RHINITIS

Summary

The veteran, who served in the Southwest Asia theater of operations during the Persian Gulf War from November 1981 to January 1993, appeals the denial of service connection for sinusitis, dental trauma, a neck condition, and headaches. The Board granted service connection for allergic rhinitis on a presumptive basis under 38 C.F.R. § 3.320, finding that the veteran's shipboard service in the Red Sea and Arabian Gulf in 1992 constituted qualifying service. The veteran's service treatment records showed complaints of sinus problems during service, and a December 2016 VA examination confirmed a diagnosis of allergic rhinitis, with the veteran reporting symptom onset during service. The Board found the evidence met the criteria for presumptive service connection for allergic rhinitis. The remaining claims were remanded for updated VA treatment records and new VA examinations. For sinusitis, the Board noted the veteran's service complaints but the lack of a current diagnosis in the December 2016 VA exam, requiring clarification on whether a current diagnosis exists or if complaints were manifestations of allergic rhinitis. For dental trauma, the Board noted the veteran's assertion of nerve damage from tooth loss, but the prior VA dental examination was over 10 years old, necessitating a more contemporaneous examination to assess current qualifying disability. For the neck condition, the Board remanded for an updated examination to consider the veteran's testimony of continuing pain since service, treated with prescription medication. For headaches, the Board remanded for an examination to determine if they constitute a stand-alone disability and whether they are related to service or secondary to other conditions.

Rationale

Qualifying service in Southwest Asia theater of operations during Persian Gulf War; Diagnosis of allergic rhinitis confirmed by VA exam; Symptoms manifest within 10 years of separation; No intercurrent cause shown

Full Decision Text

Citation Nr: 22070236
Decision Date: 12/18/22	Archive Date: 12/19/22

DOCKET NO. 16-56 477
DATE: December 18, 2022

ORDER

Entitlement to service connection for allergic rhinitis is granted.

REMANDED

Entitlement to service connection for sinusitis is remanded.

Entitlement to service connection for dental trauma with well restored porcelain fused to metal restorations on endodontically treated maxillary central incisors is remanded.

Entitlement to service connection for a neck condition is remanded.

Entitlement to service connection for headaches, to include as secondary to allergic rhinitis, sinusitis, and a neck condition is remanded.

FINDINGS OF FACT

1. The Veteran is shown to have had qualifying service in the Southwest Asia theater of operations during the Persian Gulf War for 38 C.F.R. § 3.320 purposes.

2. The persuasive evidence of record supports that the Veteran had a diagnosis of allergic rhinitis within 10 years of the date of separation from active service.  

CONCLUSION OF LAW

The criteria for entitlement to service connection for allergic rhinitis on a presumptive basis under 38 C.F.R. § 3.320 have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.320. 

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran served on active duty from November 1981 to July 1986 and October 1989 to January 1993.  

This appeal to the Board of Veterans' Appeals (Board) is from a March 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which is the Agency of Original Jurisdiction (AOJ).

The Veteran testified in support of these claims during a hearing in May 2022 before the undersigned. A transcript of the hearing is of record.

Allergic Rhinitis

The Veteran asserts that his allergic rhinitis is the result of exposure to fine particulate matter while stationed on a ship in the Red Sea and the Arabian Gulf during the Persian Gulf War. 

Under 38 C.F.R. § 3.320, for veterans with qualifying service in the Southwest Asia theater of operations during the Persian Gulf War, service connection may be presumed for certain listed chronic diseases associated with exposure to fine, particulate matter, which listed diseases include: asthma, rhinitis, and sinusitis (to include rhinosinusitis). 

Service connection may be presumed under 38 C.F.R. § 3.320 even though there is no evidence of a listed disease during the period of service if it becomes manifest to any degree (including non-compensable) within 10 years from the date of separation. Exposure to fine, particulate matter shall be presumed under 38 C.F.R. § 3.320 for veterans with qualifying service in the Southwest Asia theater of operations during the Persian Gulf War.

In this case, the Veteran's service personnel records (SPRs) indicate that he was stationed on a ship located in the Red Sea and Arabian Gulf between April and June 1992. This is qualifying service in Southwest Asia for purposes of this presumption. See 38 C.F.R. § 3.320. 

The Veteran's service treatment records (STRs) show multiple complaints of sinus problems during service including at the January 1993 Report of Medical History, completed by the Veteran for his separation from service. The Veteran's diagnosis of allergic rhinitis was confirmed by a December 2016 VA examination. At the examination, the Veteran again reported that he felt this disability onset during service. 

As shown above, the Veteran is shown to have qualifying service in Southwest Asia for 38 C.F.R. § 3.320 purposes, and he currently has diagnosed allergic rhinitis that became manifest within the 10-year presumptive period for presumptive service connection purposes, with no intercurrent cause shown. Therefore, the Board finds that service connection for allergic rhinitis should be presumed under 38 C.F.R. § 3.320, and the claim is granted.

REASONS FOR REMAND

The Board initially notes that all remaining claims must be remanded for VA to obtain updated VA treatment records. Specifically, the record only contains VA treatment records through January 3, 2017, almost six years ago. Because updated VA treatment records could contain pertinent information to the Veteran's claims, such as diagnoses of sinusitis and chronic headaches, a worsening of his dental trauma so that it is eligible for VA disability benefits, or treatment concerning his cervical spine, these claims must be remanded for VA to associate his updated treatment records with the claims file. 

Sinusitis

The record shows that the Veteran complained of sinus problems
38 C.F.R. § 3.320, and the claim is granted.

REASONS FOR REMAND

The Board initially notes that all remaining claims must be remanded for VA to obtain updated VA treatment records. Specifically, the record only contains VA treatment records through January 3, 2017, almost six years ago. Because updated VA treatment records could contain pertinent information to the Veteran's claims, such as diagnoses of sinusitis and chronic headaches, a worsening of his dental trauma so that it is eligible for VA disability benefits, or treatment concerning his cervical spine, these claims must be remanded for VA to associate his updated treatment records with the claims file. 

Sinusitis

The record shows that the Veteran complained of sinus problems multiple times during service. The December 2016 VA examination shows a diagnosis of allergic rhinitis, but no diagnosis of sinusitis. On remand, the Board finds that VA should obtain an updated VA sinus examination to determine whether the Veteran has a current diagnosis of sinusitis, or whether his complaints of sinus problems during service were related, instead, to his allergic rhinitis. 

Dental Trauma

The Veteran asserts that he had a facial injury during service that resulted in the loss of two teeth. The Veteran's STRs confirm that he had his two top front teeth replaced during service. 

Under current VA regulations, service connection for VA compensation purposes is only available for specified dental and oral conditions which are delineated in 38 C.F.R. § 4.150. A Veteran may be entitled to service connection for other dental conditions not listed in section 4.150, including treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease, but for the sole purposes of receiving VA outpatient dental services and treatment, and only if certain criteria are met. 38 U.S.C. § 1712; 38 C.F.R. §§ 3.381(a), 17.161. 

The dental and oral conditions that may be service connected for VA compensation purposes are delineated at 38 C.F.R. § 4.150, Diagnostic Codes 9900-9916. Compensation is also available for loss of teeth but only if such loss is due to loss of substance of body of maxilla or mandible due to trauma or due to disease such as osteomyelitis, but not due to the loss of the alveolar process as a result of periodontal disease. 38 C.F.R. § 4.150, Diagnostic Code 9913, Note.

The Board points out that the Veteran underwent a VA dental conditions examination in June 2011, at which time he was not found to have a dental disability that qualifies for VA disability benefits. However, the Board also points out that at this point, the examination is over 10 years old. The mere passage of time, alone, since an otherwise adequate examination, does not obligate VA to have the Veteran reexamined simply as a matter of course. Palczewski v. Nicholson, 21 Vet. App. 174 (2007) (the passage of time alone, without an allegation of worsening, does not warrant a new examination). However, at the August 2021 Board hearing, the Veteran testified that his tooth loss caused nerve damage, suggesting a worsening of the condition. As a result, remand is required to afford the Veteran a more contemporaneous examination to determine whether he now has a dental disability that qualifies for VA disability benefits.

Neck Condition

The Veteran asserts that he has a neck condition (a cervical spine disability) that is the result of his fall during service. The Veteran underwent a VA examination for this condition in December 2016, at which time he was diagnosed with a cervical strain. However, the examiner, in opining that it was not due to the Veteran's service, stated that there is no evidence to support there has been a chronic ongoing treated condition. At the May 2022 hearing, though, the Veteran testified that he has had neck pain since his fall during service that was treated via prescription by his father, a medical professional. The Veteran is competent to report experiencing neck pain, and his lay assertions must be accounted for by a VA examiner for the opinion to be proper. 

As such, a remand is necessary for the Veteran to undergo an updated VA cervical spine examination and for a VA examiner to consider all the evidence of record, including the Veteran's lay assertions that he has had neck pain since service that he treated with prescription medication. 

Headaches

The Veteran asserts that he has headaches that are either directly related to his fall during service, or, in the alternative, secondary to his cervical spine (neck) or sinusitis/allergic rhinitis. 

The Board points out that the Veteran has not undergone a VA examination for his headaches to determine
 medical professional. The Veteran is competent to report experiencing neck pain, and his lay assertions must be accounted for by a VA examiner for the opinion to be proper. 

As such, a remand is necessary for the Veteran to undergo an updated VA cervical spine examination and for a VA examiner to consider all the evidence of record, including the Veteran's lay assertions that he has had neck pain since service that he treated with prescription medication. 

Headaches

The Veteran asserts that he has headaches that are either directly related to his fall during service, or, in the alternative, secondary to his cervical spine (neck) or sinusitis/allergic rhinitis. 

The Board points out that the Veteran has not undergone a VA examination for his headaches to determine if he has a stand-alone headache disability, or instead, they are a symptom of another disability. The Veteran is competent to state that he suffers from headaches, and at the May 2022 hearing, he testified that he first experienced an onset of headaches after his fall during service, but he also has separate sinus headaches. 

A remand is necessary to obtain a VA examination to determine if the Veteran has a stand-alone headache disability and if so, whether it is either directly related to his service or secondary to a disability. 

The matters are REMANDED for the following action:

1. Obtain the Veteran's VA treatment records for the period from January 3, 2017, to the present. 

2. Schedule the Veteran for a VA examination for his claimed sinusitis. The examiner must review the claims file. The examiner is asked to clarify whether the Veteran has a diagnosis of sinusitis, in addition to his already diagnosed allergic rhinitis, or if his complaints of sinus problems during service were manifestations of his allergic rhinitis. If the Veteran has a separate diagnosis of sinusitis, the examiner is asked to determine whether it onset within 10 years of his separation from service. 

3. Schedule the Veteran for a VA examination for his dental trauma. The examiner must review the claims file. The examiner is asked to clarify whether the Veteran has existing dental trauma that meets the criteria for disability benefits for a dental disability and if so, whether it is the result of his fall and subsequent mouth injury during service that resulted in two teeth replacements. 

4. Schedule the Veteran for a VA examination for his cervical spine. The examiner must review the claims file. The examiner is asked to opine as to whether any cervical spine disability is the result of the Veteran's service, including his fall during service. In providing a rationale, the examiner is asked to consider and comment on the Veteran's May 2022 testimony that after his separation from service, he had continuing neck pain that he treated with prescription medication. 

5. Schedule the Veteran for a VA examination for his headaches. The examiner must review the claims file. The examiner is asked to clarify whether the Veteran has a diagnosis of a stand-alone headache disability, or if his headaches are, instead, a symptom of another disability. 

If the Veteran is diagnosed with a headache disability, the examiner is asked to opine as to the following: 

(a)	Is the Veteran's headache disability caused by his service, including his fall during service?

(b)	Is the Veteran's headache disability either (1) caused by; or (2) aggravated (i.e. worsened) by his now service-connected allergic rhinitis; sinusitis, if diagnosed; or a cervical spine disability?   

The examiner is reminded that in order for a full and complete opinion to be rendered on this aspect, the examiner must address both prongs (1) and (2), and that each of those opinions under prongs (1) and (2) must be supported by a distinct rationale.

(Continued on the next page)

 

The examiner must provide thorough explanations and support for any opinions expressed. If he or she cannot provide the requested opinions without resorting to speculation, he or she must expressly indicate this and provide a supporting rationale as to why that is so.

 

 

J.L. BURROUGHS

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Pak

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.