Case A26041022

Summary

The Veteran served from June 1987 to June 1991. He appeals the denial of an earlier effective date for a 10 percent rating for allergic rhinitis and the denial of an increased rating for this condition. The Veteran sought an increased rating for allergic rhinitis, which is currently rated at 10 percent. The Board reviewed VA examinations from January 2024 and July 2024. The January 2024 examination found no nasal obstruction greater than 50 percent on either side and no nasal polyps. The July 2024 examination documented greater than 50 percent obstruction of both nasal passages but still found no nasal polyps. The Board denied an earlier effective date because the severity required for a higher rating was not factually ascertainable before February 5, 2024. The Board also denied an increased rating because the 30 percent rating criteria under Diagnostic Code 6522 requires nasal polyps, which were consistently absent in the examinations. The case was remanded for an increased rating for PTSD with TBI due to inadequate and internally inconsistent VA examinations. The February 2024 PTSD exam had discrepancies between assessed impairment and described symptoms, and did not address TBI overlap. The December 2024 TBI exam was conclusory and inconsistent with prior findings. The remand aims to obtain adequate examinations for PTSD and TBI.

Rationale

DC 6522 requires nasal polyps for 30% rating.; Examinations consistently showed no nasal polyps.; Evidence supports current 10% rating for nasal obstruction.

Full Decision Text

Citation Nr: A26041022
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 250327-528032
DATE: April 30, 2026

ORDER

Entitlement to an effective date prior to February 5, 2024, for a 10 percent evaluation for allergic rhinitis is denied.

Entitlement to a disability rating greater than 10 percent for allergic rhinitis is denied.

REMANDED

Entitlement to an evaluation in excess of 70 percent for posttraumatic stress disorder (PTSD) with traumatic brain injury (TBI) is remanded.

FINDING OF FACT

1. It is not factually ascertainable that the Veteran's allergic rhinitis increased in severity to warrant a 10 percent disability rating prior to February 5, 2024.

2. The Veteran's allergic rhinitis is not manifested by nasal polyps.

CONCLUSION OF LAW

1. The criteria to establish an effective date earlier than February 5, 2024, for an increased rating of 10 percent for allergic rhinitis have not been met.  38 U.S.C. §§ 5103, 5103A, 5107, 5110; 38 C.F.R. §§ 3.102, 3.156, 3.159, 3.400.

2. The criteria to establish a disability rating greater than 10 percent for allergic rhinitis have not been met.  38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.97, Diagnostic Code (DC) 6522.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from June 1987 to June 1991.  

He appeals a February 2025 rating decision by the Agency of Original Jurisdiction (AOJ).  In his March 2025 notice of disagreement (NOD), the Veteran appealed the decision directly to the Board and chose the Direct Review docket.  See March 2025 VA Form 10182.  Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal.  38 C.F.R. § 20.301.

1. Earlier Effective Date

The Veteran seeks entitlement to an effective date earlier than February 5, 2024, for the assignment of a 10 percent rating for service-connected allergic rhinitis.  A November 2023 rating decision granted service connection for allergic rhinitis and assigned a noncompensable evaluation effective August 10, 2022.  The Veteran subsequently filed a supplemental claim received on February 5, 2024, seeking an increased evaluation.  A July 2024 rating decision granted an increased 10 percent evaluation effective February 5, 2024, the date of receipt of the supplemental claim.  The Veteran appealed the effective date assigned in his March 2025 VA Form 10182.

Except as otherwise provided, the effective date of an evaluation and award of compensation based on a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400(o)(1).  However, an effective date may be assigned as early as the date it is factually ascertainable that an increase in disability occurred, if the claim is received within one year of that date.  38 C.F.R. § 3.400(o)(2).

Here, the Veteran has been assigned an effective date of February 5, 2024, for the award of a 10 percent evaluation for allergic rhinitis.  The record does not contain competent evidence demonstrating that the criteria for a compensable evaluation were met prior to that date.  Specifically, a January 2024 VA examination showed no nasal obstruction greater than 50 percent on either side and no complete obstruction of either nasal passage, and no nasal polyps were identified.  See January 2024 VA examination report.  A subsequent July 2024 VA examination first documented greater than 50 percent obstruction of both nasal passages; however, there is no evidence establishing that such level of severity was factually ascertainable prior to February 5, 2024.  See July 2024 VA examination report.

As such, the assignment of February 5, 2024 as the effective date for the 10 percent evaluation is proper.  Therefore, entitlement to an effective date earlier than February 5, 2024, for the award of a 10 percent rating for allergic rhinitis is not warranted.  See Gilbert v. Derwinski, 1 Vet. App.
yps were identified.  See January 2024 VA examination report.  A subsequent July 2024 VA examination first documented greater than 50 percent obstruction of both nasal passages; however, there is no evidence establishing that such level of severity was factually ascertainable prior to February 5, 2024.  See July 2024 VA examination report.

As such, the assignment of February 5, 2024 as the effective date for the 10 percent evaluation is proper.  Therefore, entitlement to an effective date earlier than February 5, 2024, for the award of a 10 percent rating for allergic rhinitis is not warranted.  See Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990); 38 C.F.R. § 3.102.

2. Increased Rating

The Veteran seeks an increased rating for his service-connected allergic rhinitis.  He is presently assigned a 10 percent rating under DC 6522, which contemplates allergic rhinitis.  See 38 C.F.R. § 4.97.

Under DC 6522, a 10 percent rating is warranted for allergic rhinitis 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 warranted when nasal polyps are present.  Id.

Following receipt of the Veteran's supplemental claim, he was afforded VA examinations to assess the severity of his condition.  At the January 2024 VA examination, the Veteran reported symptoms including sneezing "all of the time," and "sinuses are sensitive to allergens."  See January 2024 VA examination report.  However, objective examination at that time showed no nasal obstruction greater than 50 percent on either side and no complete obstruction of either nasal passage.  The examiner further found no evidence of nasal polyps.  Id.

A subsequent July 2024 VA examination documented that the Veteran's allergic rhinitis resulted in greater than 50 percent obstruction of both nasal passages; however, there was again no evidence of nasal polyps.  See July 2024 VA examination report.

The Veteran's medical records do not demonstrate the presence of nasal polyps at any time during the appeal period.  Accordingly, while the evidence supports the currently assigned 10 percent evaluation based on nasal obstruction, the criteria for the next higher 30 percent rating under DC 6522 are not met, as that rating requires the presence of nasal polyps.  See 38 C.F.R. § 4.97.

Given that DC 6522 predicates a 30 percent rating on the presence of nasal polyps, and the record consistently shows no nasal polyps on examination or in treatment records, a higher rating is not warranted in this case.  Accordingly, entitlement to a disability rating in excess of 10 percent for allergic rhinitis is denied.

REASONS FOR REMAND

1. PTSD with TBI

The Veteran seeks an increased rating for his service-connected PTSD with TBI, currently evaluated as 70 percent disabling.  Further, the Veteran's VA Form 10182 appears to also disagree with the AOJ's combination of his PTSD and TBI disability evaluation.  Ultimately, the Board finds that remand is warranted to correct predecisional duty to assist errors arising from inadequate medical examinations. 

Where VA provides a veteran with an examination in a service-connection claim, the examination must be adequate.  Barr v. Nicholson, 21 Vet. App. 303, 311 (2007).  A medical examination or opinion is adequate where it is based on the veteran's prior medical history and examinations, an accurate factual premise, and contains clear conclusions with supporting data and a reasoned medical explanation connecting the two.  Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007); Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005).  When an examination is provided, the examiner must support his or her conclusions with an analysis that is adequate for the Board to consider and weigh against contrary opinions.  Stefl, 21 Vet. App. at 124.  If an examination report lacks sufficient detail, "it is incumbent upon the rating board to return the report as inadequate for evaluation purposes."  38 C.F.R. § 4.2.

Here, the February 2024 VA PTSD examination reflects internal inconsistency in its assessment of severity.  Specifically, although the examiner selected occupational and social impairment with reduced reliability and productivity, the accompanying symptomatology includes impaired impulse control (including periods of violence), difficulty adapting to stressful circumstances, and significant occupational impairment
 (2005).  When an examination is provided, the examiner must support his or her conclusions with an analysis that is adequate for the Board to consider and weigh against contrary opinions.  Stefl, 21 Vet. App. at 124.  If an examination report lacks sufficient detail, "it is incumbent upon the rating board to return the report as inadequate for evaluation purposes."  38 C.F.R. § 4.2.

Here, the February 2024 VA PTSD examination reflects internal inconsistency in its assessment of severity.  Specifically, although the examiner selected occupational and social impairment with reduced reliability and productivity, the accompanying symptomatology includes impaired impulse control (including periods of violence), difficulty adapting to stressful circumstances, and significant occupational impairment affecting reliability, decision-making, and interpersonal functioning.  See February 2024 VA examination report.  The Board finds that the discrepancy between the selected level of impairment and the symptom severity described is not adequately explained, rendering the examination internally inconsistent and of reduced probative value.  See Stefl, supra.

Further, the February 2024 PTSD examination was conducted prior to formal VA recognition of the Veteran's TBI diagnosis and therefore did not address the potential overlap between psychiatric symptoms and neurocognitive or neurobehavioral manifestations subsequently identified.  See February 2024 VA examination report.  As a result, the examination does not adequately inform the Board as to whether the Veteran's cognitive, behavioral, and emotional symptoms are attributable to PTSD, TBI, or both, as required for proper application of 38 C.F.R. § 4.124a, Diagnostic Code 8045.

Additionally, the December 2024 VA TBI examination, conducted by a physiatrist, reflects findings of mild memory loss, occasional disorientation, visuospatial impairment, and neurobehavioral effects impacting occupational and social functioning.  See December 2024 VA examination report.  However, the examiner concluded that PTSD and anxiety symptoms overlap with TBI-related neurobehavioral changes and stated that due to limitations of current medical science, the symptoms cannot be further delineated.  Id.  This conclusion is conclusory and unsupported by a sufficient explanation identifying which specific symptoms are attributable to each condition or why prior documented symptomatology, such as impaired judgment, impaired social interaction, and cognitive deficits noted in the February 2024 PTSD examination report, which were not incorporated, reconciled, or explained.  Moreover, the December 2024 TBI examination appears inconsistent with prior findings of record without explanation, particularly with respect to judgment, social interaction, and cognitive functioning, raising additional concerns regarding adequacy. 

Because the record contains conflicting and inadequately explained medical evidence regarding the nature, severity, and attribution of the Veteran's psychiatric and neurocognitive symptoms, the Board finds that the AOJ relied upon inadequate examinations in adjudicating the claim.  Accordingly, remand is required to obtain an adequate medical examination and opinion addressing the combined and/or distinct manifestations of the Veteran's PTSD with TBI.   As the above constitute predecisional duty to assist errors, remand is appropriate. 38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

1. Schedule the Veteran for examination(s) with an appropriately qualified clinician to determine the current nature and severity of both his PTSD and TBI.  The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner.  

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?

The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria.  The examiner must attempt to elicit information regarding the severity, frequency, and duration of symptoms.  To the extent feasible, the examiner should identify any residuals of TBI that are separate and distinct from his PTSD symptoms.

 

 

DONNIE R. HACHEY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Poe, 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.