Citation Nr: 21067138 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 17-49 504 DATE: November 3, 2021 ORDER Entitlement to service connection for the residuals of a broken nose disorder is denied. FINDING OF FACT The evidence does not support a finding that the Veteran's nose disorder has any functional impairment. CONCLUSION OF LAW The criteria for service connection for the residuals of a broken nose disorder are not met. 38 U.S.C. §§ 1101, 1110; 38 C.F.R. §§ 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1991 to February 1992 and from October 2004 to November 2005. The Veteran had National Guard and Reserve service. This matter comes before the Board of Veterans' Appeals (Board) from a July 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran's claim for a nose disorder extends from the date of his claim in December 2014 through the present. Most recently the Board remanded the issue of entitlement to service connection for a nose disorder and lumbar spine disorder for additional development, noting that a VA examination was necessary to determine the nature and etiology of the Veteran's disorders. As noted above, in November 2019, the Board remanded these claims for further development, which has since been substantially completed. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998), where Board's remand instructions were substantially complied with), aff'd, Dyment v. Principi, 287 F.3d 1377 (2002). Thr Board acknowledges that in a March 2020, the RO issued a rating decision granting service connection for a lumbar strain and assigned a 20 percent evaluation effective December 16, 2014; this represents a full grant of the benefits sought, and the issue is no longer in appellate status. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). The record contains no indication that the Veteran has disagreed with the initial rating or effective date assigned. The matter is not in appellate status. See Grantham, 114 F. 3d at 1158 (holding that a separate notice of disagreement must be filed to initiate appellate review of "downstream" elements such as the disability rating or effective date assigned). In March 2020, the RO also issued a supplemental statement of the case (SSOC) denying service connection claim for a nose disorder. Laws and Regulations Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish a right to compensation for a present disability, a Veteran must show: "(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 or aggravated during service" the so-called "nexus requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). With regard to the element of a current disability, current means near the time a claim is filed or at any time during its pendency. McClain v. Nicholson, 21 Vet. App. 319 (2007). Disability refers to the functional impairment of earning capacity. Saunders v. Wilkie, 886 F.3d. 1356 (Fed. Cir. 2018) (holding that pain can constitute a current disability, even without an underlying diagnosis, if it causes sufficient functional impairment). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, a preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The Board must determine the value of all pertinent lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). The evaluation of evidence generally involves three steps: competency, credibility and weighing the evidence as a whole. First, the Board must determine whether the evidence comes from a "competent" source. Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2) (2020). Lay evidence may be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition (i.e., when the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer); (2) the layperson is reporting a contemporaneous medical diagnosis, or; (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F. 3d 1372, 1377, n. 4 (Fed. Cir. 2007). However, laypersons have generally been found to not be competent to provide evidence in more complex medical situations. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (concerning rheumatic fever). The Board must then determine if the evidence is credible; in determining whether documents submitted by a veteran are credible, the Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498 (1995). The third step of this inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. 1. Entitlement to service connection for the residuals of a broken nose disorder The Veteran's contention is that his residuals from a non-displaced distal nasal bone fracture are related to his time in-service. STRs reveal that in January 1992, the Veteran fell and broke his nose. X-ray findings revealed a nasal bone with small non-displaced distal nasal bone fracture. In a 2006 post-service report of medical history, the Veteran reported an in-service broken nose. He also denied any current medical problems associated with his nose at the time of the examination. May 2013 VA outpatient treatment records reveal that the Veteran nose and breathing was noted as normal. In a February 2020 VA sinusitis/rhinitis examination, the examiner diagnosed the Veteran with the residuals of a non-displaced distal nasal bone fracture with an onset of 1992. The Veteran reports experiencing residuals such as difficulty breathing on the right side of his nose since the initial fracture. The examiner determined there were no scars and no functional impact. The examiner opined that it is less likely than not that the Veteran's nose disorder is caused by the claimed in-service injury, event, or illness. The examiner explained that x-rays from the 1992 nose fracture only show a non-displaced distal nasal bone fracture. There is no evidence of a displaced fracture, deviated septum, or evidence that the Veteran's nose fracture required manual reduction. The examiner also noted that it is highly unlikely that a small distal nose fracture that was non-displaced on x-ray would cause difficulty breathing. The examiner noted that a small distal nose fracture that was non-displaced would require displacement of bones or deviation of the septum, neither of which was evident on the x-ray. Lastly, there is no evidence of chronicity of care as the Veteran did not seek treatment for the nose after his initial injury in 1992. The Veteran is competent to report what happened in service as well as competent to report issues such as breathing problems with his nose. See Jandreau v. Nicholson, 492 F. 3d at 1377, n. 4. However, the evidence that the Veteran has experienced breathing problems since service is contradicted by the 2006 and 2013 records showing either no report or no breathing problems. Per Caluza, 7 Vet. App. 498, the Board finds the evidence that the assertion that there has been breathing problems since 1992 is not credible. As such, the foregoing summary of the treatment record reveals no possibility for service connection for a nose disorder or residuals. The most recent examination shows no current functional impairment. Saunders v. Wilkie, 886 F.3d. 1356. (Continued on the next page) 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). Based on this evidence, the Board finds service connection is not warranted. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. The preponderance of the evidence is against the claim, the doctrine is not applicable, and the claim must be denied. 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. § 3.102. Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Elliot Harris 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.