SINUSITIS

Summary

The Veteran served in the United States Navy from November 1997 to August 2005, including deployment to Bahrain in the Persian Gulf in 2000. The Veteran appealed the denial of service connection for sinusitis, while service connection for chronic lower back pain, right knee pain, left knee pain, neck pain, and GERD were remanded. The Board denied the sinusitis claim, finding that the persuasive weight of the evidence did not support a current sinusitis disability or an undiagnosed illness manifested by sinusitis. While the Veteran reported respiratory symptoms and received treatment during service, and was later diagnosed with asthma and chronic migraines, the VA examinations in March 2023 and November 2024 found no objective findings consistent with sinusitis. The March 2023 examination noted clear paranasal sinuses on X-ray, and the November 2024 examination found insufficient objective evidence to diagnose sinusitis despite the Veteran's reported symptoms. The Board acknowledged the potential presumption for sinusitis under 38 C.F.R. § 3.320 for Gulf War Veterans but found no objective development of the condition. The Board remanded the remaining claims due to a duty to assist error, specifically the failure to obtain potentially relevant private treatment records from Dr. D.B. and L.C., a nurse practitioner, which referenced in-service injuries and ongoing treatment for the Veteran's musculoskeletal and GERD conditions.

Rationale

No objective findings of sinusitis on VA examinations; March 2023 and November 2024 VA examinations showed clear paranasal sinuses and insufficient objective evidence; No post-service treatment records for sinusitis

Full Decision Text

Citation Nr: A26040690
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 250228-521788
DATE: April 30, 2026

ORDER

Entitlement to service connection for a sinusitis disability is denied.

REMANDED

Entitlement to service connection for chronic lower back pain is remanded.

Entitlement to service connection for chronic right knee pain is remanded.

Entitlement to service connection for chronic left knee pain is remanded.

Entitlement to service connection for chronic neck pain is remanded.

Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded.

FINDING OF FACT

The persuasive weight of the evidence is against a finding that the Veteran has sinusitis or had sinusitis during the pendency of this appeal or that he had an undiagnosed illness or a diagnosed medically unexplained chronic multi-symptom illness (MUCMI) manifested by sinusitis during the pendency of this appeal.

CONCLUSION OF LAW

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.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Navy from November 1997 to August 2005.  

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a February 2025 rating decision issued by a VA Regional Office, the agency of original jurisdiction (AOJ).  

In the February 2025 VA Form 10182, Notice of Disagreement (NOD), the Veteran elected the Direct Review docket.  Therefore, the Board may only consider the evidence of record at the time of the February 2025 rating decision on appeal. 38 C.F.R. § 20.301.  Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board.  38 C.F.R. §§ 20.300, 20.301, 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. 

However, because the Board is remanding the Veteran's service connection claims for his right knee, left knee, lower back, neck, and GERD, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims.  38 C.F.R. § 3.103(c)(2)(ii).

1. Entitlement to service connection for a sinusitis disability is denied.

The Veteran asserts that he has sinusitis which began during his active-duty service in the Southwest Asia Theater of operations.  See November 2024 VA Sinusitis Examination.  

Generally, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.  The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury.  Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Further, special service connection rules exist for Gulf War Veterans.  38 U.S.C. § § 1117; 38 C.F.R. § 3.317.  The Southwest Asia theater of operations includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations.  38 C.F.R. § 3.317(e)(2).

Under that section, service connection may be warranted for a Gulf War veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval or air service in the Southwest Asia theater of operations during the Gulf War.  For disability due to undiagnosed illness and medically unexplained
.F.R. § 3.317.  The Southwest Asia theater of operations includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations.  38 C.F.R. § 3.317(e)(2).

Under that section, service connection may be warranted for a Gulf War veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval or air service in the Southwest Asia theater of operations during the Gulf War.  For disability due to undiagnosed illness and medically unexplained chronic multi-symptom illness (MUCMI), the disability must have been manifest either during active military service in the Southwest Asia theater of operations or to a degree of 10 percent or more not later than December 31, 2026.  See 38 C.F.R. § 3.317(a)(1).

Additionally, effective August 5, 2021, 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, including: 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 noncompensable) at any time following separation from a qualifying period of military service.  Exposure to fine, particular 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.

Notwithstanding the foregoing presumption provisions, a claimant is not precluded from establishing service connection for a disability due to Gulf War exposures with proof of direct causation.  Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); Ramey v. Brown, 9 Vet. App. 40, 44 (1996), aff'd sub nom, Ramey v. Gober, 120 F.3d 1239 (Fed. Cir. 1997), cert. denied, 118 S. Ct. 1171 (1998).

In making all determinations, the Board must fully consider the lay assertions of record.  A layperson is competent to report on the onset and continuity of his current symptomatology.  See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition; (2) the layperson is reporting a contemporaneous medical diagnosis; or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.  Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d at 1376-77.  When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent.  Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1376-77.

In rendering this decision, the Board has reviewed all evidence of record whether discussed in detail.  See Newhouse v. Nicholson, 497 F.3d 1298, 1302 (Fed. Cir. 2007) (holding the Board must only discuss the evidence which is relevant to the issues on appeal).  To the extent the evidence is found in "approximate balance," the Board will afford the benefit of the doubt in favor of the Veteran. Lynch v. McDonough, 21 F. 4th 776 (Fed, Cir. 2021) (holding that exact equipoise is not required for the benefit of the doubt to be applied, but rather the Veteran is entitled to the benefit of the doubt when the evidence is in approximate balance or "nearly equal").

Turning to the relevant evidence of record, the Veteran's service treatment records document respiratory complaints and treatment.  In March 2003, the Veteran reported experiencing recurring headaches
7) (holding the Board must only discuss the evidence which is relevant to the issues on appeal).  To the extent the evidence is found in "approximate balance," the Board will afford the benefit of the doubt in favor of the Veteran. Lynch v. McDonough, 21 F. 4th 776 (Fed, Cir. 2021) (holding that exact equipoise is not required for the benefit of the doubt to be applied, but rather the Veteran is entitled to the benefit of the doubt when the evidence is in approximate balance or "nearly equal").

Turning to the relevant evidence of record, the Veteran's service treatment records document respiratory complaints and treatment.  In March 2003, the Veteran reported experiencing recurring headaches as well as nose bleeds that occurred once every two to three months.  The Veteran was assessed with headaches and recurrent nosebleed.  In April 2003, the Veteran complained of cough, congestion, being winded, postnasal drip, sinus pressure, and headaches and was prescribed albuterol.  In May 2004, the Veteran was again noted with persistent coughing and a past history of spring and summer allergy problems.  The provider noted that given the Veteran's history and past response to steroids and albuterol, asthma is a likely diagnosis.  May 2004 Service Treatment Record.  The Veteran was noted to have an additional uncomplicated upper respiratory infection in April 2005 which was most likely viral.  

Upon separation, the Veteran denied experiencing sinusitis, frequent colds, or ear, nose, and throat trouble.  July 2005 Report of Medical History.  The Veteran endorsed asthma, breathing problems related to weather and pollens, and shortness of breath.  Id.  The Veteran's report of medical assessment noted no problems, and the Veteran was not referred for further evaluation.  July 2005 Report of Medical Assessment.  

The Board notes that the Veteran has relevantly been awarded service connection for chronic migraines and asthma.  See December 2024 Rating Decision.  As it pertains to the Veteran's claimed sinusitis disability, however, the Board finds service connection is not warranted as the persuasive weight of the evidence is against a finding that the Veteran has a separate sinusitis disability or had such a disability during the pendency of this appeal or that he has an undiagnosed illness or a diagnosed medically unexplained chronic multi-symptom illness (MUCMI) manifested by sinusitis. 

The Veteran's military personnel records establish that the Veteran was deployed to Bahrain in the Persian Gulf in 2000.  The Veteran was afforded a Gulf War Examination in March 2023 which relevantly noted the Veteran's claimed headaches, respiratory conditions, and sinusitis.  The Gulf War examination found that there were no diagnosed illnesses for which no etiology was established from the conditions in which separate VA examinations were completed, and there further no additional signs or symptoms that were not addressed through the completed VA examinations.  March 2023 VA Gulf War Examination.  

The Veteran's March 2023 VA sinusitis examination reflected no diagnosis of a sinus, nose, throat, larynx, or pharynx condition.  The March 2023 VA examiner noted that the Veteran's episodes of nasal symptoms were self-resolving and that there are no current findings, signs, and/or symptoms to support a sinusitis or upper respiratory infection diagnosis.  March 2023 VA Sinusitis Examination.  The examiner additionally pointed to March 2023 negative x-rays of the Veteran's paranasal sinuses which showed the paranasal sinuses to be clear throughout, with intact mucosal and bony margins.  Id.  

The Veteran was afforded an additional November 2024 VA examination pertaining to his claimed sinusitis condition.  The November 2024 VA examiner similarly found no diagnosis of a sinus, nose, throat, larynx, or pharynx condition.  The examiner noted the Veteran's reported symptoms of chronic cough, uncontrolled nose bleeds a few times a week, phlegm production, and shortness of breath, but stated there was insufficient objective evidence found to diagnose a condition at this time as the Veteran's subjective complaints did not correlate with objective findings.  November 2024 VA Sinusitis Examination.  The November 2024 VA examiner also cited the March 2023 imaging of the Veteran's paranasal sinuses.  

There are further no post-service treatment records to consider as it pertains to the Veteran's claimed sinusitis.  In this regard, there is no evidence of, and the Veteran has not submitted or asserted that he has had any treatment for, sinusitis complaints.

Given the forgoing, the persuasive weight of the evidence does not support that the Veteran has a sinusitis disability (or had such a disability during the pendency of this appeal
 insufficient objective evidence found to diagnose a condition at this time as the Veteran's subjective complaints did not correlate with objective findings.  November 2024 VA Sinusitis Examination.  The November 2024 VA examiner also cited the March 2023 imaging of the Veteran's paranasal sinuses.  

There are further no post-service treatment records to consider as it pertains to the Veteran's claimed sinusitis.  In this regard, there is no evidence of, and the Veteran has not submitted or asserted that he has had any treatment for, sinusitis complaints.

Given the forgoing, the persuasive weight of the evidence does not support that the Veteran has a sinusitis disability (or had such a disability during the pendency of this appeal), or an undiagnosed illness manifested by sinus-related symptoms, or a diagnosed MUCMI manifested by sinusitis.  As noted above, service connection may be presumed for certain listed chronic diseases including sinusitis associated with exposure to fine, particulate matter during Persian Gulf service.  However, there is no evidence that sinusitis has objectively developed at any time since the Veteran's separation from service.  The Board acknowledges the Veteran's reported symptomatology, but these manifestations have not been attributed to a chronic disability.  Indeed, March 2023 imaging of the Veteran's paranasal sinuses was normal, and no medical professional has observed objective signs, symptoms, or findings consistent with any chronic sinus disability even after consideration of the Veteran's reported symptomatology.

For these reasons, the Board concludes the Veteran does not have a current sinus-related disability for VA purposes and did not have one during the pendency of the appeal.  See 38 U.S.C. § 1110; Larson v. McDonough, 10 F.4th 1325 (Fed. Cir. 2021); see also McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. §§ 3.317, 3.320.  

The Veteran, however, is not precluded from filing a supplemental claim if or when he ever develops sinusitis.  See 38 C.F.R. § 3.320.  

At this time, the evidence of record weighs persuasively against finding the Veteran has a sinusitis disability at any time proximate to, or during, the Veteran's claim.  The persuasive weight of the evidence is therefore against the claim, the benefit-of-the-doubt doctrine is not for application, and the Veteran's appeal must be denied.  38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F. 4th 776 (Fed, Cir. 2021).

REASONS FOR REMAND

2. Entitlement to service connection for chronic lower back pain is remanded.

3. Entitlement to service connection for chronic right knee pain is remanded.

4. Entitlement to service connection for chronic left knee pain is remanded.

5. Entitlement to service connection for chronic neck pain is remanded.

6. Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded.

The Board finds remand is warranted to correct a pre-decisional duty to assist error to obtain outstanding, potentially relevant private treatment records. 

Prior to the February 2025 rating decision on appeal, the Veteran provided two letters from private providers related to the Veteran's claimed right knee, left knee, lower back, neck, and GERD disabilities.  See October 2024 Medical Treatment Record - Non-Government Facility.  An October 2024 letter from Dr. D.B. outlined that he has treated the Veteran since 2021 for chronic neck, mid back, and lower back pain resulting from a service injury while in the military and that the Veteran was continuing to receive treatment to maintain his existing level of function.  Id.    

Additionally, an October 2024 letter from L.C., a nurse practitioner and the Veteran's primary care provider, indicates that the Veteran has established diagnoses to include GERD, cervical disc disorder, lumbar and cervical radiculopathy, lumbar spondylosis, arthritis of the knee, and pain in the bilateral knees.  Id.  L.C. stated that symptoms of many of the Veteran's current conditions began during his service and that eventually, the Veteran's symptoms worsened requiring the Veteran to seek treatment.  Id.  Significantly, L.C. outlined that the Veteran's conditions have required extensive evaluations, tests, and procedures by multiple specialists and that he has additional tests scheduled.  Id.  

The Veteran further reported in his November 2024 VA back and neck examinations that he had been evaluated by a civilian medical doctor and diagnosed with degenerative issues.  The Veteran additionally reported during his November 2024 VA GERD examination that he
opathy, lumbar spondylosis, arthritis of the knee, and pain in the bilateral knees.  Id.  L.C. stated that symptoms of many of the Veteran's current conditions began during his service and that eventually, the Veteran's symptoms worsened requiring the Veteran to seek treatment.  Id.  Significantly, L.C. outlined that the Veteran's conditions have required extensive evaluations, tests, and procedures by multiple specialists and that he has additional tests scheduled.  Id.  

The Veteran further reported in his November 2024 VA back and neck examinations that he had been evaluated by a civilian medical doctor and diagnosed with degenerative issues.  The Veteran additionally reported during his November 2024 VA GERD examination that he had several upper endoscopies via private providers prior to seeking VA treatment.  Finally, the VA examiner noted indicated that the Veteran had reported ACL, MCL, and lateral meniscus tear and surgery in 2015 but that there was no operative report noted in the available records.  November 2024 VA Knee Examination.

No efforts to obtain these reasonably identified, potentially relevant private treatment records have been made.  Thus, remand is appropriate to obtain these potentially relevant private treatment records. 

         

The matters are REMANDED for the following action:

1. After securing any necessary authorization, obtain any private treatment records as the Veteran may identify relevant to his claim, to include private treatment referenced in the October 2024 private provider letters of record.  If the Veteran provides a signed authorization form, make two requests for the authorized records unless it is clear after the first request that a second request would be futile.

2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. 

 

 

SHEREEN M. MARCUS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Knopp, Derek A.

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.