nasal cavity and paranasal sinuses lasting less than four weeks." The examiner further explained the Veteran's history of respiratory conditions as follows: The veteran does not have a current diagnosis of sinusitis. The January 2020 VA examiner stated that the veteran had a diagnosis of allergic rhinitis, with the claims file showing episodes of acute rhinosinusitis several times a year. The September 2018 letter from Dr. L.S.L. stated that the veteran has a history of recurrent sinusitis, as well as a history of sinusitis during his military career. The difficulty in this case involves the meaning of the terms that are being used by different examiners. This Veteran has been diagnosed by all examiners as having allergic rhinitis. This diagnosis was included in the 2016 DBQ, and other DBQ's, the September 2018 letter from Dr. L.S.L., and the current DBQ from July 6, 2021. Sinusitis is generally considered by most medical practitioners to be an infection of the sinus tissue. The term -itis can also mean inflammation. Inflammation of the nasal mucosa (rhinitis) and inflammation of the sinus tissue often occurs together and at the same time since they are contiguous tissue. Because of the proximity of these two tissue areas, and the overlap of symptoms caused by inflammation in these two contiguous areas, medical examines often refer to sinus and rhinitis problems with the same terms.... The terms sinus infections, sinusitis, and acute rhinosinusitis, also has its distinct problems. This Veteran, by my history, has episodes of acute sinusitis at 2 to 3 times a year. According to the definition I gave earlier, in order to be diagnosed with recurrent acute rhinosinusitis, one must have four or more episodes of acute rhinosinusitis per year. Thus, in this veteran, he could not be diagnosed with acute, recurrent acute, subacute, or chronic rhinosinusitis, at this time. This result ensures despite the fact that this veteran has 2 to 3 episodes of acute rhinosinusitis a year. July 2021 VA Medical Opinion DBQ. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have a current diagnosis of sinusitis and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Review of the Veteran's post-service treatment records reflects no treatment or diagnosis of sinusitis. Additionally, the VA examiners did not definitively diagnose the Veteran with sinusitis. The Board remanded the claim twice in order to obtain clarification on whether the Veteran had a diagnosis of sinusitis during the pendency of the claim. Importantly, the July 2021 VA examiner expressly found that the Veteran did not have sinusitis and/or ARS. See July 2021 VA Medical Opinion DBQ. Instead, the Veteran is diagnosed with allergic rhinitis; as noted above, importantly, this has been separately service connected. Additionally, the Board notes that imaging studies, specific diagnostic testing and review of the Veteran's medical records was conducted by the March 2011 VA examiner. The examiner further cited a March 2011 X-ray which was negative for sinusitis. It was specifically noted that there are no findings, signs, or symptoms to support a sinusitis diagnosis. See March 2011 C&P Examination Report for Nose, Sinus, Larynx, and Pharynx The July 2021 VA examiner evaluated the Veteran and determined that, while he experiences acute sinusitis at 2 to 3 times a year, he does not have a diagnosis of sinusitis or ARS. Rather, the VA examiner identified his symptoms as indicative of allergic rhinitis. The Board affords great probative weight to the July 2021 VA medical opinion as it was based on an examination as thorough review of the medical evidence. Additionally, the opinion considered an accurate history, was definitive and was supported by a detailed rationale that considered the lay and medical evidence. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Notably, the Veteran has been service connected for allergic rhinitis during the pendency of this appeal, and he is in receipt of compensation for his claimed symptoms. While the Veteran believes he has a current diagnosis of sinusitis, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires medical education and knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). In fact, in order for a physician to even make an assessment of this disability, the physician utilized an x-ray for diagnosis. Consequently, the Board gives more probative weight to the competent medical evidence. Thus, based on the foregoing the Board finds that the preponderance of the evidence shows a lack of a current diagnosis, the cornerstone element of service connection has not been met. Accordingly, service connection for sinusitis cannot be established on any basis. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (holding that a current diagnosis is the cornerstone of a claim for service connection). The Board is grateful to the Veteran for his service, and regrets that it cannot render a favorable decision in this matter. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for sinusitis is not warranted. 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Lilly, 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.