Citation Nr: 21013531 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 11-15 171A DATE: March 9, 2021 ORDER Entitlement to service connection for rhinitis, including as secondary to status post (s/p) nasal fracture with mild depression of the left nasal bone, is denied. FINDING OF FACT The Veteran’s rhinitis was not incurred in service and is not otherwise related to service or caused or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for service connection for rhinitis, including as secondary to s/p nasal fracture with mild depression of the left nasal bone, have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1977 to October 1980 and July 1991 to November 1991, with additional service in the reserves. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a November 2008 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Manila, the Republic of the Philippines. This case was previously before the Board in May 2014, March 2016, and most recently in September 2019, at which time it was remanded for additional development to include a VA addendum medical opinion addressing the etiology of the Veteran’s rhinitis under a secondary theory of service connection. The record establishes VA requested and obtained an addendum medical opinion. The Board notes that, to the full extent possible, VA complied with all prior remand instructions, and there exist no deficiencies in VA’s duties to notify and assist in that regard. See Stegall v. West, 11 Vet. App. 268 (1998); but see D’Aries v. Peake, 22 Vet. App. 97, 104 (2008). The matter has returned to the Board for further appellate review. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the disease or injury in service and the current disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. However, VA will not concede aggravation unless the baseline level of severity of the non-service-connected disease is established by medical evidence. 38 C.F.R. § 3.310(b). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Determinations as to service connection will be based on a review of the entire evidence of record, to include all pertinent medical evidence. VA must consider all favorable lay evidence of record. See 38 U.S.C. § 5107(b). A Veteran is competent to report on that of which he has actually observed and is within the realm of his personal knowledge. Layno v. Brown, 6 Vet. App. 465 (1994). 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. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Board acknowledges that the Veteran has a current diagnosis of rhinitis. See November 2020 VA sinusitis/rhinitis and other conditions of the nose, sinus, larynx, and pharynx examination. Thus, the only question for the Board is whether the current sinus disability is proximately due to, or aggravated by, his service-connected (s/p) nasal fracture with mild depression of the left nasal bone. The Veteran’s service treatment records (STRs) include a September 1977 Report of Medical History (RMH) for induction wherein the Veteran denied current or previous ear, nose, or throat trouble, and sinusitis. A September 1977 induction examination noted nose and sinuses were normal. An April 1980 treatment record noted the Veteran was hit in the nose by an elbow while paying basketball and a contemporaneous imaging report notes a chip fracture at the distal end of the nasal bones. The Veteran again denied current or previous ear, nose, or throat, and sinus problems in a July 1980 RMH for separation; however, the Veteran’s broken nose and subsequent rhinoplasty are recorded. The July 1980 separation examination indicates his nose and sinuses are normal. An August 1980 treatment record noted no sinus tenderness. The Board observes the STRs also include a December 1995 periodic Report of Medical Examination where the Veteran’s nose and sinuses were noted to be normal. Post-service treatment records include a November 2005 VA otolaryngology outpatient record that noted a nasal endoscopy and nasal sinus deviation to the left. The impression was nasal sinus deviation and hypertrophic rhinitis. An April 2006 follow-up record noted the Veteran started prescription medication to treat symptoms. An October 2016 VA primary care physician record noted diagnoses of allergic rhinitis and septal deviation. The Board acknowledges additional post service treatment records dated throughout the appeal that noted a diagnosis of nasal septal deviation and the prescription of medication to treat symptoms. The claims file includes a November 2005 nose, sinus, larynx, and pharynx examination wherein the examiner confirmed a diagnosis of hypertrophic rhinitis and noted left nasal obstruction greater than the right. Following a physical examination, the examiner noted there was no bacterial, allergic, or vasomotor rhinitis. Left nostril obstruction was noted at 30 percent; right nostril obstruction was noted at 15 percent. There was no etiology opinion. The claims file also includes a March 2007 VA nose, sinus, larynx, and pharynx examination wherein the examiner confirmed a diagnosis of allergic rhinitis. The examiner noted the Veteran’s report of nasal congestion with onset in 1978 after being hit in the nose while playing basketball. The examiner noted a close reduction procedure was done, but the Veteran still reported a deformity on his nose. The report also indicates that the Veteran has been prescribed medication to treat his symptoms including congestion, excess nasal mucous, watery eyes, and sneezing. The examiner noted bilateral nasal obstruction of 30 percent. The report referenced a nasal endoscopy that revealed skewed nasal septum, congested turbinates, and watery nasal discharge. The examiner in a September 2008 VA nose, sinus, larynx, and pharynx examination confirmed a nasal bone deviation that resulted from being hit in the nose during a basketball game. Rhinitis symptoms included nasal congestion and watery eyes. Nasal obstruction was noted at 20 percent bilaterally. No nasal polyps were noted. The Board observes that the claims file includes a February 2009 medical certificate provided by a private treatment provider. The certificate confirms a diagnosis of allergic rhinitis. However, the Board notes that there is no etiology opinion for the Veteran’s rhinitis associated with this record. A separate February 2009 medical opinion from a different private treatment provider confirmed a diagnosis of allergic rhinitis. The provider opined it is more likely than not that the physical trauma to the nose, suffered during active service, caused or contributed to the Veteran’s rhinitis. The Board notes that this etiology opinion is unsupported by a rationale or discussion of current symptoms, and, as such, sheds no further light on the Veteran’s sinus condition. The claims file includes an October 2014 VA medical opinion, based on a review of the record, wherein the examiner opined that it was not as likely as not that the Veteran’s rhinitis was incurred due to an injury, illness, or other event during active service. As a rationale, the examiner noted that a review of the Veteran’s STRs showed no complaints of or treatment for the symptoms attributable to rhinitis. In addition, there was no subsequent consultation or treatment for the nasal bone fracture that would suggest rhinitis was present or was caused by the trauma. The examiner also addressed service connection based on a secondary theory, opining that it is not as likely as not that the Veteran’s rhinitis was incurred as due to his service-connected nasal fracture. The medical opinion also addressed entitlement to service connection based on aggravation. The examiner noted a baseline level of severity could not be established. To support this opinion, the examiner noted the September 2008 VA examination showed 20 percent bilateral nasal obstruction which would not cause aggravation of the Veteran’s rhinitis symptoms. The examiner noted the best way to evaluate the Veteran’s rhinitis would be using radiologic studies. After the Board’s September 2019 remand, the Veteran was afforded a VA sinusitis/rhinitis and other conditions of the nose, throat, larynx and pharynx examination and medical opinion dated November 2020. Following an in-person examination and review of the claims file, the examiner confirmed diagnoses of allergic rhinitis from 2005 and deviated nasal septum (traumatic) from 2008. The examiner noted that the Veteran reported onset in 1977 following nasal trauma; however, the examiner also noted a review of the record revealing that the Veteran had denied nasal symptoms or complaints until 2005 when he was diagnosed with allergic rhinitis. The examiner also noted bilateral nasal obstruction greater than 50 percent but less than complete. No nasal polyps were noted. The report notes that x-rays and a nasal endoscopy were reviewed. In the concurrent medical opinion for secondary service connection, the examiner opined that the Veteran’s rhinitis was less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s (s/p) nasal fracture with mild depression of the left nasal bone. As a rationale, the examiner noted treatment records dated September 1977, July 1980, February 1983, June 1987, and December 1995 showed good health, no medication; no ear, nose, throat trouble. The examiner observed the STRs were silent for complaints of nasal obstruction. The Veteran was first diagnosed with rhinitis in 2005. During subsequent checkups, he was assessed to have allergic rhinitis, which is triggered by breathing in tiny particles of allergens. The most common airborne allergens are dust mites, pollen and spores, and animal skin, urine, and saliva. Allergic rhinitis is not in any way related to a nasal fracture. Additionally, the Veteran’s nasal fracture is stable and completely healed. The diagnosis of allergic rhinitis should be made when history and physical findings are consistent with an allergic cause (e.g., clear rhinorrhea, pale discoloration of nasal mucosa, and red and watery eyes) and one or more of the following symptoms: nasal congestion, runny nose, itchy nose, or sneezing. The Board has considered the Veteran’s lay contentions, but he lacks the training and credentials to provide a competent opinion as to a diagnosis or etiology for his rhinitis. His lay opinion accordingly does not constitute competent and probative evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In short, the preponderance of the evidence is against finding that the Veteran’s rhinitis is etiologically related to active service, or to secondary causation or aggravation due to the s/p nasal fracture with mild depression of the left nasal bone, and the claim must be denied. In the absence of competent evidence supporting the Veteran’s claim for service connection for rhinitis, the Board finds that service connection is not warranted. There is no reasonable doubt to be resolved, and the claim of entitlement to service connection for rhinitis must be denied. See 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Banks, 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.