CHRONIC SINUSITIS

Summary

The Veteran served on active duty in the Army from June 1989 to October 1992, including service in Operation Desert Storm. He appeals the June 2021 rating decision denying service connection for chronic sinusitis with allergic rhinitis. The Veteran testified that his nasal symptoms began during his Operation Desert Storm deployment due to severe sandstorms, with no prior issues. Post-service records from 1998 onwards documented diagnoses and treatment for chronic sinusitis and allergic rhinitis, including surgery in October 2020 for nasal anatomical obstructions. The Board found the Veteran's testimony credible and noted that the absence of service treatment records documenting the condition does not preclude service connection, citing Dalton v. Nicholson. The Board also found the October 2020 otolaryngology note, which indicated symptom onset post-deployment and no prior trauma, to be more probative than the June 2021 VA examiner's opinion. The examiner's opinion, which found the conditions less likely than not related to service, was criticized for failing to address the Veteran's testimony, the lack of service treatment records, and the presence of Haller cells. The Board concluded that the weight of the evidence favors service connection, granting the claim for chronic sinusitis with allergic rhinitis.

Rationale

Weight of evidence favors service connection; Veteran's testimony regarding symptom onset post-deployment is credible; Absence of service treatment records does not preclude service connection; Post-service medical evidence more probative than VA examiner's opinion

Full Decision Text

Citation Nr: A26038543
Decision Date: 04/24/26	Archive Date: 04/24/26

DOCKET NO. 210802-176386
DATE: April 24, 2026

ORDER

Entitlement to service connection for chronic sinusitis with allergic rhinitis is granted.

FINDING OF FACT

The Veteran's chronic sinusitis with allergic rhinitis began during active service.

CONCLUSION OF LAW

The criteria for service connection for chronic sinusitis with allergic rhinitis have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from June 1989 to October 1992 including service in Operation Desert Storm September 1990 to April 1991.  He also served in the Missouri National Guard and the United States Army Reserves.

This matter is before the Board of Veterans' Appeals (Board) on appeal of a June 2021 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which is the Agency of Original Jurisdiction (AOJ).  

In the August 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  In December 2024, the Veteran appeared at a hearing before the undersigned Veterans Law Judge.  A transcript of the hearing is in the record.  Therefore, the Board may only consider the evidence of record at the time of the June 2021 AOJ decision on appeal, as well as any evidence submitted by the Veteran his or representative at the hearing or within 90 days following the hearing.  38 C.F.R. § 20.302(a).  If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision.  38 C.F.R. §§ 20.300, 20.302(a), 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 claim, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision. 

Service Connection

Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement.  See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Initially, the Board notes that starting August 5, 2021, for Veterans with qualifying service in the Southwest Asia theater of operations during the Persian Gulf War, as is the case here, service connection may be presumed for certain listed chronic diseases associated with exposure to fine, particulate matter even though there is no evidence of such disease during the period of military service.  See 38 C.F.R. § 3.320.  Both sinusitis and rhinitis are subject to compensation under this provision.  38 C.F.R. § 3.320(a)(2).  Service connection may be presumed under 38 C.F.R. § 3.320 if the listed disease becomes manifest to any degree, including noncompensable, at any time following separation from a qualifying period of military service.  Id.

When a Veteran is diagnosed with chronic sinusitis and allergic rhinitis and is found to have been presumptively exposed to fine, particulate matter during active service, service connection will be granted unless there is clear evidence to the contrary, which is not present here.  Considering the foregoing, the Veteran meets all the necessary criteria for presumptive service connection for chronic sinusitis and allergic rhinitis under the provisions of 38 C.F.R. § 3.320 due to presumed exposure to fine particulate matter in Southwest Asia.  38 U.S.C. § 5107(b); 38 C
 to any degree, including noncompensable, at any time following separation from a qualifying period of military service.  Id.

When a Veteran is diagnosed with chronic sinusitis and allergic rhinitis and is found to have been presumptively exposed to fine, particulate matter during active service, service connection will be granted unless there is clear evidence to the contrary, which is not present here.  Considering the foregoing, the Veteran meets all the necessary criteria for presumptive service connection for chronic sinusitis and allergic rhinitis under the provisions of 38 C.F.R. § 3.320 due to presumed exposure to fine particulate matter in Southwest Asia.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102, 3.320.  However, service connection pursuant to 38 C.F.R. § 3.320 is not available until August 5, 2021, after the rating decision on appeal.  Nevertheless, the Board finds the weight of the evidence establishes the Veteran had chronic sinusitis and allergic rhinitis directly resulting from service.  Therefore, the Veteran is entitled to service connection.   

Service treatment records, including the September 1992 separation examination, are silent for any complaints, symptoms, findings, treatment, or diagnosis for either chronic sinusitis or allergic rhinitis.  

The Veteran testified, however, that his nasal symptoms started with his deployment in Operation Desert Storm.  He stated the sandstorms were terrible and he did not wear masks or scarves.  He did not have any problems before service. 

Post service treatment records establish clinicians diagnosed and treated the Veteran for both chronic sinusitis and rhinitis.  In October 2020, he underwent an otolaryngology evaluation.  The clinicians noted a history of problems starting in 1991 after the Veteran returned from Operation Desert Storm with the symptoms worsening over time.  He had no known trauma before service but participated in recreational activities such as football and wrestling.  The clinicians noted the Veteran did not have the classic symptoms of sinusitis but noted he had been receiving treatment for sinusitis.

That same month, the Veteran underwent surgery consisting of septoplasty, bilateral nasal endoscopy with maxillary antrostomy and anterior ethmoidectomy and bilateral inferior turbinate submucous resection.  The surgeon noted a significant posterior septal deviation to the right with deviation of the caudal septum to the left, bilateral Haller cells, and bilateral enlarged inferior turbinates. 

The Veteran has received two VA examinations.  The October 2019 VA examiner diagnosed chronic sinusitis with allergic rhinitis both having an onset in 1991.  The examiner did not make any nexus opinions.

In the June 2021 VA examination, the examiner also diagnosed chronic sinusitis and allergic rhinitis.  The VA examiner concluded that the Veteran's allergic rhinitis, chronic sinusitis, and right-sided septal deviation- surgical septoplasty are less likely than not related to any specific exposure event experienced in Southwest Asia. There are no sinusitis or allergic rhinitis symptoms or treatments documented in the service treatment records. The 1992 exit examination does not list allergic rhinitis or chronic sinusitis symptoms or conditions. The first documented treatment for sinus symptoms is noted in 1998 with antibiotics treatment for one sinus infection per year from 2011 through 2020 when he had his surgery. ENT consultation and nasal endoscopy in 2020.  The Veteran's symptoms have improved since the surgery with no infections.  

The examiner also relied upon the preoperative October 2020 note that the Veteran had engaged in recreational activities before service that could cause nasal trauma.  Finally, the June 2021 VA examiner noted the surgeon found Haller cells or infraorbital ethmoid cells in the ethmoidal pneumatization of the superior aspect of the maxillary sinus and floor of the orbit. They are an anatomical variation that can be associated with orofacial pain and sinusitis, nasal obstruction, headache, and impaired breathing. The examiner cited a medical study finding Haller cells in 10 percent of 300 individuals studied.  Given the endoscopic and CT evidence, the Veteran's sinusitis symptoms are more likely than not related to his nasal anatomical obstruction involving nasal septal deviation and Haller cells.  The examiner also determined that his allergic rhinitis is more likely than not related to regional pollens/grasses. 

After a review of the evidence, the Board concludes that the weight of the evidence weighs in favor of service connection.  The Board finds that the October 2020 preoperative otolaryngology note contained the Veteran's history that his symptoms started with his Desert Storm deployment and continued since that time.  Furthermore, he had not experienced any symptoms prior to service and had no known nasal
 in 10 percent of 300 individuals studied.  Given the endoscopic and CT evidence, the Veteran's sinusitis symptoms are more likely than not related to his nasal anatomical obstruction involving nasal septal deviation and Haller cells.  The examiner also determined that his allergic rhinitis is more likely than not related to regional pollens/grasses. 

After a review of the evidence, the Board concludes that the weight of the evidence weighs in favor of service connection.  The Board finds that the October 2020 preoperative otolaryngology note contained the Veteran's history that his symptoms started with his Desert Storm deployment and continued since that time.  Furthermore, he had not experienced any symptoms prior to service and had no known nasal trauma.  The clinician next noted that the Veteran engaged in recreational activities, football and wrestling, that could result in trauma.  The clinician, however, did not state that these activities are the cause of the Veteran's chronic nasal symptoms especially since there is no known trauma from wrestling or playing football.  Thus, the Board interprets the clinician as concluding the Veteran's onset of symptoms had its onset in service but could not exclude the recreational activities.  Stated another way, the clinician made a finding as likely as not that the Veteran's deployment to the Persian Gulf caused his chronic sinusitis and allergic rhinitis.  

Therefore, the June 2021 VA examiner errored in stating the October 2020 otolaryngologist concluded that preservice injury caused the Veteran's current symptoms.  Second, the VA examiner relied upon the lack of service treatment records documenting sinusitis or rhinitis.  The absence of a disability in service treatment records alone does not preclude service connection.  See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (lack of documented findings is not an adequate basis for a negative opinion).  Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology.   Savage v Gober, 10 Vet. App. 496 (citing Wilson v. Derwinski, 2 Vet. App. 16, 19 (1991)).  Further, VA regulations do not provide that service connection can only be shown through medical records but rather allow for proof through lay evidence.  Smith v. Derwinski, 2 Vet. App. 512, 514-15 (1992). The law specifically provides that service connection may be satisfactorily established by lay evidence without the support of official records.  Sheets v. Derwinski, 2 Vet. App. 512, 514-15 (1992).  Finally, the examiner does not explain how the presence of Haller cells precludes the Veteran's service from at least contributing to the development of the disabilities at issue.

In sum, the Board finds the most probative evidence weighs in favor of the Veteran's chronic sinusitis with allergic rhinitis resulting from service.  Accordingly, the Veteran's claim is granted.

 

 

DUSTIN L. WARE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Veldenz, Russell

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.