Service connection for rhinitis is granted. A rating in excess of 10 percent for chronic sinusitis is denied. FINDINGS OF FACT 1. The Veteran has a current diagnosis of rhinitis; it is at least as likely as not that the…

Citation Nr: A26069961 Decision Date: 07/30/26 Archive Date: 07/30/26 DOCKET NO. 220211-218772 DATE: July 30, 2026 ORDER Service connection for rhinitis is granted. A rating in excess of 10 percent for chronic sinusitis is denied. FINDINGS OF FACT 1. The Veteran has a current diagnosis of rhinitis; it is at least as likely as not that the disability can be attributed, at least in part, to his service-connected sinusitis. 2. During the period on appeal, the Veteran's sinusitis is not shown to have been productive of three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in the Veteran's favor, the criteria for an award of service connection for rhinitis have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for a rating in excess of 10 percent for chronic sinusitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.97, Diagnostic Code (DC) 6514. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from June 1978 to April 1979. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a January 2022 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. The Veteran timely appealed to the Board by filing a VA Form 10182 (Decision Review Request: Board Appeal (Notice of Disagreement)) in February 2022, selecting the hearing review option. 38 C.F.R. §§ 20.201, 20.202(b)(2). In August 2025, the Veteran testified at a Board hearing before a Veterans Law Judge. A transcript of that hearing has been associated with the record. Under the hearing review option, the Board may only consider the evidence of record at the time of the February 2022 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). The Board cannot consider (1) evidence submitted during the period after the AOJ issued the decision on appeal and before the hearing was held, or (2) evidence submitted more than 90 days after the hearing was held. 38 C.F.R. § 20.302. If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in its decision on the Veteran's claims. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider, he may file a Supplemental Claim (VA Form 20-0995) and submit or identify that evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim(s), considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. As a final introductory matter, the Board notes that the VLJ who held the hearing allowed the Veteran to testify as to the issue of entitlement to an earlier effective date for his award of a 10 percent rating for sinusitis, pending further review of the claims file to ascertain that the issue is properly before the Board. By way of history, and as noted above, the present appeal arises from the February 2022 VA Form 10182 that requested review of the January 2022 rating decision, which was issued in response to a January 2022 VA Form 526EZ, claiming, in relevant part, an "increase chronic sinusitis [sic]," i.e., a new increased rating claim. The issue of entitlement to a compensable rating for sinusitis prior to December 23, 2019, which was previously denied in a February 2021 Board decision, is therefore not on appeal. 1. Service connection for rhinitis is granted. The Veteran seeks to establish service connection for rhinitis. He contends that the condition is directly related to service. Alternatively, he contends that the condition is secondary to his service-connected sinusitis. See August 2025 Hearing Transcript. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Under applicable law, disability which is proximately due to or the result of a service-connected disease or injury shall also be service connected. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). Aggravation for purposes of 38 C.F.R. § 3.310(b) does not require that there be "permanent worsening" of a non-service-connected disability. Instead, secondary service connection is warranted for "any incremental increase in disability-any additional impairment of earning capacity-in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase-regardless of its permanence." Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). In Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023), the Federal Circuit held that 38 U.S.C. § 1110 employs only "but-for" (rather than proximate) causation in direct and secondary service connection claims. In that regard, the Federal Circuit held that 38 C.F.R. § 3.310(b) is unlawful because it requires proximate causation to establish aggravation of a disability, rather than but-for causation. The but-for causation standard is not limited to a single cause and effect, but rather contemplates multi-causal links, including action and inaction. The Federal Circuit explained that secondary service connection is warranted where a non-service-connected disability would have been less severe but-for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability. Stated another way, but-for causation is broad and undisputedly broader than proximate cause. Thus, a service-connected disability need only be a contributing cause, not the contributing cause, to establish secondary service connection. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. An approximate balance of the evidence includes, but is not limited to, equipoise. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Evidence is not in "approximate balance" or "nearly equal" when the evidence persuasively favors one side or the other. Id. In the January 2022 rating decision on appeal, the AOJ made a favorable finding that the Veteran had been diagnosed with rhinitis. It was also noted that the Veteran was service connected for sinusitis. Those favorable findings are binding on the Board and are not in dispute. 38 C.F.R. § 3.104(c). The key issue for the Board is whether the Veteran's rhinitis is secondary to his sinusitis. In October 2025, during a permissible evidentiary window, the Veteran submitted a nexus letter from his treating VA physician. The physician opined that the Veteran's rhinitis was more likely than not the result of his chronic sinusitis. He noted that "chronic sinusitis and rhinitis are dual manifestations of contiguous inflammation of the sinonasal mucosa ... and that treatment for rhinitis often necessitates treatment of sinusitis, and vice versa, as the two processes are closely interrelated." The opinion was based on a familiarity of the Veteran's medical history and is supported by a clear rationale. As such, the opinion is probative. See Nieves-Rodriguez, 22 Vet. App. at 303-304 (2008). No other, more probative medical opinion to the contrary is of record. Upon review of the record, the Board is satisfied that the requirements for an award of service connection for rhinitis have been met. The evidence, at a minimum, gives rise to a reasonable doubt on the matter. 38 C.F.R. § 3.102. The appeal of this issue is granted. 2. Entitlement to a rating in excess of 10 percent for chronic sinusitis. The Veteran seeks a higher rating for his service-connected chronic sinusitis. At his August 2025 Board hearing, he expressed the view that his rating for sinusitis should be 30 percent. Disability evaluations are determined by the application of a schedule of ratings, which is in turn based on the average impairment of earning capacity caused by a given disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the evaluations to be assigned to the various disabilities. The law mandates resolving reasonable doubt regarding the degree of disability in favor of the claimant. 38 C.F.R. § 4.3. If there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. If different disability ratings are warranted for different periods of time over the life of a claim, "staged" ratings may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). Sinusitis is evaluated under 38 C.F.R. § 4.97, DC 6510. Under that diagnostic code, a 10 percent evaluation is assigned where there are one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent evaluation is assigned where there are three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. The maximum rating of 50 percent is assigned following radical surgery with chronic osteomyelitis, or when there is near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. The regulation defines an incapacitating episode as one that requires bed rest and treatment by a physician. 38 C.F.R. § 4.97. Following review, the Board finds that the weight of the evidence is persuasively against the assignment of a rating in excess of 10 percent for the Veteran's sinusitis. The Veteran filed a claim for an increased rating in January 2022. In May 2021, a VA examiner noted that the Veteran did not have any incapacitating episodes of sinusitis during the previous 12 months, and he had two non-incapacitating episodes of sinusitis that were characterized by headaches. A December 2021 VA examiner likewise noted that the Veteran did not have any incapacitating episodes of sinusitis during the previous 12 months, and that he had five non-incapacitating episodes of sinusitis that were characterized by headaches and purulent discharge. The January 2022 VA examiner likewise noted that the Veteran did not have any incapacitating episodes of sinusitis during the previous 12 months, and that he had five non-incapacitating episodes of sinusitis that were characterized by episodes of sinusitis, headaches, pain of affected sinus, and tenderness of affected sinus. Treatment records pertaining to the appeal period do not otherwise show that the Veteran's sinusitis was productive of three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. Of note, the Veteran was treated in the emergency room in May 2021 was prescribed antibiotic Augmentin for a sinus infection. In light of the foregoing, the Board must find that the Veteran's sinusitis symptoms were most consistent with the criteria for a 10 percent rating throughout the period on appeal. As the evidence weighs persuasively against the Veteran's claim, the benefit-of-the-doubt doctrine is not for application. See 38 U.S.C.§ 5107(b); 38 C.F.R. § 3.102. The appeal is denied. M. Schlickenmaier Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Joseph T. Leonard, 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.