Citation Nr: 0000294 Decision Date: 01/06/00 Archive Date: 01/11/00 DOCKET NO. 94-36 490 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to service connection for bronchiectasis. 2. Entitlement to service connection for bronchitis. 3. Entitlement to service connection for sinusitis. REPRESENTATION Appellant represented by: Disabled American Veterans INTRODUCTION The veteran served on active duty for training from March 1974 to August 1974, and on active duty from July 1979 to December 1980. This case comes before the Board of Veterans' Appeals (hereinafter Board) on appeal from the Department of Veterans Affairs (hereinafter VA) regional office in Montgomery, Alabama (hereinafter RO). The Board's decision dated in 1996, referred the issues of entitlement to service connection for asthma, intercostal muscle strain and arthritis and/or muscle strain of the right arm and shoulder to the RO for appropriate action. However, it does not appear from the claims file that the RO addressed these issues as requested. Additionally, the veteran raised the issues of entitlement to service connection for reactive airway disease, rheumatism, heart disease ear infections, a psychiatric disorder, a low back disorder, a muscle disorder, and residuals of rheumatic fever. If a final prior decision as to any of these issues is of record, the RO should adjudicate the issues under the provisions of 38 U.S.C.A. §§ 5108, 7104, 7105 (West 1991); 38 C.F.R. § 3.104 (1999). FINDING OF FACT There is no medical evidence showing a nexus between any current sinusitis, bronchitis, and bronchiectasis and service. CONCLUSION OF LAW The claims of entitlement to service connection for sinusitis, bronchitis, and bronchiectasis are not well grounded. 38 U.S.C.A. § 5107 (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110, 1131 (West 1991). The law provides that "a person who submits a claim for benefits under a law administered by the [VA] shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded." 38 U.S.C.A. § 5107(a). Establishing a well-grounded claim for service connection for a particular disability requires more than an allegation that the disability had its onset in service or is service-connected; it requires evidence relevant to the requirements for service connection and of sufficient weight to make the claim plausible and capable of substantiation. See Franko v. Brown, 4 Vet. App. 502, 505 (1993); Tirpak v. Derwinski, 2 Vet. App. 609, 610 (1992); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). The three elements of a "well grounded" claim are: (1) evidence of a current disability as provided by a medical diagnosis; (2) evidence of incurrence or aggravation of a disease or injury in service as provided by either lay or medical evidence, as the situation dictates; and, (3) a nexus, or link, between the in-service disease or injury and the current disability as provided by competent medical evidence. See Caluza v. Brown, 7 Vet. App. 498 (1995); see also 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303 (1999). Generally, competent medical evidence is required to meet each of the three elements. However, for the second element the kind of evidence needed to make a claim well grounded depends upon the types of issues presented by a claim. Grottveit v. Derwinski, 5 Vet.App. 91, 92-93 (1993). For some factual issues, such as the occurrence of an injury, competent lay evidence may be sufficient. However, where the claim involves issues of medical fact, such as medical causation or medical diagnoses, competent medical evidence is required. Id. at 93. In the instant case, the veteran's service medical records are negative for any evidence of sinusitis, bronchitis, or bronchiectasis. Subsequent to service discharge, both private and VA medical records reveal numerous diagnoses of respiratory disorders, to include sinusitis and bronchitis. In April 1993, the veteran was diagnosed with asthma versus chronic obstructive pulmonary disorder. It was noted that the veteran had been prescribed an inhaler. Most recently, a VA respiratory examination was conducted in March 1997. The veteran complained of shortness of breath, especially on exertion and extremes of weather. Examination of the lungs revealed large airway sounds throughout, both anteriorly and posteriorly, but no wheezes or rhonchi were present. There was no active malignant process present. A chest x-ray indicated mild parabronchial thickening in both lung hila without evidence of airspace disease. A possibility of lower airspace disease was present, indicated as viral or chronic inflammation such as bronchitis. The lung size was within normal limits. A pulmonary function test reported a normal spirometry, normal lung volumes, a normal maximum voluntary ventilation, and the gas transfer was normal. The diagnosis was chronic obstructive pulmonary disorder versus asthma, secondary to longstanding cigarette smoking. The examiner noted that the veteran had been counseled "many times" in regards to smoking cessation, but continued to smoke. The examiner concluded that the veteran's "life-long habit of smoking, which he started prior to his military service, is the chief cause of his current pulmonary status, and, therefore, was not a result of activities that occurred during his military service." A VA nose and sinus examination conducted in March 1997, reported that the veteran complained of left nasal congestion and obstruction, and positive postnasal drainage. The veteran stated that he had headaches and facial pain, mostly frontal. Examination revealed an erythematous nasal cavity. He had a septum that appeared to be deviated to the left. There was no purulent drainage in the nasal cavity, and the examiner stated that the remainder of the examination was normal. The impression was nasal obstruction with allergic rhinosinusitis. In March 1998, a VA examiner reviewed the veteran's file and stated that the findings of allergic rhinosinusitis were of unknown etiology and that it would be "difficult to ascertain what is the cause of this since this particular diagnosis can be caused by a multitude of agents. [The veteran] is reportedly a smoker and this can exacerbate this problem which appears to be chronic." A VA outpatient treatment record dated in July 1999, reported a diagnosis of sinusitis. The veteran contends that due to exposure to toxins in service or due to disorders incurred in service, he acquired sinusitis, bronchitis, and bronchiectasis. However, the Board concludes that medical evidence is necessary to establish such a nexus because whether these disorders are due to toxins the veteran was exposed to in service or due to a disorder incurred while in service is not a matter that lends itself to lay observation but rather one that requires medical expertise for its support and resolution. See Falzone v. Brown, 8 Vet. App. 398, 403 (1995). The fact remains that there is no medical evidence on file linking any current sinusitis, bronchitis, and bronchiectasis to service or to any incident of service, despite the veteran's assertions that such a causal relationship exists. As there is no competent evidence that provides the required nexus between military service and sinusitis, bronchitis, and bronchiectasis, service connection for these disorders is not warranted. See Caluza v. Brown, 7 Vet.App. 498 (1995). ORDER The claims of entitlement to service connection for sinusitis, bronchitis, and bronchiectasis are denied. JOY A. MCDONALD Acting Member, Board of Veterans' Appeals