Citation Nr: 21073727 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 17-21 331 DATE: December 10, 2021 ORDER Entitlement to service connection for sinusitis with polyps is granted. Entitlement to service connection for the residuals of pilonidal cysts, left buttock scar, is granted. Entitlement to service connection for temporomandibular joint (TMJ) dysfunction with bruxism is granted. Entitlement to service connection for a left knee/quadricep disability is granted. Entitlement to service connection for a right knee/quadricep disability is granted. FINDINGS OF FACT 1. The Veteran's sinusitis with polyps is at least as likely as not the result of an in-service disease or injury. 2. The Veteran's residuals of pilonidal cysts, left buttock scar, is at least as likely as not the result of an in-service disease or injury. 3. The Veteran's TMJ dysfunction with bruxism is at least as likely as not proximately due to his service-connected psychiatric disability. 4. The Veteran's left knee/quadricep disability is at least as likely as not the result of an in-service disease or injury. 5. The Veteran's right knee/quadricep disability is at least as likely as not the result of an in-service disease or injury. CONCLUSIONS OF LAW 1. The criteria for service connection for sinusitis with polyps have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for pilonidal cyst, left buttock scar have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 3. The criteria for service connection for TMJ dysfunction with bruxism have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. 4. The criteria for a left knee/quadricep disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 5. The criteria for a right knee/quadricep disability have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS These matters come before the Board of Veterans' Appeals (Board) on appeal from a June 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama. The Veteran appeared at hearing before the undersigned in June 2021. A transcript of the hearing is of record. The Board notes the February 2017 statement of the case for the present appeal includes three additional issues other than those listed above; however, the Veteran's April 2017 substantive appeal (VA Form 9) limited the scope of this appeal to the issues of service connection for sinusitis, the residuals of pilonidal cysts, TMJ dysfunction, and a bilateral knee/quadricep disability, which was also confirmed on the record during the June 2021 hearing before the undersigned. Principles of Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for disability resulting from disease or injury incurred in or aggravated while performing active duty for training (ACDUTRA) or injury incurred or aggravated by inactive duty for training (INACDUTRA). 38 U.S.C. §§ 101(24), 106, 1110. For a member of a Reserve component, ACDUTRA means full-time duty performed by Reserves for training purposes. INACDUTRA means duty (other than full-time) prescribed for Reserves under section 206 of title 37 of the United States Code or any other provision of law. In the case of a member of the National Guard, ACDUTRA means full-time duty for training purposes or field exercises under section 316, 502, 503, 504, or 505 of title 32 of the United States Code. 38 U.S.C. § 101(22). INACDUTRA means duty (other than full-time) duty performed by a member of the National Guard under section 316, 502, 503, 504, or 505 of title 32 of the United States Code. 38 U.S.C. § 101(23). Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In accordance with these principles, service connection may also be granted when a claimed disability is found to be proximately due to or the result of a service-connected disability, or when any increase in severity (aggravation) of a nonservice-connected disease or injury is found to be proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310. The Board must consider all the evidence of record and make appropriate determinations of competence, credibility, and weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). When there is an approximate balance of positive and negative evidence regarding any material issue, reasonable doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 1. Entitlement to service connection for sinusitis with polyps is granted. The record establishes the Veteran has chronic sinusitis with polyps. The Veteran asserts his chronic sinusitis onset during his initial period of verified ACDUTRA from July 1996 to January 1998 for initial entry training. Service treatment records confirm the Veteran was treated for sinus pain during this period of service. The only issue that remains is whether there is a nexus between the claimed in-service disease or injury and the current disability. Initially, the Board notes the Veteran is a physician; therefore, he has the necessary skill and training to address complex medical issues such as the nexus element of his service connection claim for sinusitis with polyps. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Veteran has explained he first experienced severe sinus pain in August 1996 and sought treatment thereafter, which is confirmed by service treatment records that show he underwent a CT scan at that time. The Veteran has reported he has continuously experienced sinus-related symptoms since his initial treatment, which eventually led to the development of polyps, the first of which was surgically removed in January 2001. The Veteran's reports of continuous symptoms are corroborated by contemporaneous evidence, most notably a July 2000 report of medical history provided in conjunction with a commissioning physical, at which time the Veteran reported a history of chronic sinusitis requiring the use of antibiotics; therefore, the Board also finds the Veteran's reports credible. As the Veteran's nexus statements are both credible and competent, the Board finds his sinusitis with polyps is at least as likely as not the result of an in-service disease or injury. Resolving reasonable doubt in the Veteran's, service connection for sinusitis with polyps is warranted. 2. Entitlement to service connection for the residuals of pilonidal cysts, left buttock scar, is granted. The record establishes the Veteran has a left buttock scar as a residual of the removal of pilonidal cysts. Although the record establishes a cyst was initially removed in January 2000, while the Veteran was not on active duty, he has reported he first noticed a cyst during his advanced individual training during his initial ACDUTRA period and has cited medical literature that indicates pilonidal cysts are a very common problem in the military due to the physical nature of such service. The Veteran has explained he did not seek treatment for his pilonidal cysts in service because he was embarrassed by the location of the cyst and did not want to miss training time for an issue that was not inhibiting him physically due to the possibility that he would have to restart his advanced individual training (AIT) program if he incurred too many absences. The Veteran has further explained he elected to have the cyst removed after separating from ACDUTRA because it was continually aggravated during his subsequent INACDUTRA periods due to repetitive motion exercises like sit-ups that were required during such training periods. Similar to the service connection claim for sinusitis, the Board finds the Veteran's reports of initially incurring a pilonidal cyst during his initial ACDUTRA period credible, as well as competent given his medical training. As the Veteran's nexus statements are both credible and competent, the Board finds his residuals of pilonidal cysts, left buttock scar, is at least as likely as not the result of an in-service disease or injury. Resolving reasonable doubt in the Veteran's, service connection for residuals of pilonidal cysts, left buttock scar, is warranted. 3. Entitlement to service connection for TMJ dysfunction with bruxism is granted. In September 2021, a private psychologist, E.A.D., Ph.D., provided an opinion on the Veteran's behalf that indicates his currently diagnosed TMJ dysfunction with bruxism is proximately due to his service-connected adjustment disorder with anxiety. E.A.D., Ph.D., explained the fact that the Veteran's TMJ dysfunction with bruxism manifest after his deployment to Afghanistan, during which he was exposed to combat-related trauma, supports a finding that the TMJ dysfunction with bruxism manifest is a result of the Veteran's service-connected psychiatric disability. E.A.D., Ph.D., cited extensive research that shows a link between anxiety and bruxism, which is the most common cause of TMJ dysfunction. Thus, the Board finds the Veteran's TMJ dysfunction with bruxism is at least as likely as not proximately due to his service-connected psychiatric disability. Resolving reasonable doubt in the Veteran's favor, service connection for TMJ dysfunction with bruxism is warranted. 4. Entitlement to service connection for a left knee/quadricep disability is granted. 5. Entitlement to service connection for a right knee/quadricep disability is granted. In September 2021, a private orthopedic surgeon, R.D.J., D.O., provided an opinion indicating the Veteran has a bilateral knee/quadricep disability that was at least as likely as not incurred during service. R.D.J., D.O., noted a December 1996 service treatment record that documents in-service treatment for left quadricep pain, as well as the Veteran's credible and competent reports of chronic left quadricep pain since the initial injury, to support a nexus to service for his currently diagnosed left quadricep tendonitis and quadricep strain. Similarly, R.D.J., D.O., noted a March 1997 service treatment record that documents in-service treatment for a right quadricep strain, as well as the Veteran's credible and competent reports of chronic right quadricep pain since the initial injury, to support a nexus to service for his currently diagnosed right quadricep tendonitis and quadricep strain. R.D.J., D.O., explained there is no surgical intervention or treatment available for this type of condition, other than rest, ice, compression, elevation, avoidance, and aggressive stretching and physical therapy, all of which the Veteran has engaged in since the initial injuries, as confirmed by additional treatment records from October 2013, which also corroborate recurrent knee pain and limitation of motion dating back to the initial in-service injuries. R.D.J., D.O., further explained the documented chronic nature of the Veteran's condition suggest it is something he will have to deal with for the rest of his life when engaging in physical activity. The Board acknowledges a February 2017 VA examiner provided a negative nexus opinion regarding the right knee, but the rationale to support this opinion was limited solely to a lack of documented treatment without adequate consideration of the Veteran's credible, competent lay reports. Further, the specialized expertise of R.D.J., D.O., with regard to orthopedic injuries adds to the probative value of his opinion. Thus, the Board finds the Veteran's current bilateral knee/quadricep disability is at least as likely as not the result of an in-service disease or injury. Resolving reasonable doubt in the Veteran's favor, service connection for both a left and a right knee/quadricep disability is warranted. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. S. Kyle, 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.