BVA9500808 DOCKET NO. 93-06 791 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in San Francisco, California THE ISSUES 1. Entitlement to service connection for chronic sinusitis with nasal polyps. 2. Entitlement to an increased (compensable) disability evaluation for chronic headaches. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD J.W. Engle, Counsel INTRODUCTION The appellant served on active duty from May 1967 to December 1987. This matter came before the Board of Veterans' Appeals (the Board) on appeal from a decision dated in March 1992 by the San Francisco, California, Department of Veterans Affairs (VARO). The Board notes that the appellant's claim to entitlement to service connection for a nose disorder has been variously characterized to include entitlement to service connection for sinusitis and entitlement to service connection for nasal polyps. After review of the record, the Board concludes that the appellant's nose disability is most appropriately characterized as chronic sinusitis with nasal polyps. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that nasal symptomatology treated during his period of active duty was representative of the onset of nasal polyps and chronic sinusitis. He further argues, in essence, that he experiences severe headaches one to two times each month and therefore entitlement to a 10 percent disability evaluation is warranted. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that entitlement to service connection for sinusitis with nasal polyps is warranted. However, the reccord does not support entitlement to a compensable disability evaluation for chronic headaches. FINDINGS OF FACT 1. The service medical records reflect that the appellant was seen on numerous occasions with nasal congestion and other symptomatology considered to be associated with acute disorders including upper respiratory infections, allergic rhinitis and influenza. 2. In September 1985 the diagnostic assessment was upper respiratory infection versus sinusitis. In August 1987 the appellant was seen for complaints of chronic nose problems and a polyp was found on the left side. The diagnosis was nasal polyposis. 3. On service separation examination in September 1987, the appellant reported complaints of difficulty breathing from one side of his nose and that he was using an inhaler on a regular basis. On clinical examination the appellant's nose and sinuses were found to be normal. 4. A VA examination report dated in September 1991 noted findings of a right nasal polyp with allergic rhinitis and sinusitis. X-ray examination revealed a mucous retention cyst in the left maxillary sinus and the radiological diagnosis was chronic right maxillary sinusitis. The overall diagnoses included right nasal polyp with allergic rhinitis and sinusitis. 5. In May 1992 the appellant was diagnosed with chronic nasal polyposis and pansinusitis and he underwent bilateral endoscopic sinusotomies with septoplasty and nasal polypectomy. 6. Chronic sinusitis with nasal polyps had their onset during the appellant's period of active duty. 7. The appellant's chronic headaches are manifested by complaints of headaches one or two times per month relieved by medication and are not shown to be of a characteristically prostrating nature averaging one in 2 months over the last several months. CONCLUSIONS OF LAW 1. Chronic sinusitis with polyps was incurred in service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991); 38 C.F.R. § 3.303(d) (1993). 2. The schedular criteria for a compensable disability evaluation for chronic headaches have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 4.1, 4.2, 4.7, 4.10, Diagnostic Code 8100 (19930. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, the Board finds that the appellant has submitted evidence which is sufficient to justify a belief that his claim is well grounded. 38 U.S.C.A.§ 5107(a) (West 1991) and Murphy v. Derwinski, 1 Vet.App. 78 (1990). I. Sinusitis with Polyps Service connection may be granted for disability resulting from disease or injury incurred in or aggravated while on active duty. See 38 U.S.C.A. § 1131 (West 1991). Furthermore, for the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b) (1993). However, service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. Presumptive periods are not intended to limit service connection to diseases so diagnosed when the evidence warrants direct service connection. The presumptive provision of the statute and Department of Veterans Affairs regulations implementing them are intended as liberalizations applicable when the evidence would not warrant service connection without their aid. 38 C.F.R. § 3.303(d) (1993). Review of the record reveals that the appellant was seen during service on numerous occasions with complaints of sinus congestion. While these complaints were usually associated with acute conditions including upper respiratory infections, in September 1985 a differential diagnosis of sinusitis was noted. Furthermore, nasal polyps were first identified in May 1987 and in August 1987 a diagnosis of nasal polyposis was reported. While no pertinent findings were noted on clinical examination on service separation in September 1987, the appellant reported complaints of difficulty in breathing from one side of his nose and that he was using an inhaler. Post service records reveal a diagnosis of sinusitis on private examination in December 1988 and on VA examination in September 1991 x-ray examination revealed findings consistent with a mucous retention cyst on the floor of the left maxillary antrum and mucoperiosteal thickening in the right maxillary sinus considered to be consistent with chronic right maxillary sinusitis. The diagnoses included right nasal polyp with allergic rhinitis and sinusitis. Subsequent examination for complaints of nasal obstruction in April 1992 revealed findings of bimaxillary sinusitis and antral choanal polyp. Computerized tomography (CT) scan of the appellant's sinuses later in April 1992 revealed pansinusitis and extensive soft tissue density in the nasal cavity, consistent with either mucosal swelling or polyps. In May 1992 the appellant underwent bilateral endoscopic sinusotomies with septoplasty and nasal polypectomy. In weighing the evidence of record, the undersigned concludes that the appellant's repeated treatment during service for nasal complaints coupled with the diagnosis of nasal polyps in 1987, viewed in light of the post service findings of chronic sinusitis with nasal polyps, are sufficient to establish that chronic sinusitis with polyps was incurred in service. II. Chronic Headaches The appellant's service-connected chronic headaches are currently evaluated as analogous to migraine headaches pursuant to Diagnostic Code 8100 which provides, in pertinent part, that migraine headaches with characteristic prostrating attacks averaging one in 2 months over the last several months warrant a 10 percent disability evaluation, where there are less frequent attacks a noncompensable disability evaluation is warranted. In weighing the evidence of record, the undersigned concludes that entitlement to a compensable disability evaluation for chronic headaches is not warranted. Review of the record reveals that the appellant has been seen for complaints of headaches. However, the record does not reflect that the appellant's headaches have been prostrating in nature. In September 1991 on VA examination the appellant reported complaints of frontal headaches associated with pressure behind his eyes, and postnasal drip which are relieved by decongestants and Motrin. He further reported complaints of occipital headaches associated with neck stiffness two to three times per week which are improved with Motrin. The diagnoses at that time included frontal headaches secondary to sinusitis and occipital headaches secondary to tension headaches. Subsequent private treatment reports for various other disorders reflect complaints of occasional headaches. See treatment reports from Dr. Gannon dated in December 1991, and from Dr. Lowe dated in May and July 1992. However, these records do not describe headaches characterized by prostrating attacks occurring at least once every two months over the last several months. Entitlement to a compensable disability evaluation for chronic headaches contemplates functional impairment as the result of the chronic headaches. The undersigned notes that the basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. See 38 C.F.R. § 4.10 (1993). While the appellant has reported that he experiences severe headaches once or twice a month, he further noted that he takes Tylenol or Tylenol with codeine which usually cures the headaches. There is no evidence of record to establish that the chronic headaches require regular treatment including a regimen of prescription medication for relief. Furthermore, there is no evidence of record to suggest that the headaches are of such severity as to be considered "characteristically prostrating" in nature. The record does not reflect that the headaches impair the appellant's every day activities forcing him to lie down or seek other refuge with medication until the pain passes. While the appellant argues that he should be awarded a 10 percent disability evaluation for his discomfort, the undersigned concludes that the level of "discomfort" identified within the record is appropriately rated at the noncompensable disability level. Discomfort and disability are not synonymous and the level of disability necessary to establish entitlement to a compensable disability evaluation for chronic headaches has not been shown. Accordingly, in view of the above, entitlement to a compensable disability evaluation for chronic headaches is not warranted. ORDER Service connection for sinusitis with polyps is granted. A compensable disability evaluation for chronic headaches is denied. C.P.RUSSELL Member, Board of Veterans' Appeals (CONTINUED ON NEXT PAGE) The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.