Citation Nr: 21005705 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 18-38 270 DATE: February 2, 2021 ORDER Entitlement to service connection for non-allergic rhinitis, to include as secondary to service-connected traumatic deviated septum, is denied. Entitlement to service connection for sinusitis, to include as secondary to service-connected traumatic deviated septum, is denied. REMANDED Entitlement to an initial rating in excess of 10 percent for bilateral hearing loss is remanded. FINDINGS OF FACT 1. The Veteran’s non-allergic rhinitis is not secondary to service-connected traumatic deviated septum, and is not otherwise related to an in-service injury, event, or disease. 2. The evidence of record is against finding that the Veteran has had sinusitis at any time during or approximate to the pendency of the claim; even if the Veteran has sinusitis that comes and goes, and such condition was simply latent during the appeal period, the evidence is against a finding that sinusitis had onset in service or is otherwise related to an in-service injury, event, or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for non-allergic rhinitis have not been satisfied. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for sinusitis have not been satisfied. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from January 1955 to January 1959, with additional service in the Reserves that included periods of active duty for training (ADT). These matters come before the Board of Veterans’ Appeals (Board) on appeal from an August 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2019, the Board remanded the matters to the Agency of Original Jurisdiction (AOJ) for additional development. Service Connection Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. 1. Non-Allergic Rhinitis The Veteran has a current non-allergic rhinitis disability. See June 2018, January 2020 VA Examination Reports. Thus, the remaining question is whether the current non-allergic rhinitis disability is related to service or a service-connected disability. The Veteran asserts that he was hit in the nose with a rifle during service and underwent surgery for a deviated septum in 1956. See June 2018 VA Examination Report. Since the injury, the Veteran states he has had recurring nose bleeds and sinus infections. Service treatment records show no complaints, diagnosis, or treatment related to a non-allergic rhinitis disability. The Veteran underwent multiple examinations after his active duty service where evaluations of his nose and sinuses were normal. See May 1978, January 1979, February 1980, May 1981, January 1982, January 1983, April 1984, June 1986, August 1986, May 1988, December 1988, October 1989, April 1991, and August 1992 Reports of Medical Examination. In multiple corresponding Reports of Medical History, the Veteran specifically denied having had nose trouble, chronic or frequent colds, sinusitis, and chronic cough. The Veteran presented for a VA examination in June 2018, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. At the examination, the examiner diagnosed non-allergic rhinitis and acute (resolved) sinusitis. The examiner then opined that the Veteran’s disorders were not related to service, to include an in-service nose injury. Following remand by the Board, the Veteran presented for another VA examination in January 2020, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. The examiner opined that it is less likely than not that the Veteran’s chronic rhinitis is related to service, to include his service-connected deviated septum. In support of this conclusion, the examiner explained that the etiology of chronic vasomotor rhinitis is not known, although medical literature describes several factors that can cause vasomotor rhinitis which include smells, dust, fundi, cigarette smoke, humidity, and temperature. The examiner explained that the condition is not associated with any specific allergies and that a high percentage of the population has the condition making it likely that the Veteran had it prior to the military and was not caused by any event therein. The examiner explained that several studies have shown that this form of rhinitis is a persistent condition and is persistent with the majority of patients whether they have served in the military or not, with 52 percent of people reporting worsening symptoms over time. As such, the examiner opined that the Veteran’s allergic rhinitis with its associated postnasal drip and swelling of the nasal turbinates could not be attributed to his service. Regarding secondary service connection, the examiner indicated that he was unable to confirm literature showing that deviation of the nasal septum from trauma is associated with vasomotor rhinitis. In support of this conclusion, the examiner explained that while there is one mention of such relation, the examiner indicated that all standard medical literature fails to name traumatic deviated septum as an etiological factor for non-allergic rhinitis. He also opened that the Veteran’s rhinitis is less likely than not aggravated by this military service. He repeated that the condition occurs in a large percentage of the populations and tends to get worse with age regardless of whether one had served in the military. The Board finds these opinions highly probative as they were made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran. The opinions are also supported by other evidence of record. There is no medical opinion or competent and credible evidence in significant conflict with the VA medical opinion. Upon consideration of the record, the Board finds that service connection for non-allergic rhinitis is not warranted. A review of service treatment record is absent of any indication of non-allergic rhinitis. Further, during VA examinations where the Veteran was examined, the record was reviewed, and after consideration of medical literature, the examiners found that the Veteran’s non-allergic rhinitis was not related to or aggravated by service, to include his service-connected traumatic deviated septum. Thus, the Board gives great probative weight to the VA examinations, and find that service connection on a direct and secondary basis is not warranted. The Board has considered the Veteran’s statements, to include his assertions that his symptoms began during service, to include as due to his service-connected traumatic deviated septum. As the Veteran is not shown to have medical education or experience, he is a lay person and is competent to report (1) symptoms that are observable to a layperson, e.g., sneezing and runny nose; (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis. See Davidson v. Shinseki, 581 F.3d 1313 (2009). The Veteran is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues. Thus, his lay assertions do not constitute evidence upon which service connection can be granted. In any event, the Board ultimately assigns greater probative weight to the medical evidence of record, to include the opinion rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. For the above reasons, the preponderance of the evidence is against the claim and service connection is denied. 2. Sinusitis The Veteran asserts that he has sinusitis that is related to his active duty service. Alternatively, he contends that he has sinusitis that was caused by his service-connected traumatic deviated septum. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. Service treatment records show no complaints, diagnosis, or treatment related to sinusitis. The Veteran underwent multiple examinations after his active duty service where evaluations of his nose and sinuses were normal. See May 1978, January 1979, February 1980, May 1981, January 1982, January 1983, April 1984, June 1986, August 1986, May 1988, December 1988, October 1989, April 1991, and August 1992 Reports of Medical Examination. In multiple corresponding Reports of Medical History, the Veteran specifically denied having had nose trouble, chronic or frequent colds, sinusitis, and chronic cough. The Board notes that the Veteran submitted an ‘intent to file’ in July 2016. Thereafter, he submitted a formal claim for service connection in September 2016. VA and private treatment records during the period on appeal are silent for a diagnosis or treatment for sinusitis. Prior to the appeal period, during March 2009 and April 2009 private treatment, the Veteran was diagnosed with acute sphenoid sinusitis and sinusitis, respectively. In a January 2011 private treatment record, the Veteran was diagnosed with chronic sinusitis. However, after filing of the claim, October 2016, November 2017, July 2018 and September 2018 private treatment records showed clear sinuses and that active sinusitis was not identified. The Veteran presented for a VA examination in June 2018, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. Upon examination, the examiner determined that the Veteran had a diagnosis of acute sinusitis that had resolved. The examiner opined that the claimed condition was less likely than not incurred in service or caused by the claimed in-service injury, event, or illness. The examiner noted treatment for acute sphenoid sinusitis in March 2009; however, a review of a June 2018 x-ray was negative for sinusitis. The examiner further explained that a nexus had not been established as there is no evidence of chronic sinusitis caused by nose injury after being hit by a rifle butt during service. In the March 2019 Board remand, the Board noted that the June 2018 VA examiner did not address the theory of secondary service connection and that it was unclear if the Veteran still has sinusitis. The Board noted the examiner’s indication that the Veteran did have sinusitis, but the condition was not currently affecting any sinus. The Veteran presented for another VA examination in June 2020, at which time he was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. The examiner opined that while the Veteran has had episodes of acute sinusitis based on a review of his records, a current diagnosis could not be established as the treatment records indicate his acute sinusitis had resolved. The examiner further opined that sinusitis is a common condition whether the septum is deviated or not, and therefore, cannot be considered service related especially since the Veteran does not have a diagnosis at the present time. The Board finds these opinions highly probative as they were made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran. The opinions are also supported by other evidence of record. There is no medical opinion or competent and credible evidence in significant conflict with the VA medical opinion. Upon review of the evidence of record, the Board finds that service connection for sinusitis is not warranted. While the Veteran had sinusitis prior to July 2016, the date of the Veteran’s intent to file a claim, the evidence shows that his sinusitis has resolved. Even if it could be said that the Veteran has sinusitis which comes and goes, and was simply latent when he was examined during the appeal period, the overall evidence does not show a current sinusitis disability during the period on appeal and the record is against a finding that it is at least as likely as not that the sinusitis condition had onset in service or was caused by or aggravated by his service-connected deviated septum. The Board has considered the Veteran’s statements, to include his assertions that he has sinusitis that is related to his active duty service, to include as due to service-connected traumatic deviated septum. As the Veteran is not shown to have medical education or experience, he is a lay person and is competent to report (1) symptoms that are observable to a layperson, e.g., nasal discharge; (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis. See Davidson v. Shinseki, 581 F.3d 1313 (2009). The Veteran is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues. Thus, his lay assertions do not constitute evidence upon which service connection can be granted. In any event, the Board ultimately assigns greater probative weight to the medical evidence of record, to include the opinion rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. For the above reasons, the preponderance of the evidence is against the claim and service connection is denied REASONS FOR REMAND While the Board regrets additional delay, a remand is necessary prior to final adjudication for the claim of initial increased rating for service-connected bilateral hearing loss. In an August 2018 substantive brief, the Veteran asserted that his bilateral hearing loss has worsened in severity. As the Veteran has not undergone a VA examination since February 2017 for his bilateral hearing loss, the Board finds that remand is necessary to obtain a new examination. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination to determine the current symptoms, level of severity, and functional impairment associated with his bilateral hearing loss. The claims file should be reviewed by the examiner. C.B. Iwanowski Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mathew 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.