Citation Nr: 21028298 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 15-12 292 DATE: May 10, 2021 ORDER Service connection for sinusitis, to include as secondary to service-connected asthma is denied. Service connection for rhinitis, to include as secondary to service-connected asthma is denied. Service connection for bronchitis, to include as secondary to asthma is denied. Service connection for gastroesophageal reflux disease (GERD), to include as secondary to asthma is denied. FINDINGS OF FACT 1. The most probative evidence is against a finding that the Veteran's sinusitis, is related to active service or was caused or aggravated by his service-connected asthma. 2. The most probative evidence is against a finding that the Veteran's rhinitis, is related to active service or was caused or aggravated by his service-connected asthma. 3. The most probative evidence is against a finding that the Veteran's bronchitis, is related to active service or was caused or aggravated by his service-connected asthma. 4. The most probative evidence is against a finding that the Veteran's GERD, is related to active service or was caused or aggravated by his service-connected asthma. CONCLUSIONS OF LAW 1. The criteria for service connection for sinusitis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 2. The criteria for service connection for rhinitis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. 3. criteria for service connection for bronchitis have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307. 4. The criteria for service connection for GERD have not been met. 38 U.S.C. § 1101, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1981 to August 1985. These matters come before the Board of Veterans' Appeals (Board) on appeal of a July 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The case was previously before the Board in November 2018. At that time, the Board remanded the case for additional development. The Board finds that there has been substantial compliance with its prior remand directives. See Stegall v. West, 11. Vet. App. 268 (1998). Service Connection 1. Service connection for sinusitis, to include secondary to service-connected asthma 2. Service connection for rhinitis, to include as secondary to service-connected asthma 3. Service connection for bronchitis, to include as secondary to asthma 4. Service connection for gastroesophageal reflux disease (GERD), to include as secondary to asthma As there is considerable overlap in the applicable evidence for the Veteran's claims, the Board will discuss them together. Legal Criteria Service connection may be granted for a disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C. § 1110. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. § 3.303(d). Certain disabilities, including arthritis, organic neurological disorders, and psychoses, are presumed to be serviced connected if manifested to a compensable degree within one year following service. 38 C.F.R. §§ 3.303, 3.307, 3.309. Under 38 C.F.R. § § 3.310(a), service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Factual Background The Veteran contends that his sinusitis, rhinitis, bronchitis, and GERD, are caused or aggravated by his service-connected asthma. The Veteran's service treatment records document an in-service diagnosis of small airway disease. The Veteran submitted a January 2011 private medical opinion authored by Dr. J.H. The private physician opined that the Veteran's sinusitis, rhinitis, bronchitis, and GERD are due to his military service, to include the in-service diagnosis of a small airway disease. Bronchitis In a January 2011 VA examination report, the Veteran was diagnosed with chronic bronchitis. The Veteran reported he does not remember any specific treatment for bronchitis until 2005 but recently he started noticing shortness with exercise. The examiner opined it is less likely as not the Veterans current bronchitis is caused by his service-connected asthma. The examiner explained bronchitis is inflammation of the mucous membranes of the bronchi, the airways that carry airflow from the trachea into the lungs. The noted the Veteran's condition during service was exercised induced asthma and resolved once out of service. According to the examiner the Veteran's bronchitis which is an inflammatory condition, did not start until 2005 per history and documentation. At a VA examination in April 2019, the examiner opined the Veteran's bronchitis was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted review of the Veteran's file which showed bronchitis was diagnosed after service. The examiner explained the pathology of chronic bronchitis includes an inflammatory mononuclear cell infiltrate in the airway wall and a neutrophil influx into the airway lumen. Additionally, the examiner explained this pathophysiology differs from that of asthma. The VA examiner opined that it was less likely than not that the Veteran's bronchitis was proximately due to or the result of his service-connected asthma. The examiner explained that the conditions are not medically related. According to the VA examiner, the claimed disorder is a separate entity entirely from the service-connected condition and unrelated to it. The examiner also stated there is no medical literature to support a medical relationship. Additionally, the examiner opined the Veteran's bronchitis was not aggravated beyond the natural progression by his service-connected asthma. The examiner explained chronic bronchitis is characterized by inflammation. The examiner cited to the medical literature that the asthma and chronic bronchitis involve inflammation, but asthma does not aggravate bronchitis. Rhinitis and Sinusitis A June 2012 VA examination report noted a diagnosis of rhinitis and sinusitis. The report documented that in a November 2007 private medical record the Veteran was seen for his bronchitis and the physician stated the rhinitis and sinusitis is contributing to the Veteran's bronchitis. The examiner opined it is less likely as not that the Veteran's current rhinitis/sinusitis are the result of his service-connected asthma. The examiner explained medical literature shows post-nasal drip associated with any form of chronic rhinitis or sinusitis can worsen asthma symptoms. Additionally, the examiner stated literature does not state that rhinitis/sinusitis are the result of asthma. Also, per the Veteran's records his bronchitic condition and not asthmatic condition was worsened by rhinosinusitis. The Veteran received a VA examination in April 2019. The examiner opined the claimed sinusitis and rhinitis were less likely than not incurred or caused by the claimed in-service injury, event, or illness. The examiner noted review of the Veteran's claims file which showed a sinusitis and rhinitis symptoms began after service. According the examiner the medical literature there is no clear evidence reactive airway disease (asthma) causes sinusitis. Additionally, sinusitis and rhinitis can worsen asthma, but it is not clear that asthma causes either condition. The VA examiner opined that it was less likely than not that the Veteran's sinusitis and rhinitis are proximately due to or the result of his service-connected asthma. The examiner explained the claimed disorders are separate entities entirely from the service-connected asthma and is unrelated. Additionally, the examiner stated the medical literature does not support a medical relationship. Additionally, the examiner opined the Veteran's sinusitis and rhinitis was not aggravated beyond the natural progression by his service-connected asthma. The examiner explained per the medical literature there is no clear evidence that reactive airway disease (asthma) causes sinusitis or aggravates sinusitis. Additionally, sinusitis and rhinitis can worsen asthma, but it is not clear that asthma causes sinusitis. GERD In a June 2012 VA examination report noted a diagnosis of GERD. He reported intermittent symptoms of heart bun/reflux. The examiner opined it is less likely as not that the Veteran's GERD is due to or the result of his asthma. The examiner noted review of the Veteran's file and noted onset of GERD three years ago. The examiner explained the reason some people develop GERD is unclear; however, research shows that the lower esophageal sphincter relaxes while the rest of the esophagus is working. According to the VA examiner, there is no medical literature found to support a direct causal relationship of asthma a small airway disease. The examiner, however, did not address whether or not the Veteran's GERD was aggravated beyond the natural progression by his service-connected asthma. The Veteran underwent a VA examination in April 2019. The Veteran reported he was first diagnosed with GERD around November 2001. He reported he was experiencing heartburn/reflux that is unrelieved by turns and presented to his doctor who prescribed medication. He said he continues to have symptoms, but no longer aspirates at night. He has intermittent burning in the chest up near the throat, like heartburn. The Veteran denied reflux, nausea, and vomiting at this time. The VA examiner opined the Veteran's GERD was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted the symptoms of GERD did not began until after service. The examiner explained, there is no rationale to explain a relationship between in-service diagnosis of small airway disease and GERD. The VA examiner opined that it was less likely than not that the Veteran's gastrointestinal condition was proximately due to or the result of his service-connected asthma. The examiner explained that the conditions are not medically related. According to the VA examiner, the claimed disorder is a separate entity entirely from the service-connected condition and unrelated to it. The examiner also stated there is no medical literature to support a medical relationship. Additionally, the examiner opined the Veteran's GERD was not aggravated beyond the natural progression by his service-connected asthma. The examiner explained medical literature states there is a possible associate between GERD and asthma in pediatric patients seen with asthma in referral settings. However, based on the medical literature there is no rationale to explain a relationship that supports that asthma causes GERD or aggravates GERD. Analysis The Board has not overlooked the Veteran's statements about his sinusitis, rhinitis, bronchitis, and GERD. While the Veteran is competent to observe his gastrointestinal symptoms, he does not have the training or credentials to provide a competent opinion as to the cause of his sinusitis, rhinitis, bronchitis, and GERD or whether they are related to active service, or were caused or aggravated by his already service-connected asthma. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The January 2011 private medical opinion supports the Veteran's claims. However, the examiner provided no supporting explanation and thus is insufficient to support a grant of service connection. The Board finds that the April 2019 examination reports finding no connection between the Veteran's sinusitis, rhinitis, bronchitis, and GERD to active service or his service-connected asthma to be the most probative evidence of record, as the examiner reviewed the claims file and provided a detailed rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). There is nothing in his claims file to support his claims for service connection. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Braxton, 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.