Citation Nr: 21063790 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 17-50 287A DATE: October 15, 2021 ORDER Entitlement to service connection for a sinus condition is denied. Entitlement to service connection for headaches to include as secondary to a sinus disability is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a sinus condition began during active service or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that a headache condition began during active service or is otherwise related to an in-service injury or disease, or that it was secondary to (caused or aggravated by) a service-connected sinus disability. CONCLUSIONS OF LAW 1. The criteria for service connection for a sinus condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for headache due to service or secondary to a service-connected sinus disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1978 to September 1982. This appeal comes to the Board of Veterans' Appeals (Board) from the September 2014 and August 2017 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, the Board remanded the issues on appeal for additional development. The Board finds that the Regional Office (RO) substantially complied with the Board's remand instructions and an additional remand to comply with the Board's directives is not required. See Stegall v. West, 11 Vet. App. 268 (1998). Neither the Veteran nor his representative has raised any issues with regard to the duty to notify or duty to assist as they pertain to the issues considered in this decision. 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 a duty to assist argument). The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issues decided herein. The Veteran should not assume that evidence that is not explicitly discussed herein has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). Service Connection 1. Entitlement to service connection for a sinus condition The Veteran contends that his sinus condition is a continuation of the documented sinus condition for which he was treated during his active-duty military service. See Veteran's October 2017 substantive appeal form. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). 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. Although the Veteran has had sinus complaints, the preponderance of the probative evidence is against finding that these complaints are etiologically related to any in-service treatment including the dental record showing acute/transient sinus exposure to the buccal, treated successfully, without sequalae or residuals, or to any other in-service event, injury, or disease. The Board has considered the Veteran's assertion that his sinus condition is etiologically related to his active service. Although the Veteran is competent to report his current symptoms, see Layno v. Brown, 6 Vet. App. 465, 469 (1994), he is not considered competent to render an opinion as to the likely etiology of his sinus condition, as doing so requires specialized medical knowledge and expertise he has not been shown to possess. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Therefore, the Board instead turns to the competent medical evidence of record to determine whether such an etiological connection exists. The Veteran's service treatment records (STR's) do not document any complaints, treatment, or diagnosis of any sinus condition, beyond the single dental record. The Board notes that the January 2020 VA examiner indicated that the condition (is not the same as sinusitis), and there were no subsequent complaints, treatments, or diagnosis of any ENT conditions, including allergic rhinitis, sinusitis, headaches and/or sequalae. The Veteran's immediate post-service VA treatment records from 1982 to 2016 are silent for sinus conditions and/or residuals. However, the Veteran's treatment records from the Department of Corrections indicated that in October 2010 the Veteran had his left sinus clogged and had difficulty breathing. The Veteran reported a history of dust bothering him. In March 2013, the Veteran complained he had a sinus condition including, sneezing, runny nose, sinus pain and itchy eyes. In May 2013, the Veteran complained of having nasal congestion, cough, runny nose, sinus pain, and sneezing. In a June 2013 treatment note, there is a notation of unresolved sinusitis. In February 2017, the Veteran had an isolated/single episode of acute and transient sinusitis, that was resolved. In July 2017, the Veteran requested more sinus medication. In November 2018, the Veteran complained of headaches and sinus pressure. He had bilateral frontal sinus tenderness to palpation. In July 2018, the Veteran reported sinus headaches but denied sinus infections. In August 2019, the Veteran denied sinus infections and sinus headaches. In January 2020, the Veteran was afforded a VA examination for his sinus condition. The examiner indicated that the Veteran has never been diagnosed with a sinus, nose, throat, larynx, or pharynx condition. The examiner explained that the Veteran's medical history was vague and tangential. Specifically, the Veteran reported, My STR's show that in 1982 my dental record shows that they pulled my right upper tooth and a piece of my sinus was cut and since then I have had the sinus problem. The STR Dentist gave me some antibiotics and some instructions of what not to do. The Veteran reported that in the early 1990's he thinks he was diagnosed with allergic rhinitis and he was later treated for sinusitis. The examiner noted that there are no supporting VA medical records from the physician that treated the Veteran, that showed that the Veteran had sinusitis. The examiner noted that the Veteran's doctor diagnosed the Veteran with allergic rhinitis. The examiner also noted that while the Veteran may have been treated for sinus and allergy issues, he was not treated for sinusitis while in the correctional facility. The Veteran also reported that he received treatment from Dr. M. for the past two years and was diagnosed with a sinus condition and migraine headaches about a year ago. He stated that he received an injection for the migraine headache and antibiotics for the sinuses. The January 2020 VA examiner noted that the Veteran has never been referred to an ENT for sinusitis. The Veteran denied having any sinus surgeries or procedures. He denied seeing an allergy specialist. He reported having allergy and sinus episodes once a year (typically in the summer), typically when he is around grassy areas or where there is pollen. The January 2020 VA examiner checked the box that the Veteran has sinusitis and rhinitis. However, when asked to describe the "sinuses/type of sinusitis currently affected by the Veteran's chronic sinusitis," the examiner indicated "none." The examiner noted that the Veteran does not have any findings, signs or symptoms attributable to chronic sinusitis. The Veteran has not had any procedures or surgeries for a sinus related condition. In January 2020, the Veteran's x-rays showed no significant paranasal sinus disease. The January 2020 VA examiner opined that the Veteran's allergic rhinitis (claimed as sinus condition) is intermittent and has no functional limitation. The allergic rhinitis was not incurred in or caused by the Veteran's military service, including the documented sinus condition noted in the Veteran's service treatment records. As to the rationale, the examiner explained that the Veteran's STR's are silent for allergic rhinitis and or residuals. The Veteran was not diagnosed with allergic rhinitis until over 30 years after separating from service. The examiner explained that allergic rhinitis affects 20 percent of the population, and that there are geographical and seasonal variations. The examiner also explained that there is no clinical correlation between the "acute/transient sinus exposure to the buccal condition" noted in the Veteran's dental treatment records, and allergic rhinitis. The examiner also explained that there is insufficient evidence to warrant or confirm a diagnosis of acute or chronic sinusitis because there is no diagnosis for the condition. The examiner indicated that in February 2017 the Veteran had an isolated/single episode of acute and transient sinusitis, but it has since resolved. The examiner explained that "episodic sinusitis is endemic and common in the general population, usually triggered by viral or bacterial infections." The Board finds that after weighing the evidence, the Veteran did not have an in-service incurrence or aggravation of allergic rhinitis, and the conditions are not related to the Veteran's active military service. The January 2020 VA examiner explained that there was no correlation with dental treatment the Veteran received during service and the Veteran's sinus conditions. There is no evidence in the record linking the Veteran's current sinus condition to service. Finally, there is no medical evidence contradicting the January 2020 VA examiner's findings. In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claims for entitlement to service connection for a sinus condition. Because the preponderance of the evidence is against the claims, the benefit-of-the-doubt doctrine is not for application, and the claims must be denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). 2. Entitlement to service connection for headaches to include as secondary to a sinus disability The Veteran contends that his headaches are a continuation of the documented sinus condition and headaches for which he was treated as demonstrated by his dental records during his active-duty military service. See Veteran's October 2017 substantive appeal form. 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. Although the Veteran has had headaches, the preponderance of the probative evidence is against finding that these complaints are etiologically related to any in-service treatment including the dental record showing acute/transient sinus exposure to the buccal, treated successfully, without sequalae or residuals, or to any other in-service event, injury, or disease. The Board has considered the Veteran's assertion that his headaches are etiologically related to his active service. Although the Veteran is competent to report his current symptoms, see Layno, 6 Vet. App. at 469, he is not considered competent to render an opinion as to the likely etiology of his headache condition, as doing so requires specialized medical knowledge and expertise he has not been shown to possess. See Kahana, 24 Vet. App. at 428; Jandreau, 492 F.3d at 1376-77. Therefore, the Board instead turns to the competent medical evidence of record to determine whether such an etiological connection exists. The Veteran's service treatment records (STR's) do not document any complaints, treatment, or diagnosis of any headache condition, beyond the Veteran's dental records. The Board acknowledges that in December 1980 the Veteran had a chest cold and his symptoms included a cough, watery eyes, and headaches. The Veteran's post treatment records have noted headaches from time to time, but no examiner has diagnosed the Veteran with a headache condition. The January 2020 VA examiner indicated that the Veteran has never been diagnosed with a headache condition. The Veteran reported that he did not experience headache pain. The Veteran reported that Dr. M diagnosed the Veteran with a migraine headache a year ago and gave the Veteran an injection. However, the January 2020 VA examiner indicated that there is no supporting documentation of migraine headaches from Dr. M. While the Veteran's correctional records indicated the Veteran had headaches, his diagnosis was allergic rhinitis. Post-incarceration the Veteran had some headaches but also often denied having headaches. See October 2017, June 2018, July 2018 August 2019. The examiner determined that there is insufficient evidence to warrant or to confirm a diagnosis of acute or chronic headaches or residuals. As to the rationale, the examiner explained that the Veteran's STR's and post-service medical records are silent to a diagnosis of a headache condition. The examiner acknowledged that the Veteran had headaches when he was treated for his allergic rhinitis condition. However, the examiner did not find a separate headache disability. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of or was aggravated beyond its natural progress by a service-connected disability. The Board notes that the Veteran is not service connected for a sinus disability, thus the Veteran cannot be awarded secondary service connection for that disability. In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claims for entitlement to service connection for a headache condition on a direct or secondary basis. While the Veteran has a diagnosis of allergic rhinitis, he does not have a diagnosis of either sinusitis or headaches, and the allergic rhinitis did not manifest itself during service, until over 30 years later. The Board acknowledges that the Veteran has had headaches throughout his life. The January 2020 VA examiner acknowledged that the Veteran had headaches in the summary of the Veteran's medical history but differentiated between having "headaches," and a headache condition. Because the preponderance of the evidence is against the claims, the benefit-of-the-doubt doctrine is not for application, and the claims must be denied. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Quist Associate 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.