Citation Nr: 21041078 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 13-32 758 DATE: July 8, 2021 ORDER Entitlement to service connection for a sinus disorder, to include sinusitis and rhinitis, is denied. FINDING OF FACT The preponderance of the evidence is against that the Veteran's sinus disorder had its onset in service or is otherwise related to service, including as secondary to the Veteran's service-connected psychiatric disability. CONCLUSION OF LAW The criteria for service connection for sinus disorder, to include as secondary to service-connected psychiatric disorder, have not been met. 38 U.S.C. §§ 1101, 1110, 1131, 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 June 1977 to August 1977, from January 1984 to October 1989, and from December 1990 to May 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded September 2020 and April 2021. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. That determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). In addition, service connection may be established on a secondary basis for a disability which is shown to be proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310. 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 caused by or aggravated by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran contends that he has a sinus disorder directly attributable to service at Fort Benning. He also contends that his sinus disorder may be secondary to his service-connected psychiatric disability. The Board will address both theories. Direct Service Connection Service connection may be granted on a direct basis, but the preponderance of the evidence is against finding that the Veteran's sinus disorder is related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran currently has a diagnosis of rhinitis with a date of diagnosis in December 2012. See August 2019 VA Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx Disability Benefits Questionnaire (DBQ). Thus, the first element of service connection has been met. Next, the Veteran's service treatment records (STR) are completely devoid of any treatment for or complaint of a sinus disorder. Notable, the Veteran was diagnosed with rhinitis as of December 2012. See id. The Board notes that the Veteran claims while stationed at Fort Benning he suffered a cold which overtime worsened and still exists today. See July 2020 Correspondence. However, the Board finds the Veteran's STR do not support this claim. The STRs are silent for any complaint or treatment of a cold. In addition, the Veteran's medical treatment records after discharge from service are silent for any complaint of or treatment for a cold or any sinus condition. Thus, the Board finds that the Veteran does not meet the second element of direct service connection. The Board also notes that the record is devoid of any evidence that satisfies the third element of service connection. In fact, the Veteran was examined in August 2019. Here, the Veteran reported that he developed worsening sinus trouble about 12 years ago and suffers from daily symptoms described as dizziness, nasal discharge, and headaches. See August 2019 VA Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx DBQ. The examiner also opined that the Veteran's sinus disorder was less likely than not incurred in or caused by his military service. Specifically, the examiner noted that the Veteran did not have an ENT sinus disorder but was diagnosed with sinus tarsitis in December 2013 which is related to the Veteran's service-connected right foot condition. See August 2018 VA Medical Opinion DBQ. Another VA medical opinion was obtained in November 2019. Here, the examiner noted that the Veteran does not have a current sinus disability but acknowledged he has rhinitis. Unfortunately, the Board finds the examiner did not provide an opinion as to whether the Veteran's rhinitis could have been caused by or incurred in service. Therefore, the Board finds this VA medical opinion to be inadequate. See November 2019 VA Medical Opinion DBQ. In accordance with the September 2020 Board remand, a new VA medical opinion was obtained to determine whether the Veteran's diagnosed rhinitis could have resulted from service. Here, the examiner opined that the Veteran's rhinitis was less likely than not incurred in or caused by his military service. Specifically, the examiner noted that after extensive review of the claims file, there was no evidence that during service or within one year from discharge that the Veteran made a complaint or sought medical treatment for any sinus condition. In December 2012, 21 years after separation, he was diagnosed with rhinitis. See December 2020 VA BVA Medical Opinion DBQ. Lastly, an April 2021 VA medical opinion was obtained in accordance with the prior Board remand. Here, the examiner opined that it is less likely than not that the Veteran's sinus disorder was incurred in or caused by his military service. After review of the record, the examiner considered the Veteran's statements describing the onset of his symptoms while at Fort Benning as a cold. While the STRs are devoid of any treatment sought for a cold, the examiner, taking the Veteran's contention as true, determined that there is no medical evidence that this cold has persistent and/or led to a diagnosis of sinusitis. Based on the claims file and medical literature, the examiner noted that one episode of cold symptoms does not lead to a diagnosis of rhinitis or sinusitis. Again, the Veteran was not diagnosed with rhinitis until 21 years after separation. During those 21 years, the Veteran's medical records were silent as to any chronic upper respiratory, rhinitis, sinusitis symptoms. See April 2021 VA BVA Medical Opinion DBQ. Additionally, the Board acknowledges that the Veteran submitted lay statements. The Veteran's friend, Ms. A.C., stated that within the last seven years she personally witnessed the Veteran struggle to clear his throat, try to control his coughing, and deal with incontrollable sneezing. See May 2021 Lay Statement. The Board takes the lay statements into consideration but are thus of markedly lower probative value than, and are outweighed by, the VA medical opinions. In considering the Veteran's contentions, the Board notes that he is competent to observe lay symptoms but does not have the training or credentials to provide a competent opinion as to a diagnosis, the onset date of such diagnosis, or medical causation. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). His lay contentions are thus of markedly lower probative value than, and are outweighed by, the VA medical opinions. Additionally, the lack of any records documenting in-service complaints of sinus symptoms coupled with the lack of an etiology opinion undermines the probative value of the Veteran's contentions. Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). Finally, the Board notes that roughly 21 years passed between the Veteran exiting service and his first diagnosis of rhinitis. Without any competent evidence in support of the Veteran's claim, the Board finds that no medical nexus exists between the Veteran's sinus disorder and service. Accordingly, the claim is denied as to direct service connection, and there is no doubt to be resolved in the Veteran's favor. 38 U.S.C. § 5107(b). Secondary Service Connection The Veteran is also seeking entitlement to service connection for sinus disorder secondary to a service-connected psychiatric disability. As noted above, the first element of secondary service connection is the existence of a present disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Here, the Board finds that the first element of secondary service connection has been satisfied, where the Veteran was diagnosed with rhinitis. As to the second element of secondary service connection, the Veteran must have at least one service-connected disability. The Board finds the Veteran meets the second element, as he is service connected for major depressive disorder with psychotic and anxious distress features. Thus, the Veteran meets the second element of secondary service connection. Here, the third element of secondary service connection, a nexus between the current disability and the service-connected disability, has not been met. The Board reviewed the VA medical opinions and found their determinations probative that the Veteran's disability is not related to his service-connected psychiatric disability. The November 2019 VA examiner opined that the Veteran's sinus disorder was less likely than not proximately due to his service-connected major depressive disorder. The examiner found that there was no diagnosis of a sinus disorder; therefore, the service connection is not possible. See November 2019 VA BVA Medical Opinion DBQ. The December 2020 VA examiner opined that the Veteran's sinus condition was less likely than not proximately due to or the result of the Veteran's service-connected condition. The examiner explained that the Veteran's diagnosed rhinitis is congestion/inflammation of the nasal passages, and his service-connected major depressive disorder represents dysfunction that affects mood, feelings, thinking, and behavior. There is no biologic, anatomic, pathogenic, or epidemiologic relationship between the two conditions. See December 2020 VA BVA Medical Opinion DBQ. In addition, the examiner stated that the Veteran's sinus disorder was not aggravated by his service-connected major depressive disorder, as there is no evidence that it existed prior to service, and, therefore, could not have been aggravated. The February 2021 VA examiner opined that the Veteran's sinus disorder was less likely than not caused by the Veteran's service-connected major depressive disorder. The examiner noted there was no evidence in the Veteran's STRs of a diagnosis or treatment for rhinitis or sinusitis. The Veteran was not diagnosed with rhinitis until 2012, 21 years after separation. Furthermore, there was no evidence of any continuous treatment for this condition until 2015, when he mentioned he suffered from chronic symptoms to his mental health provider. In addition, the examiner opined that the Veteran's sinus condition was less likely than not aggravated by his service-connected major depressive disorder, as his STRs are silent on a preexisting rhinitis or sinusitis condition. Again, this condition did not manifest until 21 years after service. See February 2021 VA BVA Medical Opinion DBQ. Lastly, in April 2021, a VA examiner opined that the Veteran's sinus disorder was less likely than not aggravated by his service-connected major depressive disorder. The examiner, based on the claims file, medical knowledge, and medical literature, found there was no evidence that the current sinus disorder has been aggravated by his service-connected psychiatric disability, as there is no correlation between mental health conditions and a physical diagnosis of rhinitis. See April 2021 VA BVA Medical Opinion DBQ. Again, in considering the Veteran's contentions, the Board notes that he is competent to observe lay symptoms but does not have the training or credentials to provide a competent opinion as to a diagnosis, the onset date of such diagnosis, or medical causation. This includes secondary causation or aggravation, as medical expertise is required to opine as to the causal relationship between two separate disorders. See Jandreau v. Nicholson, supra. His lay contentions are thus of markedly lower probative value than, and are outweighed by, the VA medical opinions. Without any competent evidence in support of the Veteran's claim, the Board finds that no medical nexus exists between the Veteran's sinus disorder and his service-connected major depressive disorder. Accordingly, the claim is denied, and there is no doubt to be resolved in the Veteran's favor. 38 U.S.C. § 5107(b). A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Glaeser, Jennifer 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.