Citation Nr: 1017908 Decision Date: 05/13/10 Archive Date: 05/26/10 DOCKET NO. 08-00 098 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Portland, Oregon THE ISSUES 1. Entitlement to service connection for diabetes mellitus. 2. Entitlement to service connection for a heart disability. 3. Entitlement to service connection for a lung disability. REPRESENTATION Appellant represented by: Oregon Department of Veterans' Affairs ATTORNEY FOR THE BOARD K. Conner, Counsel INTRODUCTION The appellant served on active duty from August 1957 to September 1976. This matter came to the Board of Veterans' Appeals (Board) on appeal from a January 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington, which denied service connection for diabetes mellitus, a heart disability, and a lung disability. As set forth above on the cover page of this decision, the appellant's claim is now in the jurisdiction of the RO in Portland, Oregon. In April 2009, the Board remanded the matter to the RO for additional evidentiary development. In an October 2009 decision, the Board denied service connection for diabetes mellitus and a cardiopulmonary disability. Thereafter, the RO forwarded to the Board an August 2009 statement from the appellant requesting a hearing before a Veterans Law Judge. In December 2009, the Board vacated its October 2009 decision and remanded the matter to the RO for the purpose of affording the appellant his requested hearing. See 38 U.S.C.A. § 7104(a) (West 2002); 38 C.F.R. § 20.904 (2009) (providing that a Board decision may be vacated when there is a prejudicial failure to afford an appellant a personal hearing). Pursuant to the Board's remand instructions, in a March 2010 letter, the appellant was notified that he had been scheduled for a Board hearing at the RO, to be held in April 2010. Later that month, however, the appellant contacted the RO and indicated that he would be unable to attend the scheduled hearing. He requested that his appeal be forwarded to the Board for a decision. FINDINGS OF FACT 1. The record does not establish that the appellant served in the Republic of Vietnam during the Vietnam era, that his overseas service involved duty or visitation in Vietnam, or that he was exposed to an herbicide agent such as Agent Orange during active service. 2. Diabetes mellitus was not present during the appellant's active service or for many years thereafter and the record on appeal contains no indication that the appellant's current diabetes mellitus is causally related to his active service or any incident therein, other than claimed exposure to Agent Orange, which has not been established. 3. A heart disability and a lung disability were not present during the appellant's active service or for many years thereafter and the most probative evidence indicates that his current cardiopulmonary disability is not causally related to his active service or any incident therein, including claimed exposure to asbestos. CONCLUSIONS OF LAW 1. Diabetes mellitus was not incurred in active service and may not be presumed to have been incurred in active service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1116, 1131, 1137, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.313, 3.307, 3.309 (2009). 2. A heart disability was not incurred in active service and may not be presumed to have been incurred in active service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1131, 1137, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.313, 3.307, 3.309 (2009). 3. A lung disability was not incurred in active service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 2002); 38 C.F.R. § 3.303 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Veterans Claims Assistance Act of 2000 (VCAA) As a preliminary matter, the Board finds that no further notice or development action is necessary in order to satisfy VA's duties to the appellant under the VCAA. In an October 2005 letter issued prior to the initial decision on the claims, VA notified the appellant of the information and evidence needed to substantiate and complete a claim of service connection, and of what part of that evidence he was to provide and what part VA would attempt to obtain for him. 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b)(1) (2009). This information was reiterated in a subsequent June 2009 letter. Although the RO has failed to advise the appellant of the additional notification requirements imposed by the Court in Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006), no prejudice has resulted because service connection is being denied, and therefore no rating or effective date is being assigned. With respect to VA's duty to assist, the record shows that VA has undertaken all necessary development action. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2009). The appellant has not argued otherwise. The appellant's service treatment and personnel records are on file, as are all available, relevant, post-service clinical records specifically identified by the appellant. 38 U.S.C.A. § 5103A(c) (West 2002); 38 C.F.R. § 3.159(c)(2), (3) (2009). The RO has also taken reasonable actions to verify the appellant's Vietnam service. The record on appeal shows that in December 2005, the service department certified that although the appellant had served aboard the U.S.S. Annapolis, the U.S.S. Passumpsic, and the U.S.S. Kilauea, all of which were in the official waters offshore Vietnam, there was no record of the appellant having been exposed to herbicides. The Board also notes that in a June 2009 letter, the RO asked the appellant to provide more specific information regarding his recollection of service in the inland waters of Vietnam for the purpose of obtaining additional information from the service department such as ship's logs. The appellant responded that he had no additional information to submit. The appellant has been afforded a VA medical examination in connection with his claims of service connection for heart and lung disabilities. 38 C.F.R. § 3.159(c) (4) (2009). The Board finds that the examination is adequate in that it was provided by a qualified medical professional, a VA physician, and is predicated on a full reading of all available records. The examiner also addressed the appellant's contentions and provided a rationale for the opinion. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Although appellant has not undergone a VA medical examination in connection with his claim of service connection for diabetes mellitus, the Board finds that such is not necessary. An examination or opinion is necessary if the evidence of record (A) contains competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of disability; and (B) establishes that the claimant suffered an event, injury or disease in service; or has a presumptive disease or symptoms of such a disease manifesting during an applicable presumptive period; and (C) indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service; but (D) does not contain sufficient medical evidence for the Secretary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006) (discussing the four elements to consider in determining whether a VA medical examination must be provided). As discussed in more detail below, the record does not establish that the appellant served in Vietnam during the Vietnam era, that his overseas service involved duty or visitation in Vietnam, or that he was exposed to an herbicide agent such as Agent Orange during active service. Additionally, the appellant's diabetes mellitus was first diagnosed approximately 14 years after his separation from service and the record contains no indication that his current diabetes mellitus is causally related to his active service or any incident therein, other than exposure to Agent Orange exposure. As noted, however, in-service exposure to an herbicide agent has not been established, nor may it be presumed. Because the record on appeal contains no indication that the appellant's current diabetes mellitus may be associated with an established event, injury, or disease in service, an examination is not necessary. Waters v. Shinseki, No. 2009-7071 (Fed. Cir. April 6, 2010); Locklear v. Nicholson, 20 Vet. App. 410 (2006). Given the facts of this case, the Board finds that no further notification or development action is necessary on the issues now being decided. Neither the appellant nor his representative has argued otherwise. Factual Background The appellant's service treatment records are entirely negative for complaints or findings of diabetes mellitus, a heart disability, or a chronic lung disability. In-service medical records include reports of periodic physical examinations conducted in March 1960, November 1960, July 1965, and March 1971, at which the appellant's heart, lungs, and endocrine system were determined to be normal. Chest X-rays and urinalyses conducted in connection with these examinations were also consistently negative. The appellant's blood pressure was not elevated at any of these examinations. In December 1973, the appellant was treated for an upper respiratory infection. At a subsequent periodic physical examination conducted in January 1975, the appellant's heart, lungs, and endocrine system were found to be normal. A chest X-ray and urinalysis conducted in connection with this examination were also negative. The appellant's blood pressure was 128/88. In April 1975, the appellant sought treatment for nasal congestion and coughing. The impression was viral syndrome. In January 1976, he complained of a persistent cough. He was noted to be a smoker of one pack of cigarettes daily. The initial impression was persistent cough of unknown etiology. The appellant was seen on several occasions over the following week with complaints of a persistent cough and sore throat. He was diagnosed as having an upper respiratory infection. The remaining service treatment records are negative for complaints or findings of a heart disability, a lung disability, or diabetes mellitus. At the appellant's August 1976 military retirement medical examination, his heart, lungs, and endocrine system were normal. A chest X-ray was within normal limits, urinalysis was negative, and an EKG was noted to be within normal limits. The appellant's blood pressure was 124/78. On a report of medical history, the appellant denied having or ever having had shortness of breath, pain or pressure in his chest, a chronic cough, heart trouble, high blood pressure, or sugar or albumin in urine. The appellant's service personnel records show that he served aboard several ships during his period of active duty, including the U.S.S. Annapolis in the "Vietnam Combat Zone" in June 1966 and May 1967. As a result of this service, he was awarded the Vietnam Service Medal and a Vietnam Campaign Medal. The appellant's military occupational specialty (MOS) was electrical component maintenance. In August 2005, the appellant submitted an original application for VA compensation benefits, seeking service connection for a heart disability and diabetes mellitus. He indicated that to the best of his recollection, he had developed a heart condition while serving aboard the U.S.S. Annapolis in the coastal waters offshore Vietnam in the late 1960's, because he began experiencing symptoms of lightheadedness and shortness of breath. He also claimed that the early stages of his heart condition were noted at his retirement physical, during which he was found to have a heart murmur. The appellant also indicated that he had been stationed aboard the U.S.S. Kilauea, which also was in the coastal waters of Vietnam. With respect to his diabetes mellitus, the appellant argued that his condition was related to his Vietnam era service. In support of the appellant's claims, the RO obtained VA clinical records, dated from September 2000 to September 2005. In pertinent part, these records show that the appellant was seen as a new VA patient in October 2000. At that time, it was noted that he had been referred for evaluation of moderate to severe aortic stenosis discovered on a June 2000 echocardiogram (EKG). The appellant reported increasing breathlessness over the past year and indicated that he ran short of breath with exertion. He had no known history of coronary artery disease, although he had been diagnosed as having aortic valve disease 10 years prior after he underwent an ETT and cardiac catherization for breathlessness. The appellant's medical history also included hypertension and diabetes for the past ten years. On physical examination, the appellant's heart rate exhibited a grade II-III systolic ejection murmur at the left sternal border which was late peaking and radiating to the carotid arteries. There were diminished lung sounds in the bases. An EKG showed normal sinus rhythm with ST wave abnormality. A chest X-ray showed a heart size at the upper limits of normal with prominent pulmonary arteries. The assessment was no known history of coronary artery disease with increasing dyspnea on exertion and EKG evidence of moderate to severe aortic stenosis. The following month, the appellant underwent aortic valve replacement without complication. Subsequent VA clinical records show continued treatment for hypertension, diabetes, obesity, and coronary artery heart disease. In December 2005 statement, the appellant responded to the RO's request for additional information regarding his claims. He indicated that he had served aboard a ship which had used asbestos for insulation. He also recalled that he had been at sea in Vietnam and had gone up a river to re-fuel an Army fuel depot. The RO thereafter obtained additional VA and private clinical records showing continued treatment for numerous conditions, including diabetes and severe aortic stenosis. In pertinent part, these records show that in August 2006, the appellant was seen at a private facility in connection with his complaints of chest pain. His history was noted to include aortic valve replacement in 2000 and diabetes mellitus. Chest X-ray showed no evidence of acute cardiopulmonary disease. An EKG showed evidence of a severely stenotic aortic valve prosthesis with preserved systolic function and moderate concentric hypertrophy. Mild pulmonary hypertension was present. The diagnosis was chest pain of uncertain etiology in a patient with aortic valve replacement. In December 2006, the appellant reported a precipitous decline in his functional capacity over the last several months. He complained of shortness of breath with light exertion, continued chest pressure, and an inability to catch his breath. Physical examination showed a slow upstroke on S1, a harsh systolic ejection murmur which radiated to the carotid arteries, and clear lungs to auscultation. The assessment was symptomatic severe aortic stenosis, coronary artery disease, and uncontrolled diabetes mellitus. In January 2007, the appellant was hospitalized at a private facility with complaints of marked breathlessness, orthopnea, and chest discomfort. A CT scan of the chest showed small bilateral pleural effusions and diffuse perihilar interstitial thickening, no evidence of pulmonary embolism, and status-post sternotomy. An EKG showed evidence of severe to critical aortic stenosis with reduction of left ventricular systolic function and severe pulmonary hypertension. The diagnoses included severe to critical aortic stenosis of a tissue prosthetic valve, congestive heart failure, type 2 diabetes mellitus, and dyspnea, likely secondary to aortic stenosis. The appellant thereafter underwent aortic valve replacement. In an October 2008 letter, the appellant's private physician indicated that the appellant had type 2 diabetes mellitus and aortic valve disease status-post aortic valve replacement. The private physician further noted that the appellant had reported exposure to Agent Orange and indicated that "it may be very possible that his exposure to this agent has resulted in his diabetic condition, although at this time the connection is still unproven and presumptive in nature." The appellant was afforded a VA medical examination in July 2009, at which he reported that he had been exposed to asbestos for 18 years while serving aboard ships in the Navy as an electrician. He also reported a history of aortic stenosis since 2000, status post two valve replacements. In reviewing the appellant's claims file, including his service treatment records and post-service VA and private treatment records, the examiner noted that the appellant had never had been diagnosed as having asbestosis or any significant pulmonary problem. The examiner also noted that the appellant was not under treatment for any pulmonary condition. The examiner noted a diagnosis of aortic stenosis in 2000, as well as a 15 year history of diabetes mellitus. The examiner asked the appellant about his belief that his cardiopulmonary condition was due to Agent Orange exposure. The appellant responded that his cardiac surgeon said his aortic valve problems might be related to herbicide exposure. The appellant also indicated that he felt his diabetes mellitus was related to Agent Orange exposure because he had served on board an oil tanker that travelled up a river in Vietnam for 6 or 7 hours during a refueling operation, although he never actually set foot in Vietnam. After examining the appellant and reviewing the claims folder, the VA examiner concluded that the appellant's cardiopulmonary condition was not related to Agent Orange exposure. He noted that was no evidence linking Agent Orange exposure and aortic stenosis. He further noted that the appellant had not been diagnosed as having asbestosis or other significant pulmonary problem. The VA examiner indicated that the appellant's diabetes mellitus might be related to Agent Orange exposure. The diagnoses included post-operative two aortic valve replacements with no evidence of congestive heart failure and diabetes mellitus, type 2, now requiring insulin. Applicable Law Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303. Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d) (2009). Service connection for certain chronic diseases, including diabetes mellitus and cardiovascular-renal disease, may be also be established on a presumptive basis by showing that such a disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C.A. §§ 1112, 1137 (West 2002); 38 C.F.R. §§ 3.307(a)(3), 3.309(a) (2009). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307(a) (2009). Additionally, a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a)(6)(iii) (2009). Service in the Republic of Vietnam includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 U.S.C.A. § 101(29)(A); 38 C.F.R. §§ 3.307(a)(6)(iii), 3.313(a) (2009). In Haas v. Peake, 525 F.3d 1168 (Fed. Cir. 2008), cert. denied, 129 S.Ct. 1002 (2009), the United States Court of Appeals for the Federal Circuit (Federal Circuit) held that VA regulations require that a veteran must have actually set foot within the land borders of Vietnam or been present in the inland waters of Vietnam to be entitled to presumptive service connection. If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain enumerated diseases shall be service connected if the requirements of 38 U.S.C.A. § 1116, 38 C.F.R. § 3.307(a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C.A. § 1113; 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e) (2009). The enumerated diseases which are deemed to be associated with herbicide exposure include diabetes mellitus, but do not presently include a lung disability or a heart disability. See 38 C.F.R. § 3.309(e) (2009). The Secretary of Veterans Affairs also determined that there is no positive association between exposure to herbicides and any other condition for which he has not specifically determined a presumption of service connection is warranted. See Diseases Not Associated with Exposure to Certain Herbicide Agents, 72 Fed. Reg. 32,395 - 32,407 (June 12, 2007). In that regard, the Board notes that VA has proposed to amend section 38 C.F.R. § 3.309(e) to add ischemic heart disease (including, but not limited to, myocardial infarction, atherosclerotic cardiovascular disease, coronary bypass surgery, and stable and unstable angina) to the list of diseases associated with exposure to herbicide agents. See 75 Fed. Reg. 14,391 (March 25, 2010). These regulations, however, have not yet been implemented. In any event, as discussed in more detail below, the presumptive provisions are not for application in this case. In addition to the presumptive regulations, a veteran may establish service connection based on exposure to Agent Orange with proof of actual direct causation. See Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that the availability of presumptive service connection for some conditions based on exposure to Agent Orange does not preclude direct service connection for other conditions based on exposure to Agent Orange); Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994); Brock v. Brown, 10 Vet. App. 155 (1997). There is no specific statutory or regulatory guidance with regard to claims of service connection for asbestosis or other asbestos-related diseases. VA has issued guidelines for considering asbestos compensation claims. See VA Adjudication Procedure Manual, M21-1MR, part IV.ii.2.C.9. The Court has held that VA must analyze claims of service connection for asbestosis or asbestos-related disabilities under the administrative protocols established by these guidelines. See Ennis v. Brown, 4 Vet. App. 523, 527 (1993). In Dyment v. West, 13 Vet. App. 141, 145, the Court found that provisions in former paragraph 7.68 of VBA Manual M21-1, Part VI (the predecessor to the current M21-1MR asbestos guidelines), did not create a presumption of exposure to asbestos. Rather, medical nexus evidence is required in claims for asbestos related disease related to alleged asbestos exposure in service. See also VA O.G.C. Prec. Op. No. 04-00. The standard of proof to be applied in decisions on claims for veterans' benefits is set forth in 38 U.S.C.A. § 5107(b). Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. 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(b) (West 2002); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Analysis Diabetes mellitus The appellant seeks service connection for diabetes mellitus, which he argues is causally related to his exposure to Agent Orange while serving aboard ships serving in the waters of Vietnam. As noted above, a veteran who served in the Republic of Vietnam during the Vietnam era shall be presumed to have been exposed to an herbicide agent during such service. 38 C.F.R. § 3.307(a)(6)(iii). Diabetes mellitus is associated with herbicide exposure and shall be service connected if a veteran was presumably exposed to a herbicide agent during active service. 38 C.F.R. § 3.309(e). In this case, however, although the appellant is shown to have served on ships in the waters offshore Vietnam, his service is not shown to have involved duty in or actual visitation to the Republic of Vietnam. He did not set foot in the Republic of Vietnam and does not contend otherwise. Although he recalls that an oil tanker aboard which he served travelled up a river in Vietnam to refuel, this has not been established. The ships aboard which the appellant served during the Vietnam era have not been identified by the service department as having conducted operations on the inland "brown water" rivers and delta areas of Vietnam. See e.g. Compensation and Pension Bulletin, January 2010. Additionally, the record on appeal shows that the service department has certified that although the appellant served aboard the U.S.S. Annapolis, the U.S.S. Passumpsic, and the U.S.S. Kilauea, all of which were in the official waters of Vietnam, there was no record of the appellant having been exposed to herbicides. The Board also notes that the RO provided the appellant with the opportunity to provide more specific information regarding his recollection of service in the inland waters of Vietnam, but was unable to do so. Absent probative evidence establishing that the appellant set foot on the land mass of Vietnam, or was present in its inland waterways (so-called "brown water" naval activity), it cannot be presumed that the appellant was exposed to an herbicide agent during service and service connection for diabetes mellitus on a presumptive basis under 38 C.F.R. §§ 3.307 and 3.309 is not warranted. See Haas v. Peake, 525 F.3d 1168 (Fed. Cir. 2008). Setting aside the Agent Orange presumptions, the Board also notes that the appellant's service treatment and personnel records contain absolutely no indication that he was exposed to Agent Orange or any other herbicide agent in service. The appellant's contention that he was exposed to Agent Orange appears to amount to speculation on his part and is not probative as to whether or not he was exposed to Agent Orange, particularly in light of the service department's certification that there is no record of such exposure. Despite the October 2008 and July 2009 medical opinions noting the possibility that the appellant's diabetes mellitus may be due to his exposure to Agent Orange, absent probative evidence that the appellant was actually exposed to Agent Orange or other herbicide agent during service, there is no basis upon which to award service connection for diabetes mellitus on a direct basis due to Agent Orange exposure. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). The Board further notes that the appellant's service treatment records are entirely negative for complaints or findings of diabetes mellitus. The post-service medical evidence is similarly negative for complaints or findings of diabetes mellitus for many years after service. In fact, it appears that the appellant was first diagnosed as having diabetes in 1990, approximately fourteen years after his separation from service. Moreover, there is no indication in the evidence of record that any medical professional has related the appellant's current diabetes mellitus to his active service or any incident therein, other than claimed exposure to Agent Orange, which has not been established. The appellant does not contend otherwise. For the reasons set forth above, the Board finds that the preponderance of the evidence is against the claim of service connection for diabetes mellitus. The benefit of the doubt doctrine is not for application where the clear weight of the evidence is against the claim. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Heart and Lung disabilities The appellant also seeks service connection for heart and lung disabilities. He contends that his heart disability had its inception during service, as evidenced by a heart murmur noted as his separation examination as well as the fact that he began to experience symptoms such as shortness of breath on active duty. Alternatively, he contends that his heart disability may be due to Agent Orange exposure. Finally, he has contended that he developed a lung disability as a result of his exposure to asbestos aboard the ships on which he served. As discussed in detail above, the appellant's service treatment records are entirely negative for notations of Agent Orange exposure, asbestos exposure, or a chronic heart or lung disability. Indeed periodic physical examinations, as well as chest X-rays and EKGs, conducted over the course of his period of active service consistently showed that his lungs and heart were normal. Similarly, at the appellant's August 1976 military retirement medical examination, his heart and lungs were found to be normal. A chest X-ray was within normal limits, as was an EKG. On a report of medical history, the appellant denied having or ever having had shortness of breath, pain or pressure in his chest, a chronic cough, or heart trouble. The Board has considered the appellant's recollections to the effect that he experienced shortness of breath and a heart murmur during active service. As set forth immediately above, however, the contemporaneous record does not support his recollections in this regard. Rather, at the time of his military separation, the appellant denied having or ever having had shortness of breath or heart trouble and examination and diagnostic testing was normal. The Board finds that these contemporaneous records are entitled to far more probative weight than the recent recollections of the appellant of events which occurred many years previously. The Board further notes that the post-service medical record is silent for any mention of a heart or lung disability for many years after service separation. Although the objective record in this case shows that neither a heart nor a lung disability was present during the appellant's active service or for many years thereafter, as set forth above, service connection may 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. 38 C.F.R. § 3.303(d). Thus, if there is a causal connection between the current condition and service, service connection may be established. Godfrey v. Derwinski, 2 Vet. App. 354 (1992). The medical evidence currently associated with the record on appeal, however, indicates that the appellant's current cardiopulmonary disability is not causally related to his active service or any incident therein, including Agent Orange exposure or asbestos exposure. Specifically in a July 2009 opinion, a VA physician explained that there was no basis upon which to conclude that the appellant's current heart disability, aortic stenosis, or other cardiopulmonary condition was due to Agent Orange exposure. He further also noted that the appellant had not been diagnosed as having asbestosis or other significant pulmonary problem. The Board assigns this medical opinion significant probative weight. The opinion was rendered by a medical professional who has expertise to opine on the matter at issue in this case. In addition, the examiner addressed the appellant's contentions, based his opinion on a review of the claims folder, including the most pertinent evidence therein, and provided a rationale for his opinion. Finally, the Board notes that there is no medical evidence of record which contradicts this medical opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (discussing factors for determining probative value of medical opinions). The Board has considered the appellant's statement to the effect that his cardiac surgeon told him his valve problem might be related to herbicide exposure. No such medical opinion is contained in the record on appeal. Moreover, it is well established that a claimant's lay statements relating what a medical professional told him, filtered as they are through a lay person's sensibilities, are simply too attenuated and inherently unreliable to constitute competent evidence to support a claim. See Warren v. Brown, 6 Vet. App. 4 (1993). In summary, the Board finds that the most probative evidence shows that the appellant's cardiopulmonary disability was not present during his active service or for many years thereafter and the record on appeal contains no probative evidence that the appellant's current cardiopulmonary condition is causally related to his active service or any incident therein, including claimed Agent Orange or asbestos exposure. For the reasons discussed above, the preponderance of the evidence is against the claim and must be denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). (CONTINUED ON NEXT PAGE) ORDER Entitlement to service connection for diabetes mellitus is denied. Entitlement to service connection for a heart disability is denied. Entitlement to service connection for a lung disability is denied. ______________________________________________ James L. March Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs