Citation Nr: 21012561 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 18-23 040 DATE: March 4, 2021 ORDER Entitlement to service connection for a sinus disorder with a deviated septum is denied. FINDING OF FACT The preponderance of the evidence demonstrates that the Veteran’s sinus disorder with a deviated septum was not manifested during service and is not shown to be related to active service. CONCLUSION OF LAW The criteria for entitlement to service connection for a sinus disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the US Army from January 1981 to July 1984 and from November 2004 to November 2006. The Board previously remanded this case for additional development in December 2018 and in November 2020. The matter has now returned to the Board for appellate review. The record reflects that additional VA treatment records were added to the claims file following the issuance of the most recent supplemental statement of the case (SSOC) issued in December 2020. When additional evidence is received prior to the transfer of a case to the Board, a supplemental SOC must be furnished to the Veteran, and his or her representative, unless the additional evidence is duplicative or not relevant to the issue on appeal. 38 C.F.R. § 19.37 (a) (2018). Here, the records were associated with the claims file after the transfer of the appeal to the Board. Furthermore, the additional evidence is immaterial, as it reflects appointment scheduling and adds nothing to the record otherwise before the Board. Accordingly, there is no prejudice to the Veteran in proceeding with adjudication of the appeal. Id. Entitlement to service connection for a sinus disability with a deviated septum The Veteran seeks service connection for a sinus disorder with a deviated septum. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in-service. 38 C.F.R. § 3.303 (d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in-service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Turning to the record, service treatment records (STRs) reveal that while on active service in September 2006 a deviated septum was noted. Additionally, the STRs reflect that while on active service the Veteran was seen for a snoring disorder and complained of nasal discharge and morning headaches. The STRs are silent as to any complaint or diagnosis of a sinus disorder. However, the STRs reveal that in July 2005, the Veteran was prescribed a nasal spray. VA treatment records from June 2011 reveal that that Veteran was diagnosed with allergic rhinitis and snoring, likely secondary to sinusitis. In November 2017, the Veteran was afforded a VA examination in connection with her claim. At the time of the examination, the Veteran was diagnosed with acute sinusitis. The Veteran reported that her sinus disorder began during active military service that it has continued since service, to include experiencing morning headaches and stuffy nose. The examiner noted that the Veteran did not have any symptoms attributable to chronic sinusitis. Diagnostic testing was negative for sinusitis. Further, the examiner remarked that there was no treatment for sinusitis in the Veteran’s record; rather, there was only the note of the deviated septum in 2006. Pursuant to the Board’s December 2018 remand, another VA examination was conducted in November 2019. The examiner confirmed diagnoses of allergic rhinitis and acute sinusitis. The Veteran reported headaches, post-nasal drip, and sore throat. She reported that sinusitis was diagnosed in 2006. The Veteran denied having any nasal trauma. The examiner determined that there was no diagnostic testing that revealed a diagnosis of a deviated septum. Further, the examiner found that there was no obvious deformity of the Veteran’s nasal cavity. Ultimately, the examiner opined that the Veteran’s claimed deviated septum was less likely than not incurred in or caused by the Veteran’s active military service. In support of this conclusion the examiner explained that there was no objective evidence of a chronic sinus condition or deviated septum diagnosed or treated on active duty. Also, there the examiner noted that there was a lack of objective or subjective evidence of a traumatic event to render a diagnosis of deviated nasal septum. In November 2020, another VA medical opinion was obtained in accordance with the Board’s November 2020 remand. Regarding the reported nasal septum deviation, the examiner reported these were either congenital or caused by trauma. It was indicated that there was no history of trauma noted, and that in fact, several examinations after the in-service finding had failed to reveal a deviated nasal septum. This included X-ay findings of November 2017 which were negative, and it was noted a deviated nasal septum was not on any list of active problems being treated. The examiner further explained that the Veteran was diagnosed with acute sinusitis twice, in November 2017 and in December 2018, but this did not constitute a chronic sinus disability. In particular, the examiner noted that there was no evidence in the record to indicate that the Veteran had ever been diagnosed with chronic sinusitis and that the Veteran denied being treated with antibiotics for her claimed sinus disorder. The examiner went on to explain that there was no known pathophysiological mechanism to explain how the Veteran’s allergic rhinitis or acute sinusitis would be due to headaches. Rather, the examiner indicated that patients suffering from obstructive sleep apnea were more at risk for morning headaches. Therefore, the examiner opined that it was less likely than not that any currently diagnosed disorders related to the Veteran’s claimed allergic rhinitis and acute sinusitis were less likely than not incurred in or caused by the Veteran’s active military service, to include a deviated septum and in-service headaches. In light of the above, the Board determines that a preponderance of the evidence shows that the Veteran’s sinus disorder with deviated septum was not incurred in or caused by the Veteran’s active military service. Specifically, the VA examinations of record indicate that while the Veteran had a diagnosis of acute sinusitis, the Veteran did not have a diagnosis of chronic sinusitis, nor did the Veteran have a diagnosis of a deviated septum. The apparent incidental finding recorded in service has not been confirmed, including by X-ray study. Moreover, there has been no reported trauma to the nose in service. Additionally, the competent medical evidence of record indicates that the Veteran’s morning headaches likely were attributable to non-service-connected obstructive sleep apnea. The Board acknowledges that the Veteran herself has claimed her sinus disorder with deviated septum is directly related to his active service. However, while the Veteran is competent to report (1) symptoms observable to a layperson, e.g., nasal discharge; (2) a diagnosis that is later confirmed by clinical findings; or (3) a contemporary diagnosis, she is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (2009). Consequently, the Veteran’s lay assertions of medical diagnosis or etiology are afforded little probative value and cannot constitute evidence upon which to grant the claim for service connection. Latham v. Brown, 7 Vet. App. 359, 365 (1995). As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Scanlan, 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.