Citation Nr: 21070871 Decision Date: 11/26/21 Archive Date: 11/26/21 DOCKET NO. 16-36 024 DATE: November 26, 2021 ORDER Entitlement to service connection for allergic rhinitis is denied. REMANDED Entitlement to service connection for chronic cough is remanded. FINDING OF FACT The preponderance of the evidence establishes the Veteran does not have a current respiratory disability of allergic rhinitis. CONCLUSION OF LAW The criteria for service connection for allergic rhinitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.380. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Navy from March 1970 to March 1972. The matter is on appeal before the Board from an August 2015 rating decision. In September 2019, the Board initially remanded for further development regarding the issues of bilateral hearing loss and pulmonary fibrosis. In July 2020, the Board again remanded for further development regarding the issues of bilateral hearing loss, pulmonary fibrosis, and respiratory disorder other than pulmonary fibrosis, to include allergic rhinitis and a chronic cough. In June 2021, the Board again remanded for further development regarding the issue of respiratory disorder other than pulmonary fibrosis, to include allergic rhinitis and a chronic cough. In the most recent remand in June 2021, the Board returned the matter for a VA addendum medical opinion on whether: 1) the Veteran has had allergic rhinitis during the course of his appeal, and if so, the etiology of it; 2) the diagnosis of allergic rhinitis in the Veteran's VA treatment records was or was not a misdiagnosis; and 3) if allergic rhinitis is found to have been present during the course of the appeal, is it at least as likely as not (50 percent probability or greater) that the Veteran's allergic rhinitis began in or was otherwise caused by his active military service, to include as a result of his exposure to asbestos therein. Although not part of the June 2021 remand, the question of whether the Veteran's chronic cough is related to service remains unresolved. Entitlement to service connection for allergic rhinitis is denied. Service connection may be established 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. Service connection requires evidence showing: (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a nexus between the current disability and the disease or injury incurred or aggravated in service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). In the absence of a current diagnosed disability, service connection cannot be granted for such disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement that a current disability be present is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or at any time during the pendency of that claim. See McClain v. Nicholson, 21 Vet. App. 319 (2007). When there is an approximate balance of positive and negative evidence regarding the merits of an issue, the benefit of the doubt shall be given to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. If the preponderance of the evidence is against the claim, the claim is to be denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Board remanded this matter in June 2021 for a VA medical examiner to fully address whether the Veteran has had allergic rhinitis during the appeal period and to address references to allergic rhinitis in the Veteran's medical treatment records. A new medical addendum and opinion was obtained at the end of June 2021 which addressed the Board's remand instructions. The Board finds the medical report findings and opinion of the VA medical examiner complied with all the remand instructions. See June 2021 BVA Decision and June 2021 C&P Exam. Turning to the evidence, a review of the Veteran's VA medical records show the Veteran was diagnosed and treated for allergic rhinitis in January and February 2013. See June 2015 CAPRI records. Since 2013, the Veteran's VA medical records contain several references to "rhinitis" or "allergic rhinitis," and since June 2015, the Veteran's VA medical records list allergic rhinitis or rhinitis as part of the Veteran's "past medical history," or as an "active problem." See June 2015, August 2015, July 2016, and February 2021 CAPRI records; see also December 2020 C&P Exams (DBQ and medical opinion). In June 2021, the VA medical examiner reviewed the Veteran's medical treatment records from January 2015 until June 2021 and concluded that the Veteran does not now have, nor has he had allergic rhinitis during the appeal period (from January 2015 to June 2021). The VA medical examiner determined he could find no instance during the relevant period in which the Veteran was treated for allergic rhinitis. See June 2021 C&P Exam. The VA medical examiner opined that although allergic rhinitis and/or rhinitis is listed in the Veteran's past medical history, it did not appear to be an active condition from 2015 to the present. The VA medical examiner also reviewed the Veteran's current active medication list throughout the relevant period and determined none of the medications would typically be used to treat allergic rhinitis and/or rhinitis. See June 2021 C&P Exam. The VA medical examiner also acknowledged that the Veteran's treatment records do include a past diagnosis of chronic cough, however, it was his opinion that the medications prescribed to treat that condition would not typically be prescribed and would not be helpful treating allergic rhinitis. See June 2021 C&P Exam. The VA medical examiner also reviewed the Veteran's medical history for symptoms and did not find other symptoms attributable to allergic rhinitis, such as scleral erythema, scleral edema, conjunctivitis, itchy throat, postnasal drainage, asthma type symptoms, or skin manifestations. The VA medical examiner further stated that "allergic rhinitis is a common type I hypersensitivity response of the upper respiratory tract to seasonal and perennial aeroallergens, usually resulting in current nasal congestion, rhinorrhea, sneezing, and mucosal itching of the nose eyes ears and palate, [and] veterans service treatment records as well as his records since 2015-2021 are silent for these symptoms." See June 2021 C&P Exam. The VA medical examiner concluded that the Veteran's diagnosis of record, medical treatment, and past medical history of allergic rhinitis was erroneous and was a supposition of a possible diagnosis of his chronic cough. See June 2021 C&P Exam. The Board finds the June 2021 VA medical examiner's opinion is competent, adequate, and consistent with the evidence of record, and therefore the opinion is assigned significant probative weight. The VA medical examiner directly addressed all the remand instructions and provided his specific medical opinion that the Veteran does not now have, nor has he had allergic rhinitis during the appeal period. His opinion was based on his consideration and review of the pertinent medical history and evidence in the medical treatment records. His opinion was detailed, factually accurate, fully articulated, and backed up by sound reasoning. Although the Veteran's medical records indicate a diagnosis for allergic rhinitis dating back to January 2013 and treatment for the condition in January and February 2013, the Veteran's medical records do not indicate that allergic rhinitis is an active condition, or that the Veteran has a current diagnosis or has received any treatment for allergic rhinitis during the appeal period. The evidence indicates the references to allergic rhinitis found in the Veteran's medical records during the appeal period are simply references carried over and part of the Veteran's ongoing cumulative medical records. The records do not reference or indicate a diagnosis or treatment for allergic rhinitis from 2015 to the present and such lack of evidence is significantly outweighed by the most recent VA medical examiner's evaluation and opinion in that regard. See June 2021 C&P Exam. The Board has also considered the Veteran's service treatment records and the Veteran's lay assertion that his allergic rhinitis (or flem and cough) is related to his service. See January 2015 Fully Developed Claim (Compensation) see also February 2015 STRs. The Veteran is certainly competent to describe his symptoms and history of symptoms, however, he is not competent to diagnose allergic rhinitis which requires a medical expertise which he is not shown to possess. The Board finds the VA medical examiner's opinion to be the most probative evidence of record. No competent medical evidence in the medical treatment records contradict the June 2021 VA medical examiner's opinion that the Veteran does not now have, nor has he had allergic rhinitis during the appeal period. The Board has carefully reviewed the evidence of record and finds that the evidence does not support the award of service connection, as a current diagnosis of allergic rhinitis is not of record. Based on a review of the evidence of record to include the Veteran's medical records and the June 2021 addendum medical opinion, the Board finds that the probative evidence of record is against a finding that the Veteran has a current respiratory disability manifested by allergic rhinitis which is due to service and that allergic rhinitis has not been diagnosed at any point during the appeal period. REASONS FOR REMAND Entitlement to service connection for chronic cough is remanded. The issue as to whether the Veteran has been diagnosed with a chronic cough and whether the Veteran's chronic cough is a separate and distinct condition or a symptom of his service connected pulmonary fibrosis has not been resolved. Starting with the Veteran's claim filed in January 2015, the Veteran's records contain various references to "chronic cough." See, January 2015 Claim; June and July 2016 CAPRI records; November 2020 CAPRI records; December 2020 C&P Exam; January 2021 C&P Exam; and June 2021 C&P Exam. In the December 2020 C&P exam, the medical examiner opined, "[w]hile the veteran has claimed a respiratory condition to include allergic rhinitis and chronic cough, there is no objective evidence noted during the exam to warrant a diagnosis at this time." One month later, in the January 2021 C&P Exam the very same medical examiner determined the Veteran's "pulmonary fibrosis is due to asbestos exposure while working in the ships engine room. The veteran denies any other exposure to asbestos in his lifetime. In addition, the veteran's lay statement regarding chronic coughing is in line with pulmonary fibrosis." See December 2020 and January 2021 C&P Exams. In the June 2021 C&P Exam, the VA medical examiner's rationale for his determination that the diagnosis for allergic rhinitis was erroneous includes statements connecting or attributing the Veteran's chronic cough to the Veteran's pulmonary fibrosis. The VA medical examiner noted the Veteran's treatment records "do diagnose a past medical condition of chronic cough." Further the VA medical examiner opined the Veteran's medical treatment of allergic rhinitis was "a supposition of a possible diagnosis of his chronic cough;" the Veteran's diagnosis for pulmonary fibrosis "would account for his chronic cough;" and Veteran's "symptoms of chronic cough and dyspnea are more consistent with his known diagnosis of pulmonary fibrosis." See June 2021 C&P Exam. Given the various references to "chronic cough" throughout the Veteran's medical records and its potential relationship or connection to the Veteran's previously service connected pulmonary fibrosis, the matter must be remanded for further clarification in order to fully determine whether the Veteran has been diagnosed with a disability manifested by chronic cough and whether such a diagnosis or disease is a separate and distinct condition or a symptom attributed to his service connected pulmonary fibrosis. The matters are REMANDED for the following action: 1. Obtain an opinion from the appropriate provider regarding the etiology of the Veteran's chronic cough. The examiner must review the claim file, and the Veteran's contentions which must be documented in the report. The examiner should answer the following questions: a. Does the Veteran currently have, or has he had a disability manifested by chronic cough during the appeal period (since January 2015) which is separate and distinct from the pulmonary fibrosis or is the chronic cough a symptom of the pulmonary fibrosis? In answering this question, the examiner is asked to address any previous diagnosis of chronic cough in the Veteran's VA treatment records. b. If it is found that the Veteran has had a disability of chronic cough that is separate and distinct from the pulmonary fibrosis during the appeal period, is it at least as likely as not (50 percent probability or greater) that the Veteran's chronic cough began in, or was otherwise caused by his active military service, or was it caused or aggravated by his pulmonary fibrosis and exposure to asbestos therein? Why or Why not? c. The examiner is advised the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide a reason for doing so. The examination report must include a complete rationale for any opinion provided. 2. If upon completion of the above action the claim remains denied, the matter must be returned to the Board after compliance with appellate procedure. JOHN R. DOOLITTLE, II Veterans Law Judge Board of Veterans' Appeals 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.