SINUSITIS

J. SAIKH · 2026 · Case ID: A26031312

MIXED

Summary

The veteran, who served in the Air Force from December 2013 to December 2017, appealed the denial of service connection for sinusitis and thrombocytopenia, and the grant of service connection for an acquired psychiatric disorder. The Board denied service connection for sinusitis, finding no current disability and assigning little probative weight to a private chiropractor's opinion due to lack of competence and inadequate rationale. VA examiners diagnosed allergic rhinitis but not chronic sinusitis, with one opining the condition was less likely than not service-related due to a congenital deviated septum. The Board found the evidence weighed against service connection, thus the benefit of the doubt did not apply. For thrombocytopenia, service treatment records showed a transient, resolved condition. A private chiropractor's opinion was again given little weight due to lack of competence and nexus rationale. A VA examiner found no current diagnosis, stating the 2015 finding was transient and resolved. The Board denied service connection for thrombocytopenia, finding no current disability and that the evidence weighed against entitlement. Service connection for an acquired psychiatric disorder, recharacterized from generalized anxiety disorder and depressive disorder, was granted. The Board found a favorable finding from the AOJ regarding unspecified anxiety disorder, which was not rebutted. While a VA examiner opined against service connection, the Board found their opinion lacked discussion of specific facts and individual circumstances. The Veteran's lay statement detailed in-service traumatic events, including a medical emergency on a flight and fear of seeking mental health care. Finding reasonable doubt regarding the psychiatric disorder's relation to service, the Board resolved the doubt in the Veteran's favor and granted service connection. The claim for right elbow tendinosis was remanded for a new VA examination to assess severity and manifestations, particularly regarding range of motion and the impact of medication, following a duty to assist error identified by the Board.

Rationale

No current disability found; Private chiropractor opinion lacked competence and rationale; VA examiners found allergic rhinitis, not sinusitis; Evidence weighed against service connection

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250408-535826

Full Decision Text

Citation Nr: A26031312
Decision Date: 04/06/26 Archive Date: 04/06/26

DOCKET NO. 250408-535826
DATE: April 6, 2026

ORDER

Entitlement to service connection for sinusitis is denied.

Entitlement to service connection for thrombocytopenia is denied.

Entitlement to service connection for an acquired psychiatric disorder, to include depressive disorder and generalized anxiety disorder is granted.

REMANDED

Entitlement to an initial evaluation in excess of 10 percent for right elbow tendinosis is remanded.

FINDINGS OF FACT

1. The Veteran has not been shown to have had sinusitis at any time since the filing of his claim or within close proximity thereto.

2. The Veteran has not been shown to have had thrombocytopenia at any time since the filing of his claim or within close proximity thereto.

3. The Veteran's acquired psychiatric disorder, claimed as depressive disorder and generalized anxiety disorder, is related to his military service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for sinusitis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.655.

2. The criteria for entitlement to service connection for thrombocytopenia have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.655.

3. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for an acquired psychiatric disorder, claimed as depressive disorder and generalized anxiety disorder, have been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from December 2013 to December 2017.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a March 2025 rating decision.

The Veteran submitted a VA Form 10182 in April 2025 and elected the evidence submission docket. Therefore, the Board may only consider the evidence of record at the time of the March 2025 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a supplemental claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision.

However, because the Board is remanding the claim of entitlement to an initial evaluation in excess of 10 percent for right elbow tendinosis, any evidence that the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103 (c)(2)(ii).

Law and Analysis

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Generally, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service; and (3
.F.R. § 3.103 (c)(2)(ii).

Law and Analysis

In adjudicating these claims, the Board must assess the competence and credibility of the Veteran. Washington v. Nicholson, 19 Vet. App. 362 (2005). Lay testimony is competent to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Falzone v. Brown, 8 Vet. App. 398, 405 (1995) (lay person competent to testify to pain and visible flatness of his feet).

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and 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. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (benefit-of-the-doubt rule not for application when evidence persuasively favors one side or the other).

Sinusitis

The Veteran has contended that he developed sinusitis during his active service, characterized by intermittent runny nose and stuffiness. See November 2020 VA Form 21-526EZ.

The Board finds that the Veteran does not have a current disability associated with his claimed sinusitis and has not had such a disability at any time during the pendency of the claim or recent to the filing thereof. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

The Veteran submitted September 2024 private medical opinions from Dr. A.N. (initials used to protect privacy). She indicated that the Veteran developed sinus issues while stationed in Portugal, including ongoing sinus infections. She noted that, due to these infections, he was advised to undergo a tonsillectomy and adenoidectomy but that both procedures were cancelled when thrombocytopenia was found on his pre-surgical blood work. However, she indicated that he continued to suffer from ongoing sinus issues since service, including congestion of the maxillary and frontal sinuses with difficulty breathing, cough, drainage, throat irritation, and facial pain; she rendered a diagnosis of chronic sinusitis. Thus, she concluded that it was at least as likely as not that his chronic sinusitis was directly and causally related to his service.

The Board assigns the September 2024 private medical opinion regarding sinusitis little probative weight, as the practitioner merely listed evidence before stating her conclusion and did not provide adequate rationale. See Dennis v. Nicholson, 21 Vet. App. 18, 22 (2007). It is also unclear whether Dr. A.N. actually examined the Veteran, as her opinion contains no clinical findings. Furthermore, Dr. A.N. is a licensed chiropractor and has not demonstrated her competence to treat or diagnose a respiratory condition, particularly considering the chiropractic focus on "manipulating the spine and musculoskeletal system." Occupational Outlook Handbook, Chiropractors, U.S. Bureau of Labor Statistics, https://www.bls.gov/ooh/Healthcare/Chiropractors.htm (accessed January 29, 2026). Although Florida law permits chiropractors to use diagnostic tools and testing, there is nothing in law regarding the competency to interpret such testing, nor has the chiropractor disclosed any personal training, experience, or expertise. See 38 C.F.R. § 3.159 (a)(1). Thus, the chiropractor is not qualified to do
chiropractor and has not demonstrated her competence to treat or diagnose a respiratory condition, particularly considering the chiropractic focus on "manipulating the spine and musculoskeletal system." Occupational Outlook Handbook, Chiropractors, U.S. Bureau of Labor Statistics, https://www.bls.gov/ooh/Healthcare/Chiropractors.htm (accessed January 29, 2026). Although Florida law permits chiropractors to use diagnostic tools and testing, there is nothing in law regarding the competency to interpret such testing, nor has the chiropractor disclosed any personal training, experience, or expertise. See 38 C.F.R. § 3.159 (a)(1). Thus, the chiropractor is not qualified to do more than relay the Veteran's lay statements, which does not make those statements competent medical evidence. LeShore v. Brown, 8 Vet. App. 406, 409 (1995).

April 2021, January 2025, and March 2025 VA examiners noted a diagnosis of allergic rhinitis, for which the Veteran is presently service connected, but did not indicate a diagnosis of chronic sinusitis. A March 2025 VA examiner opined that the Veteran's claimed sinusitis was less likely than not incurred in or caused by his service. Although she noted the Veteran's report of sinusitis in service, and an in-service referral for sinus surgery, she asserted that he had a current diagnosis of congenital, non-traumatic, deviated nasal septum which had no nexus to his service. Indeed, the Board acknowledges that August 2015 and October 2015 service treatment records show that the Veteran was diagnosed with chronic adenotonsillitis, a deviated septum, and hypertrophied inferior turbinates, for which he was referred for surgery. However, the Board notes that the Veteran has not claimed service connection for a deviated septum, and that the April 2021 VA examiner attributed his hypertrophied nasal turbinates to his service-connected allergic rhinitis. The Veteran is advised that he may pursue a separate claim for a deviated septum before the AOJ.

The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. §§ 1110, 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that the Veteran currently has a disability for which benefits are claimed.

The Board acknowledges the Veteran's assertion that he has a diagnosis of sinusitis. Although lay persons are competent to provide opinions on some medical issues, Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the diagnosis of sinusitis, falls outside the realm of common knowledge of a lay person, as it is a medical determination involving internal processes and requires diagnostic testing. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).

As the evidence shows that the Veteran does not have a current disability, the Board concludes that service connection is not warranted, and discussion of the remaining elements is not necessary. See Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006) (the absence of any one element will result in denial of service connection). Because the evidence persuasively weighs against entitlement to service connection, the Board concludes that the evidence as a whole is not in approximate balance, and the benefit-of-the-doubt rule does not apply. See Lynch, 21 F.4th at 776. Accordingly, the claim for service connection for sinusitis is denied.

Thrombocytopenia

The Veteran has contended that he has a current diagnosis of thrombocytopenia due to his active service.

Service treatment records from October 2015 and September 2016 indicate that the Veteran had a brief period of mild thrombocytopenia which was treated by a hematologist but subsequently resolved without residuals.

The Veteran received a VA examination for his claimed thrombocytopenia in April 2021. The examiner indicated that the condition was resolved without any current symptoms or treatment. Thus, he concluded that no present diagnosis of a hematologic or lymphatic condition was warranted.

In a September 2024 private medical opinion, Dr. A.N. indicated that the Veteran suffered from fatigue, frequent bruising, and heart palpitations associated with his thrombocytopenia. She rendered a current diagnosis of thrombocytopenia and opined that the condition was at least as likely as not causally related to the Veteran's military service. However, the practitioner failed to provide evidence in support of her conclusions that the condition persisted and was causally related to the Veteran's service. Further, as noted previously, Dr. A.N. is a licensed chiropractor and has not demonstrated her competence to treat or diagnose autoimmune disorders. See LeShore, 8 Vet. App. at 409. Thus, the Board affords the September 2024 private medical opinion little probative weight.

The Veteran received a new VA hematologic and lymphatic conditions examination in March 2025, in which the examiner opined that the Veteran did not have a current diagnosis associated with thrombocytopenia. She indicated that the finding of a low platelet count in 2015 was a transient finding that was determined to be related to a temporary immune response and subsequently resolved on its own without treatment, intervention, or sequelae. Therefore, she concluded that there was no evidence of a chronic thrombocytopenia condition.

The Board acknowledges the Veteran's assertion that he has a diagnosis of thrombocytopenia and that the record demonstrates he was diagnosed with thrombocytopenia during service. However, the diagnosis of thrombocytopenia falls outside the realm of common knowledge of a lay person, as it is a medical determination involving internal processes and requires diagnostic testing. See Jandreau, 492 F.3d at 1377 n.4. In addition, the evidence of record indicates that the Veteran's thrombocytopenia resolved during his active service without sequalae.

As the evidence shows that the Veteran does not have a current disability, the Board concludes that service connection is not warranted, and discussion of the remaining elements is not necessary. See Coburn, 19 Vet. App. at 431. Because the evidence persuasively weighs against entitlement to service connection, the Board concludes that the evidence as a whole is not in approximate balance, and the benefit-of-the-doubt rule does not apply. See Lynch, 21 F.4th at 776. Accordingly, the claim for service connection for thrombocytopenia is denied.

Acquired Psychiatric Disorder

In considering the evidence of record under the laws and regulations as set forth above, the Board finds that the Veteran is entitled to service connection for an acquired psychiatric disorder.

As a preliminary matter, the Board notes that the Veteran initially filed a claim for generalized anxiety disorder and depressive disorder. See December 2024 VA Form 21-526EZ. In light of the Veteran's assertions and the evidence of record, the Board has recharacterized the issue more broadly to encompass any acquired psychiatric disorder, to include generalized anxiety disorder and depressive disorder. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6, 8 (2009).

In the March 2025 decision on appeal, the AOJ made a favorable finding that the Veteran had a current diagnosis of unspecified anxiety disorder. The Board is bound by this favorable finding unless rebutted by evidence that identifies a clear and unmistakable error in the favorable finding. 38 C.F.R. § 3.104 (c).

The Veteran submitted a private September 2024 mental disorders evaluation which noted diagnoses of generalized anxiety disorder and depressive disorder. Specifically, licensed social worker M.P., indicated that the Veteran's generalized anxiety disorder was due to an in-service aircraft incident, and that his depressive disorder was due to his other medical conditions. She opined that the Veteran's psychiatric disorders began during in-service physical training, when he began experiencing pain in his right knee, and as a result of a plane ride following his wisdom teeth removal during which he felt trapped, panicked, fearful, and nauseous. She also indicated that the Veteran feared he would become seriously ill due to his medical conditions, including thrombocytopen
. § 3.104 (c).

The Veteran received a VA mental disorders examination in February 2025 in which the examiner diagnosed the Veteran with unspecified anxiety disorder with associated depression and difficulty sleeping. The examiner indicated that the Veteran's post-military records documented an ongoing adjustment disorder related to an unexpected break up with his girlfriend, which was unrelated to his military service. She concluded that the findings of the September 2024 private medical examination were inconsistent with her examination and were unsubstantiated by the Veteran's medical record. Thus, she opined that there was no clinical certainty that warranted or supported any service-related mental health conditions. Nevertheless, the Board notes that the VA examiner did not discuss facts pertaining to the Veteran's condition or individual circumstances, to include the service-related incidents noted in the September 2024 private medical opinion. See Bailey v. O'Rourke, 30 Vet. App. 54, 60-61 (2018).

In a June 2025 VA Form 21-0781, the Veteran indicated several traumatic in-service events, including a medical emergency on a flight characterized by vomiting and panic during severe turbulence, fear of permanent damage due to ignored chronic illnesses, deception and manipulation by leadership, and living in unsafe, freezing conditions. He asserted that he was afraid to obtain mental health services during service due to fear and anxiety over his security clearance. He also noted that these incidents resulted in anxiety induced overeating, and a lack of ability to make and maintain friendships due to anxiety and depression.

Based on the foregoing, there is at least a reasonable doubt as to whether the Veteran's current acquired psychiatric disorder, diagnosed as an unspecified anxiety disorder, is related to his military service. Thus, resolving any reasonable doubt in favor of the Veteran, the Board concludes that service connection is warranted.

REASONS FOR REMAND

Upon review, the Board finds that a remand is needed to correct a pre-decisional duty to assist error.

The Veteran was afforded a VA elbow and forearm conditions examination in March 2025 during which it was noted that his service-connected right elbow tendinosis was treated with Motrin. Moreover, an April 2021 VA elbow and forearm conditions examination and service treatment records also noted that the Veteran used Motrin to mitigate his right elbow symptoms. In Ingram v. Collins, 38 Vet. App. 130 (2025), the United States Court of Veterans Appeals for Veterans Claims (Court) held that the beneficial medication effects must be discounted and that the baseline severity of the disability must be evaluated when rating disabilities that do not reference medication use. Therefore, the Board finds that an additional examination was needed.

The matter is REMANDED for the following actions:

The Veteran should be afforded a VA examination to ascertain the severity and manifestations of his service-connected right elbow tendinosis. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed.

The examiner is requested to review all pertinent records associated with the claims file.

It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation.

The examiner should report all signs and symptoms necessary for rating the Veteran's right elbow disability. In particular, he or she should test the Veteran's range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing (if applicable). If the examiner is unable to conduct the required testing, he or she should clearly explain so in the report.

The presence of objective evidence of pain, excess fatigability, incoordination, and weakness should also be noted, as should any additional disability (including additional limitation of motion) due to these factors.

The examiner should also discuss any additional functional impairment that occurs during flare-ups, including any additional limitation of motion. To the extent possible, he or she should address the frequency, duration, characteristics, and severity of flare-ups (through an examination, review of the medical records, and/or history provided by the Veteran). The examiner is specifically requested to estimate as to degrees of range of motion lost during flare-ups and/or with repeated use. If the examiner is unable to provide an opinion as to functional loss, he or she should provide an explanation.

In providing the above measurements, the examiner should discount the beneficial effects of any medication the Veteran uses for his service-connected right elbow disability. If the examiner cannot do so without resorting to speculation, he or she should state whether all procurable lay and medical evidence has been considered; whether the inability is due to the limits of the medical community or the limits of the examiner's medical knowledge; and whether there is additional evidence, which if obtained, would permit the opinion to be provided.

A clear rationale should be provided for all opinions.

J. SAIKH

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board R. Carrier, Attorney Advisor

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.

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