Citation Nr: 21075561 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 13-36 403 DATE: December 20, 2021 ORDER Entitlement to service connection for asthma including as secondary to service-connected sinusitis is denied. FINDING OF FACT The Veteran's asthma is not secondary to service-connected sinusitis, and is not otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for asthma including as secondary to service-connected sinusitis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from June 2000 to December 2004. Most recently, in April 2019, the Board remanded the above issue to obtain a VA opinion, which was rendered in November 2019. The Board is therefore satisfied that there was substantial compliance with its remand orders. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999); Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for asthma including as secondary to service-connected sinusitis is denied. The Veteran contends that her asthma is secondary to service-connected sinusitis. Specifically, she contends that sinusitis caused pharyngitis, which caused bronchitis which ultimately resulted in her asthma. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board's adjudication will consider only entitlement to secondary service connection. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated beyond its natural progress by her service-connected sinusitis. At the outset, the Board acknowledges that the Veteran has a diagnosis of asthma. See September 2010 VA examination. Further, the Veteran is service-connected for sinusitis. Therefore, the only remaining issue is whether a nexus may be established between his asthma and her service-connected sinusitis. In September 2010, the VA examiner concluded that the Veteran's asthma is less likely as not caused by or a result of her service-connected chronic sinusitis. The examiner reasoned that the Veteran's allergic rhinitis and sinusitis seems to have an allergic component. Asthma can also have an allergic component. The examiner noted that while there is no direct link between the sinusitis and asthma, they both may have a common etiology related to allergy. Therefore, the examiner concluded that it is less likely than not that the asthma is directly related to chronic sinusitis as the asthma, allergic rhinitis, and allergic sinusitis are all related to a primary allergy etiology. In in March 2018, the VA examiner opined that the Veteran's asthma was not proximately caused by, or result of, the Veteran's sinusitis, because "the symptoms are caused by environmental allergens not by her sinus condition." The examiner added that the Veteran's contention that sinusitis caused pharyngitis which ultimately caused asthma has not been proven medically in the literature. In November 2019, the VA examiner concluded that it is less likely than not that the Veteran's asthma is aggravated beyond its natural progression by her service-connected chronic sinusitis. The examiner reasoned that there is no evidence in the records provided that the Veteran has chronic sinusitis other than a CT which revealed mild mucosal thickening, which does not necessarily equate to chronic sinusitis. There is no mention of chronic sinusitis in her treatment records from Charleston Allergy and Asthma. There was no mention of chronic sinusitis in the evaluation by J. H., MD, Board Certified Otolaryngologist. In fact, the examiner noted that Dr. H. stated that she has chronic rhinitis and not chronic sinusitis. Nevertheless, the overwhelming medical literature does not show sinusitis or rhinitis causing or worsening asthma. In fact, the examiner noted that the medical literature supports a one airway hypothesis where asthma, rhinitis, and sinusitis coexist and represent similar disease entities. Many experts propose that one should consider patients with asthma as a subgroup of the larger population that has allergic Sino rhinitis. In this Veteran's case, she is allergic to several environmental allergens which will cause her allergic rhinitis to flare, resulting in rhinorrhea and congestion. The same allergen will also cause a similar reaction in her lungs leading to shortness of breath. The examiner opined that the allergic rhinitis did not cause her asthma or vice versa. The symptoms are caused by the environmental allergens, not by her sinus condition (meaning allergic rhinitis). One must consider allergic rhinitis and allergic sinusitis as similar disease processes; however, there is little evidence of chronic sinusitis and no mention of chronic sinusitis in the Veteran's treatment records reviewed. Moreover, the examiner noted that her asthma is not worsened beyond its natural history of the disease and, in fact, her asthma is only mild in nature. The Board finds the September 2010, March 2018, and November 2019 VA opinions, taken together, probative, because they are based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran believes her asthma is proximately due to, the result of, or aggravated beyond its natural progression by her service-connected sinusitis. However, the Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex. Therefore, it is outside the competence of the Veteran in this case because the record does not show that she has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the September 2010, March 2018, and November 2019 VA opinions. Lacking a nexus linking the Veteran's asthma to her service-connected sinusitis, service connection for asthma, including as secondary to service-connected sinusitis, is not warranted. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. E. Grossman, 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.