Citation Nr: 21065953 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 17-30 950 DATE: October 28, 2021 ORDER Service connection for allergic rhinitis is denied. FINDINGS OF FACT 1. The Veteran served on active duty from February to August 2003, October 2004 to December 2005, and April 2007 to November 2016. 2. Allergic rhinitis was noted at entry but did not increase in severity during service. CONCLUSION OF LAW Preexisting allergic rhinitis was not aggravated by service. 38 U.S.C. §§ 1101, 1110, 1111, 1112, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.307, 3.309 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSION In December 2019, the Board remanded the appeal for additional development. The case has now been returned to the Board for further appellate action. Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). In addition to the laws and regulations outlined above, a veteran is presumed to be in sound condition upon entrance into service, except for defects, infirmities or disorders noted when examined, accepted, and enrolled for service, or where evidence or medical judgment is such as to warrant a finding that the disease or injury existed before acceptance and enrollment. 38 U.S.C. § 1111. Only such conditions as are recorded in examination reports are to be considered as noted. 38 C.F.R. § 3.304(b). If a disorder is noted, the question is whether it was aggravated by service. The government may show a lack of aggravation by establishing that there was no increase in disability during service or that any "increase in disability [was] due to the natural progress of the" preexisting condition. 38 U.S.C. § 1153. 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. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(b); Falzone v. Brown, 8 Vet. App. 398, 402 (1995). Moreover, "temporary or intermittent flare-ups of a pre-existing injury or disease are not sufficient to be considered aggravation in service unless the underlying condition, as contrasted to symptoms, is worsened." Crowe v. Brown, 7 Vet. App. 238, 247-48 (1994); Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). However, the increase need not be so severe as to warrant compensation. Browder v. Derwinski, 1 Vet. App. 204, 207 (1991). As an initial matter, a current disorder is shown. Specifically, the January 2017 and March 2020 VA examiners noted that the Veteran had been diagnosed with allergic rhinitis. As such, the medical evidence reflects a current diagnosis, and the first element of service connection is met. Moreover, service treatment records (STRs) indicated that the Veteran had preexisting allergic rhinitis. Specifically, on the April 2001 entrance examination, the clinical assessment at the time of enlistment was silent for rhinitis. The April 2001 enlistment Report of Medical History included sinusitis and hay fever. The physician summary noted seasonal allergic rhinitis since the Veteran was 5 years old, improved with Claritin without interference with his normal activities. Accordingly, rhinitis was noted upon entry into service, the presumption of soundness does not attach, and the claim may only be considered on the basis of aggravation. Next, STRs showed several notations for allergic rhinitis. February 2006 VA treatment records indicated a diagnosis of sinusitis and chronic rhinitis, and that the Veteran had nasal congestion due to rhinitis. A July 2007 private treatment record revealed an assessment of allergic rhinitis and the plan was to take antihistamines daily. A March 2010 progress note reflected symptoms of nasal congestion. The October 2016 separation examination report did not reflect any allergic rhinitis diagnosis or findings. Having found that allergic rhinitis clearly and unmistakably existed prior to service, the question is whether allergic rhinitis clearly and unmistakably was not aggravated by service. On a January 2017 VA examination report, the Veteran reported using an antihistamine as needed for his allergies. The examiner diagnosed allergic rhinitis. The examiner opined that allergic rhinitis was less likely as not related to a specific exposure event experienced by the Veteran during service in Southwest Asia. Further, the examiner opined that the Veteran's allergic rhinitis, which predated service, was less likely as not aggravated, beyond a normal progression, during service. The examiner explained that while the Veteran's enlistment examination notated a history of allergies since he was 5 years old, the rest of the STRs made no mention of treatment for allergic rhinitis or uncontrolled allergies while on active duty. This opinion is assigned less probative value because the Veteran's STRs reflected that he sought treatment for sinus allergies, was diagnosed with allergic rhinitis, and was instructed to take a daily antihistamine. A March 2017 VA addendum opinion found that the Veteran's allergic rhinitis predated service and was less likely as not permanently aggravated beyond a normal progression during service. The examiner explained that the Veteran's enlistment examination indicated that he used an antihistamine as needed prior to active duty, which did not change while he was on active duty. Additionally, the examiner explained that allergic rhinitis was listed as a medical problem in the evidence of record but there was no documentation of ongoing treatment for the condition or documentation of uncontrolled allergies. The examiner concluded that the Veteran did not have a current medical issue. The March 2017 VA addendum opinion is assigned less probative value as the opinion was inconsistent with the January 2017 opinion where the same examiner concluded that the Veteran had allergic rhinitis and used an antihistamine for his condition. Additionally, it did not reflect consideration of the February 2006 VA treatment records indicating a diagnosis of sinusitis and chronic rhinitis, and that the Veteran had nasal congestion due to rhinitis nor the March 2010 progress note also reflecting symptoms of nasal congestion. The Veteran underwent another VA examination in March 2020. The Veteran reported experiencing flare-ups of his allergic rhinitis during sandstorms while on active duty after his first deployment to Kuwait. He described symptoms of puffy eyes, runny nose, red eyes and difficulty breathing and current symptoms of stuffy nose, headaches, phlegm, puffy eyes, runny nose, red eyes, and shortness of breath. He treated his allergic rhinitis with Claritin D 1 daily and a daily nasal spray. The examiner opined that the Veteran's allergic rhinitis which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event or illness. The examiner explained that there was no evidence of aggravation of the Veteran's symptoms above and beyond the noted pre-existing symptoms. The examiner noted that the Veteran received treatment for continued/ on-going symptoms of allergic rhinitis while on active duty, but he received treatment for the exact same symptoms that he had prior to entering service and he was treated with the exact same class/type of medications. The examiner indicated that there was no evidence of increased frequency of symptoms, increased intensity of symptoms or increased need of treatment. The examiner explained that the Veteran's pre-enlistment Report of Medical History noted allergic rhinitis since childhood, that was treated effectively with antihistamines. Further, there were 1-2 episodes during service that the Veteran was seen for these allergic rhinitis type symptoms and again recommended and given the exact same treatment he has had since childhood of anti-histamines. The examiner indicated that there was no evidence of aggravation such as needing referral to allergist, no evidence of needing allergy testing or allergy shots and no evidence of not being able to do his job functions due to worsening allergies. The examiner noted the Veteran's lay statements that his allergies were made worse by working in the motor pool, but she explained that there was not any evidence of worsening symptoms, worsening frequency of visits, or evidence of increased need for stronger treatment. She concluded that there was no evidence in medical records or on objective examination to support the Veteran's statement of worsening symptoms of allergic rhinitis. There is no contradictory medical opinion. As such, the medical evidence does not support a finding of aggravation as the evidence shows that allergic rhinitis clearly and unmistakably existed prior to service and clearly and unmistakably was not aggravated by service. The Board has also considered the Veteran's lay statements that his disorder was aggravated by service. He is competent to report symptoms because this requires only personal knowledge as it comes to her through him senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matter involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Grzeczkowicz 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.