Citation Nr: 22017549 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 19-03 574 DATE: March 25, 2022 ORDER Service connection for granulomatous disease in the lungs is granted. Service connection for interstitial lung disease is granted. From March 29, 2016, an increased (compensable) disability rating for the service-connected allergic rhinitis with sinusitis is denied. REMANDED Service connection for bilateral sensorineural hearing loss is remanded. FINDINGS OF FACT 1. The Veteran has a diagnosis of granulomatous disease in the lungs. 2. The granulomatous disease in the lungs began during service and has been present since service separation. 3. The Veteran has a diagnosis of interstitial lung disease. 4. The interstitial lung disease is proximately due to the granulomatous disease in the lungs. 5. From March 29, 2016, the service-connected allergic rhinitis with sinusitis has not manifested as one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting, or allergic rhinitis without polyps but with greater than 50-percent obstruction of nasal passage on both sides or compete obstruction on one side. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for granulomatous disease in the lungs have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for interstitial lung disease, as secondary to the service-connected granulomatous disease in the lungs, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. From March 29, 2016, the criteria for an increased (compensable) disability rating for the service-connected allergic rhinitis with sinusitis have not been met. 38 U.S.C. §§ 1110, 1131, 1155, 5107; 38C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Codes 6513, 6522. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from August 1967 to August 1992. The instant case is on appeal from a July 2016 Department of Veterans Affairs (VA) Regional Office (RO) rating decision that, in pertinent part, denied service connection for a lung disorder (claimed as spots on lungs with shortness of breath), denied service connection for bilateral sensorineural hearing loss, and denied a compensable initial rating for allergic rhinitis with sinusitis. The Veteran testified at a July 2020 Board of Veterans' Appeals (Board) hearing. A copy of the hearing transcript has been associated with the claims file. Service Connection Legal Authority Direct Service Connection Service connection can be granted for a disability resulting from a disease or injury incurred in or aggravated by active 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). Service connection generally requires competent (1) evidence of a current disability; 2) evidence of an in-service incurrence or aggravation of a disease or injury; and 3) evidence of a nexus between the claimed in-service disease or injury and the current disability. Secondary Service Connection Service connection may be granted for a disorder that is proximately due to or the result of a service-connected disability. An increase in severity of a non-service-connected disorder that is proximately due to or the result of a service-connected disability, and not due to the natural progress of the non-service-connected condition, will be service-connected. See 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995). 1. Service Connection for Granulomatous Disease in the Lungs is Granted. The evidence shows a current diagnosis of granulomatous disease in the lungs. See August 2021 VA Examination (diagnosing old healed granulomatous disease in the bilateral lungs); May 2019 Chest X-Ray (diagnosing calcified granulomas in the lung). After a review of all the lay and medical evidence of record, the evidence is at least in relative equipoise on the question of whether the granulomatous disease had its onset during service, such that direct service connection pursuant to 38 C.F.R. § 3.303(d) is warranted. The May 1975 Service Treatment Record found that lateral views of the chest revealed evidence of granulomatous disease. Similarly, a June 1975 Service Treatment Record stated that there was evidence of a prior granulomatous disease in an x-ray. Both of these records demonstrate an in-service incurrence of granulomatous disease in the lungs. When given the results of the records from during service and post-service, the August 2021 VA examiner issued a positive nexus opinion. The August 2021 VA examiner wrote that the old healed granulomatous disease in both lungs is at least as likely as not incurred in or caused by the respiratory issues during service. The August 2021 VA examiner noted that records in 1975 indicated that the Veteran had old healed granulomatous disease in both lungs, which was confirmed on chest x-rays, and subsequent imaging in 1992 and 2012 confirmed the presence of granulomatous disease in the lungs. The August 2021 VA examiner opined that this is a chronic condition and the Veteran is experiencing continuation of the condition from service. Resolving reasonable doubt in favor of the Veteran, the Board finds that service connection for granulomatous disease in the lungs is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Service Connection for Interstitial Lung Disease is Granted. The evidence shows a current diagnosis of interstitial lung disease. See July 2021 Private Disability Benefits Questionnaire; June 2021 Private Opinion by Dr. C.B. (relating a present diagnosis of interstitial lung disease to chemical exposures during service). The evidence is at least in relative equipoise on the question of whether the interstitial lung disease is proximately due to the now service-connected granulomatous disease in the lungs. A May 2021 CT scan found "mild basilar predominant interstitial lung disease of indeterminate etiology, in the setting of sequelae of old pulmonary granulomatous disease." Resolving reasonable doubt in favor of the Veteran, the service connection for interstitial lung disease is warranted as secondary to the now-service-connected granulomatous disease in the lungs. 38 C.F.R. § 3.310. The grant of secondary service connection means that the interstitial lung disease is to be rated as part of the granulomatous disease. 3. A Compensable Disability Rating for Allergic Rhinitis with Sinusitis is Denied. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. § Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of ratings with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Sinusitis under Diagnostic Code 6513 is rated according to the General Rating Formula for Sinusitis at 38 C.F.R. § 4.97. A 0 percent (noncompensable) rating is granted for sinusitis detectable by x-ray only. A 10 percent rating is granted for one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per yar of sinusitis characterized by headaches, pain, and purulent discharge or crusting. See 38 C.F.R. § 4.97. A 30 percent rating is granted for three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. See id. A maximum 50 percent rating is granted following radical surgery with chronic osteomyelitis, or; near constant sinusitis characterized by headaches, pain, and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. See id. Per Note 1, an incapacitating episode of sinusitis means one that requires bed rest and treatment by a physician. Allergic rhinitis under Diagnostic Code 6522 warrants a 10 percent rating when it occurs without polyps, but with greater than 50-percent obstruction of nasal passage on both sides or complete obstruction on one side. A maximum 30 percent rating is given when there are polyps. See id. The Veteran appeals for a compensable rating for allergic rhinitis with sinusitis. For the increased rating period on appeal from March 29, 2016, the Veteran is in receipt of a noncompensable (0 percent) disability rating. After a review of the lay and medical evidence of record, the Board finds that an increased (compensable) disability rating is not warranted. The Veteran participated in two VA examinations during the review period. In May 2016, the VA examiner gave a diagnosis of allergic rhinitis with acute sinusitis. While the Veteran had been prescribed antihistamines, he had not been prescribed antibiotics and had not had surgeries or emergency room or hospital visits. As of the May 2016 examination, there were no findings, signs, or symptoms attributable to the chronic sinusitis, to include no incapacitating or non-incapacitating episodes of sinusitis. Accordingly, a compensable rating for sinusitis is not warranted. Additionally, there was not greater than 50 percent obstruction on both sides of the nasal passage due to rhinitis, complete obstruction on either side, permanent hypertrophy of the nasal turbinates, or nasal polyps. A compensable rating for allergic rhinitis is not warranted. In a June 2020 VA examination, the Veteran reported that he had one non-incapacitating episode of sinusitis characterized by headaches, pain, and purulent discharge or crusting in the past 12 months. He had not had incapacitating episodes requiring prolonged (4-6 week) antibiotic treatment and had not had sinus surgery. Accordingly, the criteria for a compensable disability rating for sinusitis are not met. Similarly, there was not greater than 50 percent obstruction on both sides of the nasal passage due to rhinitis, complete obstruction on either side, permanent hypertrophy of the nasal turbinates, or nasal polyps, so a compensable rating for allergic rhinitis is not warranted. The VA and private treatment records reflect the findings of the VA examinations. For example, there was a notation in May 2019 that the Veteran was treated for a cough and runny nose with Nyquil as needed and an antihistamine. A private treatment record from January 2020 noted the Veteran presented with sinusitis with symptoms for a few days, but the treatment was an over-the-counter allergy antihistamine and to restart an antihistamine nasal spray. The Veteran was given an antibiotic in case the symptoms did not clear up with antihistamines. The Veteran testified at the July 2020 Board hearing that he was treated with different prescriptions for a short period, sometimes four to five days and sometimes a couple of weeks. The records do not demonstrate that the prescriptions lasting more than a few days were for anything other than antihistamines. The record does not reflect any of the findings necessary for a compensable disability rating, such as any incapacitating episodes requiring prolonged antibiotic treatment, three to six non-incapacitating episodes, or greater than 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side. Accordingly, the criteria for a compensable disability rating have not been met. REASONS FOR REMAND 4. Service Connection for Bilateral Sensorineural Hearing Loss is Remanded. The Veteran seeks service connection for bilateral sensorineural hearing loss. In May 2016, the Veteran participated in a VA examination in which the audiologist gave a positive nexus opinion between the bilateral sensorineural hearing loss and service due to acoustic trauma sustained during service. At the time of that examination, however, the criteria for a hearing loss disability under 38 C.F.R. § 3.385 were not met. The Veteran has alleged that the bilateral sensorineural hearing loss has worsened since the May 2016 VA Examination. Accordingly, the Board finds that a new examination is warranted to help determine if the criteria for a hearing loss disability under 38 C.F.R. § 3.385 have been met. The issue is REMANDED for the following action: Obtain an updated VA hearing loss examination. After obtaining the results from the updated examination, readjudicate the claim for service connection for bilateral sensorineural hearing loss. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Smith, 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.