Citation Nr: 21012932 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 07-03 457 DATE: March 8, 2021 ORDER Entitlement to service connection for chronic sinusitis is denied. FINDING OF FACT The Veteran's sinusitis was not manifested in service or for many years thereafter and is not shown to be etiologically related to his service. CONCLUSION OF LAW Service connection for chronic sinusitis is not warranted. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from August 1968 to August 1970. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a July 2006 rating decision. In December 2007, a Travel Board hearing was held before the undersigned; a transcript is in the record. In February 2008, April 2015, and March 2016 this case was remanded for additional development; including to update medical records and arrange for a follow-up examination. The Board finds s that there has been substantial compliance remand instructions; noncompliance has not been alleged. Entitlement to service connection for chronic sinusitis is denied. Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. To substantiate a claim of service connection, there must be evidence of: (1) a current claimed disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a nexus between the disease or injury in service and the current disability. See Shedden v. Principi, 281 F.3d 1163, 1166-67 (Fed. Cir. 2004). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). The Veteran asserts he has had lifelong problems with sinusitis, described as terrible during service in Vietnam (with inability to breathe through his nose and chronic nosebleeds); he reports having headaches and nasal drainage. A September 1969 service treatment record (STR) notes a diagnosis of allergic rhinitis. The Veteran’s July 1970 separation exam documented a history of ear, nose and throat problems, with a normal exam. [Records in the file show he has established service connection for rhinitis.] November 2006 computerized topography (CT scan] showed unremarkable ethmoid sinuses. In April 2007, the Veteran underwent septoplasty for a deviated septum (an assessment of chronic sinusitis was noted). Ia a February 2009 VA medical advisory opinion, the provider (a chief of otolaryngology) noted that a February 2009 CT scan found clear sinuses. The examiner opined that the Veteran does not have chronic sinusitis Thereafter, treatment records show the Veteran’s complaints including on 2012 of sinus pressure waxing and waning throughout the summer, that examination found pain on palpation of maxillary sinuses; in April 2013, he presented with a complaint of sinus pressure and the assessments included sinusitis; and in April April 2014, when he presented with complaints of cough and congestion for four months, examination did not reveal on palpation of the sinuses. When he was seen for ENT complaints in September 2015, the Veteran denied having sinus pressure or headache. He was assessed with chronic rhinitis, and, instructed to dust regularly. The provider indicated that the Veteran did not have the classic signs/symptoms of acute or chronic sinusitis (facial pain, purulent drainage, headaches, nasal airway obstruction) nor was there evidence that such were documented in the medical record in the past. In January 2016, the Veteran reported having sinus congestion, but there was no pain. Examination found normal sinuses. On November 2016 VA examination, the Veteran denied having facial pain or pressure. The examiner noted that the Veteran did not have any signs or symptoms of acute or chronic sinusitis. In a follow-up opinion in January 2017, the examiner noted that the Veteran had several “acute” documented episodes of sinusitis, and that in the normal healthy population one to two episodes of such per year is expected. He did not have any evidence of chronic sinusitis; most likely the etiology for these acute episodes were upper respiratory infections that may have begun as a viral infection. It was noted that the previous notation of “sinusitis” in the Veteran’s record was not by an Ear, Nose, and Throat doctor with a deep knowledge of diseases of the nose/sinuses; rather, it was by a primary care provider. The examiner noted that the primary care provider only documented thick drainage and facial pain (nonspecific symptoms that can be present with any upper respiratory infection). The provider also noted that the October 2006 treatment notes did not show symptoms or findings supportive of a sinusitis diagnosis, only a nonspecific report of nose bleeds and thick mucus on the left side of the Veteran’s nose, and that three separate CT scans did not show any disease in the sinuses or osteomeatal obstruction. The examiner opined, regarding etiology, of any sinusitis noted, that the Veteran may have seasonal or perennial allergies which can contribute to nasal congestion and development of acute sinusitis, and concluded that it is not as least as likely as not that [any] current sinusitis is related to the Veteran’s military service (and the notations of sinusitis and ENT problems treated therein). Chronic sinusitis was not noted in service. While the Veteran had ENT complaints in service, those were manifestations of rhinitis (for which service connection was established). The earliest postservice evidence of record pertaining to sinusitis is in 2006 when he was evaluated for ENT complaints and a CT scan did not find sinusitis pathology. Consequently, service connection for sinusitis on the basis that it presented as chronic is service and has persisted is not warranted. The preponderance of the evidence is also against a finding that the Veteran has a current diagnosis of chronic sinusitis. While treatment records since 2007 in the claims file show that he has been seen for various ENT complaints and sinusitis, whether any sinusitis mentioned reflected a chronic disability that may be related to service/complaints therein or an acute infection that resolved without residuals, is a medical question that requires medical expertise, and is beyond the scope of common knowledge and incapable of resolution by lay observation. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed Cir. 2007). The most probative evidence in the record that addresses that question is in the January 2017 medical advisory opinion that is summarized above. The opinion reflects familiarity with the Veteran’s medical history/the evidence in his claims file, and includes rationale that cites to medical principles and clinical data in the record. The provider explained that acute episodes of sinusitis that resolve are a common phenomenon in the general population (any may be due to seasonal allergies), and cited to the 3 sinus CT scans in the record, none of which found chronic sinus pathology. The provider also noted that no ENT provided has assigned the Veteran a diagnosis of chronic sinusitis, and observed that when a primary care provided noted a diagnosis of sinusitis in the record, the symptoms/findings reported were nonspecific for a chronic sinusitis. Because he is a layperson, the Veteran’s own opinion that he has a chronic sinusitis that arose in service is not competent (and probative) evidence in the matter. He has not presented any medical opinion or treatise evidence indicating that he has a chronic sinusitis that originated in service was reflected by his ENT complaints. The notations of sinusitis in the record are not accompanied by rationale that explains that such is a chronic disability (that was incurred in service), and therefore are insufficient to establish that he has a chronic sinusitis and that it is etiologically related to his service and ENT complaints therein. Therefore, the Board finds the January 2017 VA medical provider’s opinion persuasive. Considering the foregoing, the Board finds that the preponderance of the evidence is against this claim, and that the appeal in the matter must be denied. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Fabian Lokenauth, 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.