Citation Nr: 21067432 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 12-17 315 DATE: November 4, 2021 ORDER 1. Entitlement to service connection for sleep apnea, to include as secondary to post nasoseptal deviation with allergic rhinitis is denied. 2. Entitlement to an increased compensable disability rating for post nasoseptal deviation with allergic rhinitis is denied. FINDINGS OF FACT 1. The Veteran's sleep apnea did not have its onset during active service and is not caused or aggravated by his service-connected post nasoseptal deviation with allergic rhinitis. 2. For the entire period on appeal, the Veteran's post nasoseptal deviation with allergic rhinitis has not been manifested by 50 percent obstruction of the nasal passage on both sides, or complete obstruction of the nasal passage on one side. CONCLUSIONS OF LAW 1. The criteria for service connection for sleep apnea, to include as secondary to post nasoseptal deviation with allergic rhinitis, have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2019). 2. The criteria for an increased compensable disability rating for post nasoseptal deviation with allergic rhinitis have not been met for any period on appeal. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.97, Diagnostic Code (DC) 6502 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from March 1982 to March 1988. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a January 2019 videoconference hearing, and a transcript of the hearing has been associated with the claims file. This matter was previously remanded by the Board in January 2020 for additional development, including obtaining outstanding VA and private treatment records and obtaining medical opinions concerning the Veteran's claims. A review of the claims file documents that relevant treatment records and opinions were added to the claims file. As such, the Board finds that there has been substantial compliance with prior remand directives and adjudication of the Veteran's appeal may proceed. 1. Entitlement to service connection for sleep apnea, to include as secondary to post nasoseptal deviation with allergic rhinitis. The Veteran asserts that his sleep apnea had its onset during active service, is a result of his in-service nasal injury, or that it is secondary to his service-connected post nasoseptal deviation with allergic rhinitis. At the January 2019 Board hearing, the Veteran testified that he was previously service-connected for allergic rhinitis and "all associated breathing problems," and he asserts generally that this includes his current sleep apnea. In February 2020, the Veteran stated that he often complained of fatigue during active service without knowing that it could be sleep apnea or receiving related treatment. However, following a review of the evidence of record, and as discussed more fully below, the Board finds that the preponderance of the evidence weighs against the Veteran's claim of entitlement to service connection for sleep apnea. The reasons for this decision follow. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 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. Service connection may be granted on a secondary basis for a current disability which is proximately due to or the result of a service-connected disease or injury. Where a service-connected disability aggravates a nonservice-connected condition, a Veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Regarding the first element of a service-connection claim, a current disability VA and private treatment records document that the Veteran was diagnosed with sleep apnea following a sleep study in December 2001. As such, the requirement of a current disability has been met. Regarding the in-service element of the claim, service treatment records document the Veteran's various complaints of fatigue without specific complaints, treatment, or diagnosis of sleep apnea. For example, in February 1984, the Veteran complained of tiredness and headaches for four months. He admitted that he had been under pressure lately and was assessed with tension headaches and mild chronic fatigue. In June 1986, the Veteran again complained of fatigue for six to eight weeks and reported that he could play tennis only for five minutes before becoming tired. In November 1986, he reported a sore throat with multiple other problems and was advised that the attending physician could not take care of all the problems in one visit; however, it was noted that he complained of intermittent fatigue for approximately 12 months, since being in California, and he was assessed with fatigue. Finally, in March 1987, he complained of weakness and fatigue for one year but reported that he dieted the week before and felt improvement in his health and energy. His examination was normal, and he was assessed with questionable hypochondriasis and instructed on proper diet. A separation examination does not appear to be of record. Given the above, the Board finds that service treatment records document several complaints of fatigue, without specific complaints, treatment, or diagnosis of sleep apnea during active service. However, resolving reasonable doubt in favor of the Veteran, this is sufficient to meet the in-service element of his direct service connection claim. Additionally, the Board is mindful that the Veteran is service-connected for post nasoseptal deviation with allergic rhinitis from March 30, 1988, and this is sufficient to satisfy that element of his secondary service connection claim. However, following a review of the evidence of record, and as discussed below, the Board finds that the preponderance of evidence weighs against the finding of a direct nexus between sleep apnea and his active service, and a secondary nexus between sleep apnea and his service-connected post nasoseptal deviation with allergic rhinitis. As noted above, post-service private and VA treatment records confirm that the Veteran was diagnosed with sleep apnea following a December 2001 sleep study. In June 2003, the Veteran reported that he had problems with recurring nasal congestion, blockage, and breathing difficulties since an in-service nasal injury. He stated that two years prior to the examination, he was diagnosed as having sleep apnea syndrome, and he believed that all of his symptoms were secondary to his nasal fracture. The VA examiner stated that the Veteran had no significant residual deformities associated with his nasal fracture but noted that he had chronic vasomotor rhinitis, which is probably allergic in character, and sleep apnea syndrome for which he used a CPAP. The examiner concluded that the Veteran's current breathing problems, vasomotor rhinitis, and allergies/sinus were not secondary to the in-service nasal fracture but secondary to chronic vasomotor allergic rhinitis. Similarly, upon VA examination in October 2009, a VA examiner concluded that the Veteran's obstructive sleep apnea was not related to his rhinitis. Again, upon VA examination in October 2010, a VA examiner opined that the Veteran's sleep apnea is not caused by or a result of his deviated septum. The examiner noted that the Veteran did incur a deviated septum during active service in 1987 but stated that there was no evidence in his service medical record or in a presumptive period of any signs or symptoms of sleep apnea, which occurred several decades after the initial incident. The examiner noted that common risk factors for sleep apnea included excess weight, neck circumference, high blood pressure, narrow airway, being male, being older, family history, use of alcohol, sedatives or tranquilizers, smoking, and prolonged sitting. Therefore, the examiner opined that there was no direct correlation between the deviated septum which occurred in 1987 and the sleep apnea which was diagnosed in 2002. In November 2013, a VA examiner concluded that the real cause of the Veteran's sleep apnea is redundant pharyngeal tissue. In December 2013, the same examiner opined that the Veteran's obstructive sleep apnea is not aggravated by his service-connected deviated nasal septum and rhinitis, as his nasal septal deviation is very mild, without evidence of obstruction, nasal polyps, or hypertrophy of the nasal turbinates. In April 2019, a private physician, Larry Flake, M.D., reported that he had been the Veteran's primary care physician for numerous years. He stated that the Veteran had a diagnosis of sleep apnea with both obstructive and central apneas for many years, which required him to wear a BiPAP seven days a week. In July 2019, Dr. Flake again noted the Veteran's diagnosis of obstructive sleep apnea, with a prior history of comminuted non-displaced fracture of the nasal bone and deviated septum from a prior injury in remote past. He also stated that the Veteran had surgical procedures by local ENT specialists that attempted to correct a deviated septum and nasal bone spurring in 2015, at which time, tonsillar asymmetry was also noted. Dr. Flake stated that all of these conditions would also contribute to any airway obstruction that would worsen the Veteran's obstructive sleep apnea, and that surgical attempts to improve these conditions were marginal in the end. Given the conflicting medical opinion evidence above, the Board remanded this matter in January 2020 in order to obtain a clarifying medical opinion that considered the relevant opinions of record and reconciled them as necessary. Thereafter, in March 2020, a VA examiner opined that the Veteran's sleep apnea was at least as likely as not proximately due to or the result of the Veteran's service-connected condition. In support of the opinion, the examiner stated that many of the veterans who suffer a deviated septum also develop sleep apnea during service or after their military service, and there is medical evidence that suggests that a deviated septum can cause or contribute to the development of obstructive sleep apnea, as a deviated septum is one of the most common types of nasal obstruction, and depending on the severity, a person with a deviated nasal septum can develop obstructive sleep apnea. However, that same month, the same VA examiner opined that the Veteran's claimed sleep apnea was less likely than not proximately due to or the result of Veteran's service-connected condition and not at least as likely as not aggravated beyond its natural progression by his service connected-condition. Confusingly, the examiner then cited the same medical literature discussed in her positive nexus opinion and stated that the service-connected post nasoseptal deviation with allergic rhinitis aggravates the Veteran's sleep apnea. Given the internal inconsistency of the March 2020 VA opinions, VA obtained a subsequent addendum opinion in July 2020. At that time, following a thorough review of the claims file, a new VA examiner opined that it is less than likely that the Veteran's current sleep apnea condition is related to or caused by military service, less than likely that the current sleep apnea condition is related to or caused by the service-connected nasoseptal deviation with allergic rhinitis) conditions, and less than likely the current sleep apnea condition has been aggravated beyond normal progression by the service-connected nasoseptal deviation with allergic rhinitis) conditions. As a rationale, the VA examiner noted that the claims file had been thoroughly reviewed, and that lay statements, verbal histories, and previous examinations were considered in forming the opinion. The examiner stated that service treatment records did not contain complaints, diagnosis or treatment for the current condition, sleep apnea, which was not diagnosed during active duty service or within a year after separation from service. Additionally, the examiner stated that there was no continuity of symptoms from service discharge until the current diagnosis. Therefore, the examiner opined that the Veteran's obstructive sleep apnea (OSA) and central sleep apnea (CSA) are less than likely directly related to military service, as a nexus linking the current conditions to military service cannot be established. The examiner stated that OSA occurs when the brain sends the signal to the muscles and the muscles make an effort to take a breath, but they are unsuccessful because the upper-airway striated dilating muscles relax during sleep and the airway is or becomes obstructed and prevents an adequate flow of air. The examiner reviewed risk factors for developing OSA, including male gender, increased BMI, age over 40 years, increased neck size, family history, GERD, nasal obstruction due to a deviated septum, allergies or sinus conditions, and large tonsil or tongue causing airway compromise. The examiner then noted that the Veteran has increased BMI, increased neck size, chronic rhinitis, adeno-tonsillar hypertrophy & type IV Mallampati abnormal airway. The examiner then noted that central sleep apnea (CSA) are respiratory pauses caused by lack of respiratory effort and often is most commonly found in the presence of cardiac failure (CHF) or neurologic disease, especially stroke (CVA); however, there is no evidence of CHF, CNS neurologic disease, or CVA found on review of the record. The examiner stated that the most likely etiologies of the Veteran's sleep apnea were abnormal oral airway, abnormal nasal airway, and increased weight gain after separation; however, the exact percent each condition contributes to the development of the sleep apnea could not be determined without speculation. The examiner stated that it is unlikely the service-connected deviated septum and allergic rhinitis were significant etiologies, as these conditions did not significantly obstruct the nasal passages, and the deviated septum had been repaired in 1986 and 2015 without change in the sleep apnea condition. Therefore, the examiner stated that the oral airway abnormality and increased BMI should be considered the most likely causes of the Veteran's sleep apnea. The examiner acknowledged that symptoms suggesting sleep apnea may include daytime fatigue and sleepiness, insomnia, poor concentration and attention, memory problems, anxiety, irritability, headaches, and difficulty performing work duties, but noted that the Veteran's in-service fatigue was diet-related. Moreover, the examiner stated that most individual symptoms and signs have limited utility in determining the likelihood of OSA, that no one sign is sufficiently precise to rule in or rule out this condition. The examiner added that snoring on its own is not a unique symptom of sleep apnea. The examiner acknowledged that the Veteran is competent to attest to his experience in service and describe symptoms, but he is not medically qualified to diagnose his current medical condition or its etiology, and the current sleep apnea condition diagnosis and etiology are complex medical questions and not determinable by lay observation. The examiner concluded that it is less than likely the sleep apnea condition has been aggravated beyond normal progression, as the current PAP level is equal to or less than the original PAP pressure instigated in 2001, and the Veteran used standard treatment therapy for the condition, with no history of surgery for the sleep condition, or other airway procedures to support aggravation of the sleep apnea condition, and the evidence did not support a diagnosis of heart failure to suggest other end-organ damage from the sleep apnea. Therefore, the examiner opined it is less than likely the sleep apnea condition has been aggravated by the service-connected condition. Given the above, the Board affords the most probative value to the July 2020 VA negative nexus opinion, which is supported by detailed, well-reasoned rationales and reliance upon a thorough review of the Veteran's claims file, including the Veteran's service treatment records and post-service treatment records, as well as the Veteran's own lay statements. In contrast, the March 2020 VA nexus opinion is less probative as to a nexus, as the VA examiner rendered conflicting nexus opinions. This internal inconsistency has caused the Board to afford the opinion no probative value. Similarly, the Board affords little probative value to the July 2019 private opinion by Dr. Flake, wherein he wrote that the Veteran's deviated septum and allergic rhinitis conditions would also contribute to any airway obstruction that would worsen his sleep apnea. While the Board previously acknowledged that this was at least some probative evidence that the Veteran's sleep apnea is aggravated by his service-connected post nasoseptal deviation with allergic rhinitis, it is significant that Dr. Flake's opinion did not establish by medical evidence a baseline level of severity of the Veteran's sleep apnea prior to any aggravation. As such, it is inadequate to warrant a grant of secondary service connection on the basis of aggravation. Moreover, the minimal probative value of this private nexus opinion is outweighed by the comprehensive July 2020 VA examiner's opinion discussed in detail above, which is well supported by a detailed, reasoned rationale and explained why the service-connected disability did not aggravate the Veteran's sleep apnea. The Board has also considered the relevant lay evidence of record, including the Veteran's July 2019 Board hearing testimony and November 2020 statement discussed above. While the Veteran is competent to report observable symptoms, such as fatigue, to the extent he asserts that his sleep apnea is related to active service or his service-connected post nasoseptal deviation with allergic rhinitis, such statements are of no probative value given the Veteran's lack of medical expertise needed to diagnose complex and internal conditions and to render a nexus opinion relating them to active service or a service-connected disability. Additionally, to the extent that the Veteran has asserted that his current sleep apnea first had its onset during active service, such statements are inconsistent with other evidence of record, including service treatment records (which the Board acknowledges document his reports of fatigue attributed to various factors, such as diet, without mention of sleep apnea) and post-service medical records, which document the first diagnosis of sleep apnea in December 2001, over 13 years after his separation from active service. To the extent that the Veteran has claimed, including within a June 2009 statement and at the January 2019 Board hearing, that he was previously awarded service connection for allergic rhinitis and "all associated breathing problems," which he believes should include his currently claimed sleep apnea, the Board disagrees with this reasoning as discussed immediately hereafter. The Board acknowledges that a February 2006 Board decision included an Order which granted "[s]ervice connection for allergic rhinitis and all associated breathing problems." Notably, however, this Order does not include any specific reference to sleep apnea. Similarly, the relevant finding of fact therein states: "The appellant was diagnosed with perennial rhinitis with post nasal drip during service[,] and he is currently diagnosed with chronic vasomotor (allergic) rhinitis." This finding of fact also specifically addresses rhinitis and does not mention a diagnosis of sleep apnea. Likewise, the Board's conclusion of law therein states: "The criteria for the establishment of service connection for chronic vasomotor rhinitis/allergic rhinitis are met." As above, this conclusion is limited to rhinitis, without reference to sleep apnea. Moreover, the Board's February 2006 reasons and bases for its finding and conclusion do not include a discussion or analysis related to sleep apnea, but was again limited to the diagnosis of rhinitis: The Board finds that the preponderance of the evidence indicates that the appellant experienced symptoms of allergic rhinitis each year at approximately the same time while on active duty. There is uncontroverted evidence of a diagnosis of perennial rhinitis with post nasal drip while on active duty. The most recent VA examiner concluded that the appellant has a chronic vasomotor rhinitis that is probably allergic in character. The June 2003 VA examiner also stated that the allergic rhinitis is the likely cause of the appellant's current breathing problems and allergies. Based on the above, the Board finds that the evidence is, at a minimum, in relative equipoise as to whether the appellant's allergic rhinitis was incurred while on active duty. Consequently, reasonable doubt should be resolved in favor of the appellant and service connection for allergic rhinitis (and all associated breathing problems) is, accordingly, granted." See February 2006 Board Decision at pp. 7-8. The Board is mindful that the June 2003 VA examination relied upon by the Board in its February 2006 decision to grant service connection for allergic rhinitis (and all associated breathing problems) also does not attribute the Veteran's currently-claimed sleep apnea to active service or his rhinitis. Rather, as noted previously, the examiner concluded that the Veteran's current breathing problems, vasomotor rhinitis, and allergies/sinus were not secondary to the in-service nasal fracture but secondary to chronic vasomotor allergic rhinitis. The Board reasonably infers that the examiner's conclusion was specifying what the examiner meant by "current breathing problems," which the examiner then clarified as "vasomotor rhinitis, and allergies/sinus." The Board finds it significant that the 2003 examiner did not include sleep apnea in the medical opinion, which the 2006 Board relied on to grant the Veteran's claim. If the examiner had intended to include sleep apnea as part of the Veteran's "current breathing problems," he could have specified it and included it with the additional listed conditions of "vasomotor rhinitis, and allergies/sinus;" however, he did not do so. Moreover, the Board finds that by using the phrase "all associated breathing problems" in its February 2006 Order, the Board did not intend to encompass sleep apnea. Rather, the Board was simply using the same terminology that the June 2003 VA examiner used when addressing the Veteran's specific conditions of vasomotor rhinitis and allergies. Given the above, the Board finds that the preponderance of the evidence is against a finding that the February 2006 Board decision, which awarded service connection for allergic rhinitis and "all associated breathing problems," encompassed the Veteran's currently claimed sleep apnea. For all the reasons laid out above, the Board concludes that the preponderance of evidence weighs against the Veteran's claim for service connection for sleep apnea on direct and secondary bases. As such, there is no reasonable doubt to be resolved, and the claim is denied. 2. Entitlement to an increased compensable disability rating for post nasoseptal deviation with allergic rhinitis. Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. Whether the issue is one of an initial rating or an increased rating, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Regarding the Veteran's increased rating claim for post nasoseptal deviation with allergic rhinitis, the Board has considered the relevant temporal period, including one year prior to the Veteran's June 2009 increased rating claim, as well as whether any staged ratings periods are warranted. The Veteran claims that his service-connected post nasoseptal deviation with allergic rhinitis is more severe than his current 0 percent, or noncompensable, disability rating pursuant to DC 6502. 38 C.F.R. § 4.97, DC 6502. Thereunder, a compensable 10 percent disability rating is warranted for a traumatic deviated septum only when there is 50 percent obstruction on both sides of the nasal passage or when one side is completely obstructed. Although the rating schedule does not provide a zero percent evaluation for DC 6502, a noncompensable, zero percent disability rating shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. Turning to a review of the evidence of record during the relevant temporal period, upon VA examination in October 2010, the Veteran denied interference with breathing through the nose, purulent discharge, speech impairment, and chronic sinusitis. He also denied functional impairment of his occupation. The VA examiner noted that upon physical examination, the nasal passages were clear, without polyps, septal deviation, or deformity of the nose. Additionally, the Veteran did not have any difficulty with speaking or breathing, and he denied any surgery of the larynx. The resulting diagnosis was post nasoseptal deviation with no loss of function. In December 2013, a VA examiner noted that the Veteran's nasal septal deviation was very mild. Upon physical examination, the nasal passages were widely patent, without evidence of obstruction. There were no nasal polyps present and no hypertrophy of the nasal turbinates. The examiner also noted that a review of VA treatment records documented that the Veteran was not taking any treatment for rhinitis. Private treatment records from February 2015 document that the Veteran underwent a flexible laryngoscopy, at which time, a fiberoptic telescope was advanced under direct visualization through the right nostril and a thorough evaluation of the nasopharynx, oropharynx, and larynx was carried out without complication, although the left side eustachian tube was noted to be compromised, and the resulting assessment was a deviated nasal septum. That same month, the Veteran underwent an adult tonsillectomy, and upon follow up in September 2015, he was noted to have a normal nose, including the nares, septum, and turbinates. VA treatment records from May 2017 document that the Veteran had a deviated nasal septum, convex worse on the right, and nasal congestion. In July 2019, a private physician, Dr. Flake, noted the Veteran's history of comminuted non-displaced fracture of the nasal bone and deviated septum from a prior injury in remote past, with surgical procedures by local ENT specialists that attempted to correct a deviated septum and nasal bone spurring in 2015. Dr. Flake stated that the surgical attempts to improve these conditions were marginal in the end. VA treatment records from June 2019 document the Veteran's complaint of sinus congestion and request for evaluation of his deviated nasal septum. The attending practitioner noted that a CAT scan of the sinuses would be requested and be done within a week. The following month, in July 2019, the Veteran submitted a statement that his most current CAT scan was done at the Overton Brooks VAMC on July 3, 2019. However, a review of VA treatment records from July 2019 to the present does not document that a sinus CAT scan was completed in July 2019. An August 2019 VA treatment record document a carotid ultrasound, which is unrelated to the sinus CAT scan referenced in June 2019. Upon follow up in September 2019, the Veteran reported increasing nasal congestion. He stated he was told by a pharmacy to stop using Afrin nasal spray because of the rebound effect from recurrent use, but he noted it was the only thing that helped with his congestion. A physical examination of the nose revealed swollen turbinates, right greater than left, and dry crusting in the nares. In January 2020, the Veteran requested that his VA primary physician refer him to an ENT for major breathing issues due to both central and obstructive sleep apnea. That same month, he reported that his bi-pap machine was no longer working properly and he requested a replacement. Private treatment records from January 2020 document that his septum was deviated to the right, though no obstruction was noted. In February 2020, he was referred to the relevant VA clinic at Overton Brooks VAMC, though a VA note that month documents that they were unable to contact him by telephone to schedule an appointment. Upon VA examination in March 2020, the VA examiner diagnosed acute sinusitis and post nasoseptal deviation with allergic rhinitis. Regarding the onset of his service-connected condition, the Veteran reported that while lying on his back and working on a desk at Travis Air Force Base, an iron bar fell and hit him on his face and nose, which resulted in a fractured and deviated nasal septum. He stated that subsequent surgical procedures by local ENT specialists attempted to correct his deviated septum and nasal bone spurring in 2015. He reported that his condition had progressed to him having sinus problems and current symptoms including congestion, running nose, nasal drainage, difficulty breathing, facial pain, and itchy throat. He reported current treatment including various medications, such as sodium chloride nasal spray, daily Montelukast, Fluticasone nasally as needed, Azelastine nasal solution as needed, Afrin nasal spray as needed, and daily Cetirizine HCl. Upon physical examination, the VA examiner documented that there were no findings due to chronic sinusitis and no incapacitating or non-incapacitating episodes of sinusitis in the past 12 months. Regarding his allergic rhinitis, the examiner documented that there was not greater than 50 percent obstruction on both sides, complete obstruction on either side, permanent hypertrophy of nasal turbinates, nasal polyps, or granulomatous conditions. There were no larynx/pharynx conditions. Similarly, regarding his deviated nasal septum, the examiner stated that there was not at least 50 percent obstruction on both sides or completely obstruction on either side. More recently, VA treatment records from November 2020 document that the Veteran's sleep apnea and deviated septum needed to be addressed, and that once he was released from physical therapy for his back surgery in three to four months, they would get x-rays, CAT scan, and refer to an ENT doctor to evaluate for correction of the deviated septum. The Veteran reported that he was still using steroid nasal spray and cetirizine, which helped his symptoms. In September 2020, the Veteran submitted a private medical prescription form from Dr. J. William Parker, of the Highland Clinic, which states that the Veteran "has had severe nasal injury resulting in severe nasal septal deviation 100% obstruction on the right. This will require nasal surgery." The Board notes that it is unclear as to the correct date of this submission, as it only contains the notation "9/1;" however, given the timing of the Veteran's submission, it is reasonable to assume that the date refers to September 1, 2020. In any event, to the extent that the Veteran relies on this submission to support his increased rating claim, the Board affords the private prescription form less probative value than the objective VA records and examinations discussed above, which fail to document findings that warrant a compensable disability rating for any period on appeal. Significantly, for the entire period on appeal, the most probative evidence documents that the Veteran did not have 50 percent obstruction on both sides of the nasal passage or complete obstruction on one side in order to warrant a compensable disability rating. To the extent that the Veteran relies on the September 2020 prescription form to support his claim, the Board finds that this evidence is of little probative value given its inconsistency with the additional probative evidence of record. Notably, the March 2020 VA examination failed to document any compensable obstruction of the Veteran's nasal passages, and the September 2020 submission is unsupported by any objective evidence or testing. Although the Veteran is competent to report observable symptoms, including nasal congestion, he is not competent to opine regarding the severity or degree of his nasal obstruction, which requires diagnostic observation and/or testing by a medical professional. As such, his lay statements of record are insufficient to warrant a compensable disability rating for any period on appeal when weighs against the more probative objective medical evidence of record. Given the above, the Board finds that the preponderance of the evidence weighs against a finding that the Veteran's post nasoseptal deviation with allergic rhinitis has been manifested by 50 percent obstruction of the nasal passage on both sides, or complete obstruction of the nasal passage on one side, for any period on appeal to warrant a 10 percent rating. As the preponderance of the evidence weighs against the claim, there is no reasonable doubt to be resolved, and the claim for increase is denied. A. P. SIMPSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Chad Johnson, 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.