Citation Nr: 21009948 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 14-13 911 DATE: February 23, 2021 ORDER Service connection for allergic rhinitis is denied. FINDING OF FACT The Veteran’s allergic rhinitis is not secondary to service-connected eustachian tubes dysfunction (ETD) and is not otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for allergic rhinitis due to service or service-connected disease or injury are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1980 to October 1987. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2011 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In October 2020, the Board remanded the claim for an addendum opinion. There has been substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). 1. Service connection for allergic rhinitis is denied. The Veteran initially filed a claim seeking service connection for sinusitis. In an October 2020 Board decision, service connection for sinusitis was denied due to a lack of a current disability during the pendency of the claim or recent to the filing of the claim. As noted by the Board, a December 2019 VA examiner opined that the evidence does not support a diagnosis of sinusitis and the Veteran’s sinusitis-type symptoms (of mucus, facial pressure, and headaches are manifestations of allergic rhinitis and migraine headaches). The Veteran is service-connected for migraine headaches; hence, the Board remanded the appeal for an addendum opinion to address the etiology of the allergic rhinitis. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). 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 related to service, or is otherwise caused or aggravated beyond its natural progress by service-connected disability. The Board concludes that, while the Veteran has a current diagnosis of allergic rhinitis, the preponderance of the evidence weighs against finding that it is related to service, or is otherwise caused or aggravated by his service-connected ETD. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The Veteran’s service treatment records are silent for any complaints or treatment for allergic rhinitis except for a December 1985 record. The Veteran’s October 1979 enlistment exam noted normal nose, sinuses, mouth, and throat. In the October 1979 report of medical history, the Veteran denied any ear, nose, or throat trouble, or sinusitis. The Veteran’s December 1984 report of examination noted normal nose, sinuses, mouth, and throat. In the December 1984 report of medical history, he denied any ear, nose, or throat trouble, or sinusitis. A December 1985 service treatment record noted “c/o allergic type sxs [symptoms].” It noted that the Veteran is under care of ENT for chronic tonsillitis, and is scheduled for tonsillectomy and adenoidectomy. For impression, “rhinitis ? allergic” was noted. An April 1986 service treatment record noted status post tonsillectomy. It noted right septal deviation, and a septoplasty was scheduled. Another April 1986 service treatment record noted, “S/P tonsillectomy resolved. Schedule septoplasty priority II.” A June 1986 service treatment record noted, “Last Thursday - Septoplasty. Stuffy feeling in nose.” It further noted the results were good. In the September 1987 report of medical history, the Veteran noted “Yes” for sinusitis and ear, nose, or throat trouble. The Veteran’s September 1987 separation exam noted his nose, sinuses, mouth, and throat were normal. Post-service treatment records first document rhinitis in January 2005. In a December 2003 post-service private note, the Veteran complained of hoarseness, nasal congestion, and sore throat. ENT examination noted, “post-nasal drip, throat injected, right fluid behind drum, left tm [tympanic membrane] perforated and injected.” Nasacort was noted. For assessment, otitis media and acute laryngotracheitis without mention of obstruction were noted. In a March 2004 private record, the Veteran complained of nasal congestion and hoarseness. For assessment, ETD was noted. In a January 2005 private record, review of the systems noted “Nose - nasal congestion and rhinitis.” Examination of ENT noted, “left tm injected, dull, retracted, rt tm bulging, clear, post-nasal drip and throat injected.” Current medications included Rhinocort. For assessment, ETD, upper respiratory infection, and myalgia were noted. Private treatment records generally show prescription of Nasacort or Rhinocort from 2003 to 2008. In a June 2014 private treatment record, the Veteran complained of hoarseness. The record noted “chronic rhinitis.” The assessment noted acute laryngitis and chronic eustachian tube salpingitis. VA treatment records note prescription of fluticasone for rhinitis from June 2015 to May 2016. VA treatment records are otherwise silent for any treatment or prescription for rhinitis. The Veteran underwent a VA examination in December 2019 and was diagnosed with allergenic rhinitis. The examiner opined that the rhinitis was not incurred in or related to service. He explained that the Veteran’s service-related activities are unlikely to be the cause of his current allergic rhinitis symptoms given that he still has the symptoms with his current environmental allergens. The examiner added there is no evidence that prior exposure to allergens in the military which gave him allergic symptoms could have worsened his current allergic rhinitis symptoms. The October 2020 Board remand requested an addendum opinion on the likely etiology of the Veteran’s allergic rhinitis – specifically whether it is caused or aggravated by the service-connected ETD. In the November 2020 VA addendum opinion, the examiner opined that the Veteran’s allergic rhinitis is less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner explained that no chronicity of care is documented for allergic rhinitis during active duty service. The examiner added that nasal spray for allergic rhinitis was prescribed in 2003, which was well after active service. The examiner also opined that the Veteran’s allergic rhinitis is less likely than not proximately due to or aggravated by the Veteran’s service-connected ETD. The examiner explained that the conditions of allergic rhinitis and ETD are not medically related. She noted that allergic rhinitis is an entirely separate entity from the ETD, and that a thorough review of medical literature did not demonstrate a causal relationship. She also commented that as the mechanism of allergic rhinitis is entirely unrelated to ETD, no aggravation is plausible. After considering the totality of the evidence of record, the Board finds that service connection for allergic rhinitis is not warranted as there is no competent evidence linking the current disability to the Veteran’s military service. While service treatment records do show a single record of rhinitis in December 1985, follow up records are silent with respect to rhinitis. Significantly, the Veteran’s discharge examination shows his ear, nose, throat, and sinuses were clinically evaluated as normal. Further, the first post-service medical record that documented rhinitis was in 2005. The passage of many years between discharge from active service and clinical record of a claimed disability is a factor that tends to weigh against a claim for service connection. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Further, VA medical opinions of record demonstrate that the Veteran’s allergic rhinitis is less likely than not related to his service or to his service-connected ETD. The VA examiners’ opinions are 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). There is no medical opinion of record to the contrary. The Veteran believes his allergic rhinitis is related to an in-service injury, event, or disease, but he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge and understanding of the interaction between multiple internal systems in the body and their pathophysiology. Therefore, it is outside of his competence se because the record does not show that he has the medical training or credentials 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 VA examiners’ opinion. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim for entitlement to service connection for allergic rhinitis. As such, that doctrine is not applicable. Service connection is not warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Jake Choi, Associate 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.