Citation Nr: 0001487 Decision Date: 01/18/00 Archive Date: 01/27/00 DOCKET NO. 97-11 659 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Newark, New Jersey THE ISSUE Entitlement to benefits under 38 U.S.C.A. § 1151 for loss of sense of smell, claimed to have resulted from surgery at a VA medical center. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL Appellant and his daughter ATTORNEY FOR THE BOARD Richard Giannecchini, Associate Counsel INTRODUCTION The veteran had active military service from February 1946 to October 1947. A perfected appeal to the Board of Veterans' Appeals (Board) of a particular decision entered by a Department of Veterans Affairs (VA) regional office (RO) consists of a Notice of Disagreement (NOD) in writing received within one year of the decision being appealed and, after a Statement of the Case (SOC) has been furnished, a substantive appeal (VA Form 9) received within 60 days of the issuance of the Statement of the Case or within the remainder of the one-year period following notification of the decision being appealed. The present appeal arises from an October 1996 rating decision, in which the veteran was denied benefits under 38 U.S.C.A. § 1151 for loss of sense of smell, sense of taste, loss of balance, and aggravation of sleep apnea, as a result of VA medical treatment. The veteran filed an NOD that same month, and the RO issued an SOC in November 1996. The veteran filed a substantive appeal in January 1997. A supplemental statement of the case (SSOC) was issued by the RO in July 1997. In April 1998, a hearing at which the veteran testified before the undersigned was conducted in Washington, D.C. Thereafter, in a September 1998 decision, the Board denied the veteran's claim for benefits under 38 U.S.C.A. § 1151 for loss of sense of taste, and remanded the remaining issues on appeal to the RO for additional development. In July 1999, the RO issued an SSOC. Subsequently, in October 1999, the veteran testified before the undersigned at another hearing in Washington, D.C., during which he withdrew his claims for benefits under 38 U.S.C.A. § 1151 for loss of balance and aggravation of sleep apnea. FINDINGS OF FACT 1. All evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. A VA medical opinion in September 1996 noted that the veteran's loss of smell "could be" caused by both his chronic sinusitis and his endoscopic sinus surgery, and that, while chronic sinusitis certainly could have caused complete loss of the sense of smell over time, whether the surgical procedure exacerbated the veteran's loss of smell was at most speculative. 3. An evaluation report from the Monell-Jefferson Taste and Smell Center noted that the veteran suffered from a complete loss of smell, and that whether this loss derived from ongoing inflammatory pathology was not clear; the report also noted that it was difficult to separate the role of ongoing sinus problems from the results of surgery. 4. A January 1999 VA medical opinion noted that the veteran's nasal surgery and nasal septal perforation, within a reasonable degree of medical certainty, were not the causes of his difficulty smelling. 5. The claim for benefits under the provisions of 38 U.S.C.A. § 1151 for loss of sense of smell is not plausible under the law, as there is no competent medical evidence that any claimed additional disability resulted from VA hospitalization, or VA medical or surgical treatment. CONCLUSION OF LAW The claim for benefits for loss of sense of smell, under the provisions of 38 U.S.C.A. § 1151, is not well grounded. 38 U.S.C.A. §§ 1151, 5107(a) (West 1991); 38 C.F.R. § 3.358 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Factual Basis A review of the claims file reflects a medical record from the VA Medical Center (VAMC) in Wilmington, dated in March 1992, which noted the veteran's treatment for chronic sinusitis and an obstructed nasal airway. In June 1992, the veteran was medically examined for VA purposes. He reported having had sinus problems for 28 years, and that he could not breathe or smell appropriately, and had a chronic discharge. He further reported having had an operation on his nose in March 1992, and that this had produced about a 10-percent improvement in his shortness of breath. On clinical evaluation, the external nose was found to be normal, and there was no evidence of deformity or discharge. In addition, there was no tenderness on palpation and percussion over the sinuses. In August 1994, the RO received VAMC Wilmington medical records, dated from August 1992 to October 1994. In particular, an August 1992 discharge summary noted that the veteran had undergone revision endoscopic sinus surgery to correct problems with nasal airway obstruction, facial pressure, and headache. The veteran was noted preoperatively to have hyposmia, and a preoperative CT (computed tomography) scan revealed pansinusitis. Postoperatively, the veteran experienced a period of epistaxis. In addition, treatment records in September 1993 and January 1994 reported that the veteran had a septal perforation and complained of anosmia and blockage of his sinuses. In October 1995, the veteran filed a claim for benefits under 38 U.S.C.A. § 1151, inter alia, for a punctured sinus and loss of smell as a result of VA surgery. He noted that surgery had been performed to clear his sinuses. In December 1995, the veteran submitted a statement to the RO from Basil Paparone, M.D., dated in October 1995. Dr. Paparone reported that the veteran had chronic sinus disease and a septal perforation from his previous sinus surgery. That same month, December 1995, the veteran was medically examined for VA purposes. It was noted that the veteran had a long standing history of problems with his nose and sinuses. He reported that this was related to irritation from dust at work and also environmental factors. As a result, the veteran indicated that he had problems with airway obstruction, facial pressure, and headaches. He reported having been treated with several decongestants but had severe discomfort and problems on a regular basis. The veteran also reported that endoscopic surgery had been performed in March 1992, following which he began to experience a loss of sense of smell. He was treated on an outpatient basis, and later underwent a second surgical procedure on his sinuses in August 1992. It was noted that, since that time, the veteran had experienced a loss of sense of smell and continued problems with his sinuses. The examiner's diagnosis was chronic rhinosinusitis. Also in December 1995, the veteran underwent an additional VA medical examination to evaluate his sense of smell. He reported a loss of smell for over a year, and that he could appreciate some pungent odors but his sense of smell was much diminished. The examiner's diagnosis was hyposmia. In September 1996, the RO received a medical opinion from a VA physician regarding the veteran's claimed loss of sense of smell due to VA surgery. The physician noted, inter alia, that the loss of sense of smell could have been caused by both the chronic condition of sinusitis and the veteran's surgeries. He reported that it was difficult to determine which was the main contributor, and that certainly chronic sinusitis could have caused complete loss of smell over time. The physician further noted that whether or not the surgical procedures had exacerbated the loss of sense of smell was at most speculative. Thereafter, the RO received a medical report from the Monell- Jefferson Taste and Smell Center, dated in December 1996. In addition to the report, the RO also received a copy of an earlier report, dated in March 1996, and a copy of a scientific review article entitled, "The Risk to Olfaction From Nasal Surgery," by Charles Kimmelman, M.D. A review of the reports, in particular, revealed the veteran's claim that he was able to smell for the first 24 hours following his second nasal surgery in August 1992, and that he had then lost his sense of smell. He had experienced no substantial change in olfaction since that time. Upon clinical evaluation, the veteran was noted to suffer from a profound and/or complete loss of smell. The report also noted that, given the veteran's failure to respond, even temporarily, to oral corticosteroid therapy, it was not clear that his sense of smell loss derived from ongoing inflammatory pathology. Also, it was reported that other patients had linked their loss-of-sense-of-smell problems to sinus surgery, but it was difficult to separate the role of their ongoing sinus didease problems from the results of their surgery. Furthermore, the article by Dr. Kimmelman noted that, in a study conducted involving 93 patients, the risk of becoming anosmic after nasal surgery was low (1.1%), and, in summary, there was no statistical evidence that any of the types of operations or combinations of anesthetics examined in the study were found to be harmful to olfactory function. In April 1998, the veteran and his daughter testified before the undersigned during a Board Hearing in Washington, D.C. The veteran reported that he underwent his first sinus operation in March 1992, because of an inability to breathe. After the first surgery, there had been no appreciable loss of sense of smell, but his sinuses had become very dry. He further reported that, following his second surgery in August 1992, his nose had started to bleed profusely after he was wheeled out of the operating room. His nose was immediately packed with gauze, and he reported experiencing extreme pain. He testified that, following his release from the hospital, he then began to notice his loss of sense of smell. In addition, he stated that he had asked the VA physician who had performed the operation, whether he would regain his sense of smell, and was told "no." The veteran also reported that, while he was being taken to surgery, he had signed a form but wasn't sure what it was for, and that the procedure and its possible consequences were never explained to him. Furthermore, he indicated that he had been told following his first surgery that he had a perforated septum, but later, seeking a second opinion, he was told there was no perforation. He also reiterated his contention that his perforated septum caused his loss of sense of smell. In addition to his testimony, the veteran submitted additional evidence for consideration. A March 1992 operation report noted the veteran's complaints of nasal airway obstruction, post nasal drip, and headaches. Included in the report, a CT scan revealed anterior ethmoid disease as well as agger disease, bilaterally. Also the nasal septum was deviated to the right and the inferior turbinates were hypertrophied. The operation report noted that- there was marked deviation of the septum to the right. Leaving an adequate strut for the nasal tip, an incision was made in the cartilage anterior to the point of deflection. Takahashi forceps were used to remove the area of cartilage posterior to the incision. Care was taken not to leave an inadequate support superiorly. In addition, care was taken not to remove any septum from above the intercanthal ligaments. Once the cartilaginous portion of septum was removed, the Blakesley forceps were used to remove bony portions of the septum which were not in the midline. Additional evidence included a pathological report, dated in March 1992, which noted mild chronic inflammatory changes in the specimen tissue. A CT scan, dated in October 1995, revealed increased thickness of mucoperiosteum of the frontal, ethmoid, maxillary, and sphenoid sinuses. In October 1998, the RO received VAMC Wilmington medical records, dated from January 1991 to October 1995. In particular, a February 1992 treatment record noted the veteran's complaint of hyposmia. A treatment record, dated in May 1992, noted his complaint that his sense of smell was worse since "OR." He was also noted to have a septal perforation. Also, records in September 1992 and September 1993 also noted complaints of loss of sense of smell. That same month, the RO received medical studies from the Albert A. Marks Sleep Disorders Center, dated in October 1993. These studies noted findings which reflected that the veteran suffered from severe obstructive sleep apnea syndrome. In December 1998, the veteran underwent a VA medical examination. He reported his medical history with respect to his nasal surgeries and subsequent nasal perforation and loss of sense of smell. He also reported that he had had a nasal button placed in the perforation, but found it uncomfortable and crusty and so had it removed. On clinical evaluation, the examiner noted that there was no evidence of chronic sinusitis, or of allergy symptoms or attacks. A perforation of the central portion of the cartilaginous nasal septum was noted. The lesion was noted as a bit smaller than a dime, and had unremarkable, well-healed edges. It was also noted to be far from the dorsal septum, and was not producing any cosmetic or functional defect of any kind. An associated radiographic study revealed ethmoid sinusitis bilaterally and sphenoid sinusitis. The examiner's diagnosis was nasal septal perforation following nasal surgery, and ethmoid sinusitis on X-ray. In January 1999, the examiner offered an addendum to his examination report. He noted various treatment notes of record which documented the veteran's complaints of a decreased sense of smell, and findings of a perforated septum. The examiner also noted that records reflected that the veteran had been employed in a job which involved spray- painting cars. This, the examiner reported, if in fact accurate, was certainly a significant contributory history in an individual who complained of difficulty smelling and had chronic sinus disease. The examiner also stated that there had been complications from the veteran's August 1992 nasal surgery, in that the veteran experienced postoperative bleeding from his nose sufficient to require packing. This was reported as a known complication, and did not reflect negligence or faulty performance of the procedure. The examiner further reported that hyposmia was not an uncommon complaint in persons with chronic sinus disease, but that it was not a known or accepted complication of endoscopic sinus surgery. He indicated that, if the veteran had a history of spray-painting automobiles, this was most likely the cause of his chronic sinus disease and hyposmia. The examiner also indicated that the veteran's nasal surgery, and nasal septal perforation, were not the causes of his loss of smell, within a reasonable degree of medical certainty. In October 1999, the veteran testified before the undersigned during a Board Hearing in Washington, D.C. He modified the issue on appeal, indicating that his loss of sense of smell had been present prior to his August 1992 surgery, but had been aggravated and made worse as a result of the procedure. The veteran testified that, prior to his surgery, his sinuses would swell as result of allergies, and that, on many occasions, he could not smell anything. He stated, however, that there were other occasions during which his sinuses were not swollen, and during those times he did not experience anosmia. The veteran testified that, since the surgery, he had not been able to smell at all, whether his sinuses were swollen or not. Furthermore, the veteran reported, with respect to his prior painting job, that he had worn a protective breathing apparatus and had never remained in the painting area after removing his mask. In addition to his testimony, the veteran submitted at the hearing CT scan films, dated in November 1991, June 1992, and July 1993. II. Analysis The statutory criteria applicable to this case appear at 38 U.S.C.A. § 1151 (West 1991), which provides that, if a veteran suffers an injury or an aggravation of an injury as a result of VA hospitalization or medical or surgical treatment, not the result of the veteran's own willful misconduct, and the injury or aggravation results in additional disability or death, then compensation, including disability, death, or dependency and indemnity compensation, shall be awarded in the same manner as if the additional disability or death were service-connected. See 38 C.F.R. § 3.358(a), 38 C.F.R. § 3.800(a) (1999). The regulations provide that, in determining whether additional disability exists, the veteran's physical condition immediately prior to the disease or injury upon which the claim for compensation is based will be compared with the physical condition subsequent thereto. With regard to medical or surgical treatment, the veteran's physical condition prior to the disease or injury is the condition which the medical or surgical treatment was intended to alleviate. Compensation is not payable if the additional disability or death results from the continuance or natural progress of the disease or injury for which the training, treatment, or hospitalization was authorized. 38 C.F.R. § 3.358(b)(1), (2). In addition, the regulations specify that the additional disability or death must actually result from VA hospitalization or medical or surgical treatment, and not merely be coincidental therewith. In the absence of evidence satisfying this causation requirement, the mere fact that aggravation occurred will not suffice to make the additional disability or death compensable. 38 C.F.R. § 3.358(c)(1), (2). The regulations further provide that compensation is not payable for the necessary consequences of medical or surgical treatment properly administered with the express or implied consent of the veteran, or, in appropriate cases, the veteran's representative. "Necessary consequences" are those which are certain to result from, or were intended to result from, the medical or surgical treatment provided. Consequences otherwise certain or intended to result from a treatment will not be considered uncertain or unintended solely because it had not been determined, at the time consent was given, whether that treatment would in fact be administered. 38 C.F.R. § 3.358(c)(3). Finally, if the evidence establishes that the proximate cause of the injury suffered was the veteran's willful misconduct or failure to follow instructions, the additional disability or death will not be compensable, except in the case of a veteran who is incompetent. 38 C.F.R. § 3.358(c)(4). So as to avoid any misunderstanding as to the governing law, the Board notes that earlier interpretations of the statute, embodied in regulations, required evidence of negligence or other fault on the part of VA, or the occurrence of an accident or an otherwise unforeseen event, to establish entitlement to benefits under 38 U.S.C.A. § 1151. See 38 C.F.R. § 3.358(c)(3) (1994). Those provisions were invalidated by the United States Court of Appeals for Veterans Claims (formerly known as the United States Court of Veterans Appeals) in the case of Gardner v. Derwinski, 1 Vet.App. 584 (1991). That decision was affirmed by both the United States Court of Appeals for the Federal Circuit, in Gardner v. Brown, 5 F.3d 1456 (Fed. Cir. 1993), and the United States Supreme Court, in Brown v. Gardner, 513 U.S. 115, 115 S. Ct. 552 (1994). In March 1995, the Secretary of Veterans Affairs published an interim rule amending 38 C.F.R. § 3.358 to conform with the Supreme Court decision. The amendment was made effective November 25, 1991, the date the initial Gardner decision was issued by the Court of Appeals for Veterans Claims. 60 Fed. Reg. 14,222 (Mar. 16, 1995). The interim rule was later adopted as a final rule, 61 Fed. Reg. 25,787 (May 23, 1996), and codified at 38 C.F.R. § 3.358(c) (1998). Subsequently, Congress amended 38 U.S.C.A. § 1151, effective for claims filed on or after October 1, 1997, to preclude compensation in the absence of negligence or other fault on the part of VA, or an event not reasonably foreseeable. Pub. L. No. 104-204, § 422(a), 110 Stat. 2926 (Sept. 26, 1996), codified at 38 U.S.C.A. § 1151 (West Supp. 1997); see also VAOPGCPREC 40-97 (Dec. 31, 1997). As noted above, the veteran's claim for benefits under section 1151 for loss of smell was filed in October 1995. Therefore, under the statute and the opinion of the General Counsel cited above, this claim has been adjudicated by the RO, and is being reviewed by the Board, under the version of 38 U.S.C.A. § 1151 extant before the enactment of the statutory amendment, as interpreted in the Gardner decisions, supra, and under the interim rule issued by the Secretary on March 16, 1995, and adopted as a final regulation on May 23, 1996. Thus, neither VA fault nor an event not reasonably foreseeable would be required for this claim to be granted. However, a claimant seeking benefits under any law administered by the Secretary of Veterans Affairs has the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. If the claim is well grounded, the Secretary is obligated to assist a claimant in developing evidence pertaining to the claim. 38 U.S.C.A. § 5107(a). If the claim is not well grounded, there is no duty to assist. Epps v. Brown, 9 Vet.App. 341 (1996), aff'd sub nom. Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997), cert. denied sub nom. Epps v. West, 118 S. Ct. 2348 (1998); Murphy v. Derwinski, 1 Vet.App. 78 (1990). Thus, the threshold question for any claim, including one filed under the provisions of 38 U.S.C.A. § 1151, is whether the claimant has presented a well-grounded claim. See Elkins v. West, 12 Vet.App. 209, 213 (1999) (en banc), citing Caluza v. Brown, 7 Vet.App. 498 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table), and Epps, supra. See also Morton v. West, 12 Vet.App. 477, 480 (1999) (noting that the Federal Circuit, in Epps v. Gober, supra, "rejected the appellant's argument that the Secretary's duty to assist is not conditional upon the submission of a well-grounded claim"). A well-grounded claim is one which is meritorious on its own or capable of substantiation. Such a claim need not be conclusive, but only plausible, to satisfy the initial burden of 38 U.S.C.A. § 5107(a). Murphy, supra. To present a well grounded claim, the claimant must provide evidence; mere allegation is insufficient. Tirpak v. Derwinski, 2 Vet.App. 609 (1992). The evidence the claimant must provide must be sufficient to justify a belief by a fair and impartial individual that the claim is plausible. Lathan v. Brown, 7 Vet.App. 359 (1995). Where the determinative issue is factual in nature, competent lay evidence may suffice. Gregory v. Brown, 8 Vet.App. 563 (1996). Where the determinative issue involves medical etiology or diagnosis, medical evidence is required. Lathan, supra. The Court of Appeals for Veterans Claims has recently held that the requirements for a well-grounded claim under section 1151 are, paralleling those generally set forth for establishing other service-connection claims, as follows: (1) medical evidence of a current disability; (2) medical evidence, or in certain circumstances lay evidence, of incurrence or aggravation of a disease or injury as the result of hospitalization, medical or surgical treatment, or the pursuit of a course of vocational rehabilitation under chapter 31 of title 38, United States Code; and (3) medical evidence of a nexus (i.e., a link or a connection) between that asserted injury or disease and the current disability. In addition, the Court has determined that an appellant's claim would also generally be well grounded, with respect to the continuity-of-symptomatology analysis under 38 C.F.R. § 3.303(b), if he or she submitted evidence of each of the following: (a) evidence that a condition was "noted" during his/her VA hospitalization or treatment; (b) evidence showing continuity of symptomatology following such hospitalization or treatment; and (c) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post- hospitalization/treatment symptomatology. See Jones v. West, 12 Vet.App. 460, 464 (1999). Therefore, a claim for benefits under the provisions of 38 U.S.C.A. § 1151 must be supported by medical evidence of additional disability that resulted from VA hospitalization, or medical or surgical treatment. See Boeck v. Brown, 6 Vet.App. 14, 16-17 (1993), and Ross v. Derwinski, 3 Vet.App. 141, 144 (1992), holding that a veteran must submit evidence sufficient to well ground a claim for benefits under 38 U.S.C.A. § 1151. See also Jimison v. West, 13 Vet.App. 75, 77-78 (1999). The veteran has contended that, while he did suffer from intermittent anosmia prior to his VA surgery in August 1992, following the operation he found that he had completely lost his sense of smell. Upon review of the evidence of record, the Board finds that the veteran has not submitted a well- grounded claim for benefits under 38 U.S.C.A. § 1151, for loss of sense of smell. With respect to the veteran's claim, the Board is aware that a VA medical opinion in September 1996 noted that the veteran's loss of sense of smell "could be" caused by both his chronic sinusitis and his endoscopic sinus surgery. The examiner noted that, while chronic sinusitis certainly could have caused complete loss of smell over time, whether the surgical procedure exacerbated the veteran's loss of smell was, at most, speculative. We thus find that, given the medical conclusions reported, the VA opinion is not material. See Bostain v. West, 11 Vet.App. 124, 127-28 (1998), quoting Obert v. Brown, 5 Vet.App. 30, 33 (1993) (a medical opinion expressed in terms of "may" also implies "may or may not" and is too speculative to establish a plausible claim"). See also Warren v. Brown, 6 Vet.App. 4, 6 (1993) (doctor's statement framed in terms such as "could have been" is not probative); Tirpak v. Derwinski, 2 Vet.App. 609, 611 (1992) ("may or may not" language by physician is too speculative). We recognize that, in Lee v. Brown, 10 Vet.App. 336 (1997), the Court held that cautious language by a physician does not always express inconclusiveness. There, however, the Court noted that there was another doctor's statement in the record which provided evidentiary support for the otherwise speculative statement in issue. Here, there is no other medical evidence tending to support more than the possibility that the veteran's complete loss of sense of smell, or a permanent aggravation of a pre-existing loss of sense of smell, was incurred as a result of his August 1992 surgery. In this regard, an evaluation report from the Monell- Jefferson Taste and Smell Center noted that the veteran suffered from a complete loss of smell. We find, however, that the report's ensuing medical conclusions paralleled those of the VA examiner's opinion in September 1996. The report noted that, given the veteran's failure to respond, even temporarily, to oral corticosteroid therapy, it was not clear that his sense of smell loss derived from ongoing inflammatory pathology. However, the report also indicated that other patients had linked their loss of sense of smell problems to sinus surgery, but it was difficult to separate the role of their ongoing sinus disease problems from the results of their surgery. In addition, the Board is also cognizant that a VA medical examination, in December 1998, reported that the veteran's septal perforation was not producing any cosmetic or functional defect. Furthermore, a subsequent VA medical opinion in January 1999, based upon a complete review of the claims file, noted that the veteran's nasal surgery and nasal septal perforation, within a reasonable degree of medical certainty, were not the causes behind his difficulty smelling. While the law applicable to this case, as discussed above, exempts the veteran from a requirement to establish negligence or other wrongdoing on the part of VA, the law does require proof of causation; in other words, any claimed additional disability must be shown, by medical evidence, to have resulted from, and not merely to have been coincidental with, the VA hospitalization or medical or surgical treatment. The medical evidence of record does not reflect that the veteran's nasal surgery in August 1992 resulted in a complete and/or profound loss of sense of smell, or that there was a worsening of a previous intermittent anosmia. Furthermore, the evidence reflects that the veteran's septal perforation did not result in his loss of sense of smell. Thus, under the law, the veteran must provide medical-nexus evidence to well ground his claim, and in this instance, he has not done so. Therefore, the only evidence supporting the veteran's assertion, that he sustained additional disability as a result of VA hospitalization or medical or surgical treatment, consists of his own statements to that effect. However, neither he or his representative is not shown to possess the technical competence to establish such a relationship. As discussed above, a claim based upon an assertion as to cause-and-effect relating to a particular disability requires competent medical evidence in order to be well grounded. The Court has reiterated this requirement many times. See, e.g., Voerth v. West, 13 Vet.App. 117, 120 (1999) ("Unsupported by medical evidence, a claimant's personal belief, no matter how sincere, cannot form the basis of a well-grounded claim."); Bostain v. West, supra ("lay testimony . . . is not competent to establish, and therefore not probative of, a medical nexus"); Routen v. Brown, 10 Vet.App. 183, 186 (1997) ("a layperson is generally not capable of opining on matters requiring medical knowledge"), aff'd sub nom. Routen v. West, 142 F.3d 1434 (Fed. Cir. 1998), cert. denied, 119 S. Ct. 404 (1998). See also Espiritu v. Derwinski, 2 Vet.App. 492 (1992); Moray v. Brown, 5 Vet.App. 211 (1993); Grottveit v. Brown, 5 Vet.App. 91 (1993). Moreover, as sympathetic as we might be toward the veteran's condition, the Board is not permitted to reach medical determinations without considering independent medical evidence to support our findings, and must cite to competent evidence of record to support our conclusions. See Rucker v. Brown, 10 Vet.App. 67, 74 (1997), citing Colvin v. Derwinski, 1 Vet.App. 171 (1991), and Hatlestad v. Derwinski, 3 Vet.App. 213 (1992). Having reviewed the medical records in this case, we can find none supporting the veteran's contentions that he incurred additional disability with respect to anosmia as a result of VA hospitalization, or medical or surgical treatment. Accordingly, it is the Board's conclusion that the veteran has failed to present evidence sufficient to justify a belief by a fair and impartial individual that his claim for compensation under 38 U.S.C.A. § 1151 is well grounded, as required by 38 U.S.C.A. § 5107(a) (West 1991), and therefore, the claim must be denied. We observe in addition, as is noted above, that, at his Board Hearing in October 1999, the veteran submitted three sets of CT films as evidence in support of his claim. Given that the RO did not have the opportunity to review these films in the first instance, and that the Board would not be qualified to make a medical determination as to what the films show, a remand would normally be in order to allow a qualified individual, i.e., a physician, make pertinent findings. However, in this instance, we find that remanding for a report on the content of the films would not be beneficial to the veteran's claim. The veteran reportedly has offered the films into evidence as a means of demonstrating that a septal perforation was not in existence prior to his August 1992 nasal surgery. While the films may or may not reveal that fact, it would appear that they otherwise would not provide evidence as to the etiology of the veteran's loss of sense of smell, that is, they could not fill the gap in the requirement of medical nexus evidence. Therefore, after careful review of the record, the Board can find no reason that a remand of the veteran's appeal, for review of the recently submitted CT films would be judicially expedient or otherwise result in a different finding. Thus, such a remand would result in unnecessarily imposing additional burdens on the RO with no benefit flowing to the veteran. The Court has held that such remands are to be avoided. See Winters v. West, 12 Vet.App. 203, 207 (1999) (en banc); Soyini v. Derwinski, 1 Vet.App. 540, 546 (1991); Sabonis v. Brown, 6 Vet.App. 426, 430 (1994). The Board appreciates the veteran's sincere testimony at his personal hearings in this matter. ORDER Entitlement to benefits under 38 U.S.C.A. § 1151 for loss of sense of smell, claimed to have resulted from treatment at a VA medical facility, is denied. ANDREW J. MULLEN Member, Board of Veterans' Appeals