Citation Nr: 1305286 Decision Date: 02/13/13 Archive Date: 02/21/13 DOCKET NO. 08-15 587 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUE Entitlement to service connection for a pulmonary disease, also claimed as asbestosis. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARINGS ON APPEAL Appellant and his friend ATTORNEY FOR THE BOARD A. Barner, Associate Counsel INTRODUCTION The Veteran served on active duty from August 1963 to September 1965. Thereafter, the Veteran spent additional time in the Navy Reserve. This matter initially came before the Board of Veterans' Appeals (Board) on appeal from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. The Veteran and a friend testified before the undersigned Veterans Law Judge at an August 2010 hearing in Washington, D.C. The Veteran also testified before a decision review officer (DRO) at the RO in October 2008. Transcripts are associated with the claims folder. This issue was previously before the Board in December 2010, at which time it was remanded to request additional treatment records and afford the Veteran a VA examination. VA and private treatment records were associated with the claims folder, and the Veteran was afforded a VA examination in December 2010. Given the foregoing, the Board finds that VA has substantially complied with the Board's prior remand with regard to this appeal. See Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998) where there was substantial compliance with Board's remand instructions). FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's pulmonary disease, also claimed as asbestosis, is related to active military service or events therein, to include asbestos exposure. CONCLUSION OF LAW Pulmonary disease, also claimed as asbestosis, was not incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & 2012); 38 C.F.R. §§ 3.159, 3.303 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION The requirements of 38 U.S.C.A. §§ 5103 and 5103A have been met. There is no issue as to providing an appropriate application form or completeness of the application. VA notified the Veteran in January 2006 and June 2007, of the information and evidence needed to substantiate and complete a claim, to include notice of what part of that evidence is to be provided by the claimant and what part VA will attempt to obtain. This letter also provided information regarding the assignment of disability ratings and effective dates. The Veteran's claim was thereafter readjudicated, most recently in a November 2011 supplemental statement of the case, thereby curing any pre-decisional notice error. VA has also satisfied its duty to assist. The claims folder contains the Veteran's service treatment and personnel records. In support of his claim, the Veteran submitted various private medical records and statements. He has not provided authorizations for the release of any additional records. Although the Board is aware that there may be outstanding medical evidence from DuPont, the Veteran was notified that such records should be submitted, per his August 2010 Board hearing, following which he was given an additional 60 days during which the record was held open to submit such evidence. Following remand, in December 2010 the Veteran was again provided an opportunity to supplement the record or authorize release of private records, but failed to do so in regards the DuPont medical examinations. As the Court of Appeals for Veterans Claims has held, "[t]he duty to assist in the development and adjudication of a claim is not a one-way street." Wamhoff v. Brown, 8 Vet. App. 517, 522 (1996). "If a [claimant] wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence." Wood v. Derwinski, 1 Vet. App. 190, 193 (1991); see also Olson v. Principi, 3 Vet. App. 480, 483 (1992). The Veteran was provided a VA examination in December 2010 to address the nature and etiology of his claimed pulmonary disease, to include asbestosis. On review, the examination report appears comprehensive and includes a rationale for the opinion provided. Although the Board is aware of the Veteran's concerns that the examiner found he was not exposed to asbestos in service, the Board notes that in fact the examiner also provided an opinion assuming exposure to asbestos in service. As such, the exam is considered adequate and additional examination is not warranted at this time. In sum, there is no evidence of any VA error in notifying or assisting the Veteran that reasonably affects the fairness of this adjudication. See 38 C.F.R. § 3.159. 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). 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) (2012). Although there is no specific statutory or regulatory guidance regarding claims for residuals of asbestos exposure, VA has several guidelines for compensation claims based on asbestos exposure. See M21-1MR, IV.ii.2.C.9; and M21-1MR, IV.ii.1.H.29. In addition, an opinion by the VA General Counsel discussed the provisions of M21-1 regarding asbestos claims and, in part, concluded that medical nexus evidence was needed to establish a claim based on in-service asbestos exposure. VAOPGCPREC 4-00; 65 Fed. Reg. 33422 (2000). Essentially, VA must determine whether military records demonstrate evidence of asbestos exposure during service; whether there was pre-service, post-service, occupational, or other asbestos exposure; and whether there is a relationship between asbestos exposure and the claimed disease. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. See 38 U.S.C.A. § 5107(b) (West 2002); 38 C.F.R. § 3.102 (2012). In October 2005 the Veteran claimed entitlement to service connection for hardening of the lungs due to asbestos, pleural plaque, indicating that his disability began in 1996, with treatment from 2003 to the present. Service treatment records show that on enlistment in July 1962 the Veteran reported that he had a history of chronic or frequent colds, sinusitis, and hay fever. The examiner commented that the Veteran experienced occasional respiratory illness each winter; a slight post-nasal discharge, with no real sinus disease; and, mild Fall hay fever not requiring medications or interfering with work. On examination chest inspiration and expiration were measured, and the lungs and chest were considered normal; however, a chest X-ray was not taken because facilities were not available. In August 1963 the Veteran reported a history of sinusitis and hay fever, which the examiner indicated was a mild case, not incapacitating, and the Veteran's lungs and chest were normal. A June 1964 chest X-ray revealed negative findings. An August 1965 discharge examination indicated that the lungs and chest were normal, and chest X-ray was negative. Subsequent Reserve examinations indicated that the chest and lungs were normal; however, chest X-ray facilities were unavailable. A December 1998 letter from Dominic Gaziano, M.D., indicates that the Veteran was evaluated for occupational lung disease at the request of an attorney. His occupational history was reported to include serving in the Navy for two years, and working at DuPont from 1959 to 1993. The report indicates that the Veteran was exposed to asbestos incidentally on steam lines, and as a maintenance mechanic at DuPont Textile while removing asbestos from pipes, boilers, and spinning heads of machines. The walls were apparently of asbestos board, and the Veteran reported that he drilled holes through the boards. In addition, the Veteran reported exposure to sand in sandblasting and to coal dust from the power house. The Veteran's smoking history included smoking greater than one pack of cigarettes a day for 35 years, and quitting in January 1996. He also smoked two cigars daily for a year. Review of systems indicated that there was no cough or phlegm; the Veteran became short of breath with running or strenuous work, but did not experience chest pain. On examination the Veteran's lungs were clear to percussion and auscultation. Chest X-ray showed rounded and irregular opacities throughout all zones, and bilateral pleural plaques were seen. Calcified granulomata were noted scattered throughout both lungs. As such, Dr. Gaziano opined that to a reasonable degree of medical certainty, the Veteran had a mixed dust pneumoconiosis, including asbestosis, with a moderate degree of pulmonary functional impairment. A May 2002 memorandum regarding asbestos claims provided a Navy Job Titles (Ratings) and Probability of Exposure chart to determine the likelihood of asbestos exposure. The Veteran's probability of exposure was considered to be "minimal" as either a Gunner's Mate or as a Seaman. Private treatment records from 2004 to 2005 are of record from RMH Pulmonary Associates, with corresponding PFTs, X-rays and CT scans. The records show that the Veteran attended outpatient pulmonary rehabilitation for emphysema. In March 2004 the Veteran reported asbestos exposure to pipe and steam lines as a maintenance worker at DuPont Textile from 1959 to 1993, and a history of noncalcified pleural plaques bilaterally in the mid lung fields. The Veteran also reported that he had worked in the Navy for two years, and had a 35 pack year history, but had quit smoking in December 1998. Impression was of: 1) a history of asbestos exposure while in maintenance from 1959 to 1993 at DuPont, and two years of service in the Navy at which time he was also exposed to maintenance and steam lines; 2) old chest X-rays read by a B reader showed noncalcified pleural plaques in the right and left mid lung fields; however, the Veteran had not brought his X-ray with him; and 3) a history of mild chronic obstructive pulmonary disease (COPD), with FEV1 at 71 percent of predicted value according to outside PFT tests. April 2004 note revealed a similar history as above, and indicated that PFTs showed a significant decrease in FEV1, and reduced lung capacity. Chest X-ray showed very mild pleural thickening, and no evidence of problems with his lung fields. Lungs were clear without wheezes, rales or rhonchi. Impression was of a history of asbestos exposure with mild pleural disease evidence on current X-ray; mild COPD under good control; and restrictive lung disease with some obstructing pattern also. April 2005 note indicated that the Veteran experienced shortness of breath, which had worsened even on minimal exertion, and had been a concern for the previous three years. Chest X-ray showed bilateral pleural fibrosis, with essentially no change since 2002. Impression was in part of pleural fibrosis, noncalcified, probably secondary to asbestos, and of COPD with mild restriction and moderate obstructive disease. June 2005 problem list included COPD and a history of asbestos exposure as a maintenance worker at DuPont Textile. It was indicated that the April 2005 chest X-ray showed evidence of pulmonary nodule in the left upper lobe, which more likely represented old healed granulomatous disease; however, a CT scan was recommended. Impression was of COPD with an FEV1 as indicated, and mild obesity with a decrease in ERV on PFTs. There was a history of tobaccoism, and asbestos exposure. July 2005 note listed bilateral pleural plaques, probable asbestos-related pleural disease and moderate restrictive disease with low ERV, possibly body habitus related from obesity as problems. Assessment was of a somewhat obese male who had dyspnea, and asbestos-related pleural disease. Chest X-rays, in this examiner's opinion, did not show parenchymal disease, and the computed tomography (CT) scan did not confirm parenchymal disease. There was no pulmonary parenchymal nodule as was suggested on previous chest X-ray. This appears to have been more related to pleural thickening. In January 2006 the Veteran emphasized that while in the Navy he worked in ordinance and was a Gunner's Mate, and as such was exposed to asbestos. In particular, he indicated that the magazines were insulated with asbestos, and that he was exposed to damaged hot water and steam lines, also insulated with asbestos. He reported that he was exposed while the ship was being overhauled in Long Beach shipyard in 1963, and that he stood fire watch for welders who used asbestos cloth for flame protection, during which time he did not have asbestos protection. The Veteran was afforded a VA respiratory examination in September 2006, wherein the claims folder was not reviewed. The Veteran reported that he had a screening chest X-ray at DuPont, following which he was sent to a respiratory clinic in West VA where he had multiple tests and was told that he had asbestosis. The Veteran indicated that he did not experience symptoms until approximately 2002 when he began to feel short of breath. He indicated that he was unable to hunt and split wood as he used to, and tired quickly. The report showed the problem being detailed was pleural fibrosis, with a 1998 date of onset, reported to be progressively worse, and for which the Veteran was medically treated with an inhaled anti-inflammatory that slowed the progression of disease. The Veteran's medical history included dyspnea on moderate and severe exertion. Otherwise, there was not a history of hospitalization or surgery, trauma to the respiratory system, respiratory system neoplasm, pneumothorax, emphysema, asthma, cough, hemoptysis, wheezing, anorexia, chest pain, swelling, respiratory failure, fever, or incapacitation. On physical examination there were abnormal respiratory findings in the rhonchi, and diaphragm excursion was slightly limited. Chest X-ray showed no evidence of active cardiopulmonary disease. There was associated pleural thickening. Diagnoses were of COPD, an obstructive respiratory disease of unknown etiology; and associated pleural fibrosis. A medical opinion was not provided. VA treatment records from 2006 to 2007 indicate that the Veteran was treated for COPD and asbestos exposure. In 2006 he reported that he worked around asbestos for 2 years, and that he had smoked a pack per day for 30 years, and quit smoking approximately 10 years earlier. The Veteran transferred his care to the VA. A nurse practitioner indicated that asbestosis was related to Agent Orange; however, there was no further explanation, just a conclusory statement based on the Veteran's reported history. In January 2007, a chest CT indicated in part that there was scarring of both lung apices, calcified granulomata of the right hilum and right lower lung; a tiny area of focal emphysema and scarring identified in posterior portion of the right lower lung; and, bilateral non-calcified pleural plaques. Impression was of bilateral non-calcified pleural plaques, consistent with stated clinical history of asbestosis. In May 2008 the Veteran indicated that his exposure to asbestos was regulated by the Occupational Safety and Health Administration while at DuPont. He compared this to the absence of safety controls onboard the USS ALAMO, where the piping was covered by asbestos and the ship was often being repaired, including when it was drydocked. At his December 2008 hearing before a DRO the Veteran contended that he was exposed to asbestos while aboard the USS ALAMO. In particular he reported that the ship was stripped down and tore up in a drydock yard where steam lines and electrical components were being replaced, such that he believed he was exposed to asbestos. In addition, he reported that the magazines were insulated with asbestos, and he speculated that the steam condensation lines on board were most likely covered with asbestos. He indicated that his duties involved working on the gun mounts, where there was not asbestos exposure as far as he was aware. He indicated that at one time his duty involved tearing up floor tiles, which he now believed to have exposed him to asbestos. He reported that he did not experience any breathing difficulties or chest pains when he separated from service. He also indicated that he had been on a ship for approximately two-weeks of Reserve training each year. He indicated that in approximately 1997 he noticed shortness of breath that worsened over the course of a year, such that it was noticeable to him when it interfered with his activities splitting wood or walking in the mountain to hunt. The Veteran discussed working at DuPont, where he indicated that he was exposed to asbestos, but wore protective equipment, which included a fresh air mask and suit. He indicated that he had not worn protective gear during the entirety of his time at DuPont, but rather started in approximately 1978 until his retirement in 1993. The Veteran reported that he had worked for DuPont even prior to entering service, starting there as a machine operator or textile operator, in which capacity he did not work with pipes. In 1980 he reportedly began to work as an industrial mechanic, which was also around the time that he indicated the industry was aware of the dangers of asbestos exposure. The Veteran reported that the earliest that he was diagnosed as having asbestosis was in 1998. The Veteran was afforded a hearing before the Board in August 2010 wherein he indicated that he had employment physicals at DuPont approximately every 18 months, which included audiological testing but did not include breathing tests or evaluating the respiratory system. He indicated that he was given a clean bill of health when he retired from DuPont. With further clarification, however, the Veteran reported that he was also given routine chest X-rays and that in approximately the mid 1970s or early 1980s he was told that he had pleural plaques. The Veteran indicated that besides serving on the USS ALAMO as a Gunner's Mate, he also had other duties, which included tearing up the tile covers. In addition, he reported that he was in charge of the ammunition and explosives, and asbestos was contained in the barrels, and magazines were insulated most likely with asbestos. He reported that he did not wear a mask or any protection from asbestos in service. He contrasted his work in service without safety gear to his work at DuPont where employees were required to wear safety gear around asbestos, to include fresh air masks. He contrasted the time during which he was exposed, indicating constant exposure in service aboard a ship where asbestos form work on a steam line could travel through the ventilation systems, versus at DuPont, where exposure was intermittent. The Veteran reported that while on the USS ALAMO it was overhauled while he lived on ship in Long Beach, California, and he was exposed to dust particles in the air, and in close proximity (standing fire watches) to the yard workers repairing or replacing steam pipes. He indicated that he may have been exposed to asbestos while in the Navy Reserve as he served on board old ships. The Veteran reported that he noticed respiratory difficulties beginning in the mid-to-late 1980s, and he noticed a problem with his breathing in the late 1990s. He reported that the union sent him for an evaluation by Dr. Gaziano in 1998, at which time he was told he had asbestosis. The Veteran at first indicated that Dr. Gaziano had written in his report that his asbestosis was due to exposure in service, but with clarification from his representative who indicated that the report did not include an opinion regarding military exposure, the Veteran indicated that Dr. Gaziano did not "point the finger" for his asbestosis at the military. The record was held open an additional 60 days to allow the Veteran to attempt to secure additional records from DuPont; however, while records regarding the Veteran's audiological testing were forthcoming, they did not include chest X-rays or further physical examinations. An Internet article in which it was indicated that asbestos was often used on ships such as the USS ALAMO to insulate and fireproof materials on board was submitted. The article discussed how crew members were often exposed to asbestos, which in addition to its use in boiler and engine rooms, was also present in pipes, walls, and ceilings, and had caused asbestos related diseases following latency periods from 20 to 50 years. The Board remanded this claim in December 2010 in order to afford the Veteran a VA examination, and an opportunity to identify additional treatment records. According to a December 2010 notice regarding outstanding treatment records and submitting authorization and release forms, the Veteran identified and/or submitted records from Rockingham Pulmonary Associates, Chest Medical Services Inc., and the VA. The Board observes, however, that no authorization and release or treatment records for DuPont were received. VA treatment records of chest imaging studies from December 2007 include an impression of COPD, and asbestos exposure with evidence of pleural plaques with no parenchymal involvement. March 2009 chest imaging indicated that there was no change compared to the December 2007 studies. As such, treatment report indicated that there was unchanged mild bilateral lower lung interstitial prominence that could indicate mild asbestosis; scattered bilateral pleural plaques consistent with asbestos exposure; no acute infiltrate pleural effusion or pulmonary venous congestion; and, mild hyperaeration consistent with COPD. In December 2010 the Veteran was afforded a VA examination for miscellaneous respiratory diseases, and the claims folder was reviewed. The Veteran reported that he experienced shortness of breath beginning in the 1980s, although he was not treated for it. He reported that in approximately 1997 he was encouraged by the union to see a doctor at DuPont who indicated that he had hardening of the lungs, but not asbestosis. He indicated however, that at a medical follow-up he was diagnosed as having asbestosis. The Veteran reported that this was related to his time in the Navy as well as with DuPont. Specifically he reported that in service there was asbestos on the ship, and as an ordinance mate he was exposed to magazines insulated with asbestos. The Veteran reported that he had not been tested for asbestosis in the Navy, and did not have a chest X-ray in service. He reported that post-service he worked for DuPont as a machine operator, and believed he was exposed to friable and nonfriable asbestos in the pipes. He reported that he handled asbestosis while working at DuPont, likely from 1965 to 1993. He indicated that prior to 1984 he did not use a screen or mask, but from 1984 onwards he wore a mask and underwent X-rays approximately every 18 months. The Veteran reported that he was told he did not have asbestosis, but his Union recommended he go to the clinic. The Veteran indicated that he smoked tobacco from age 18 to 56. Previous chest X-ray from September 2006 was emphasized, showing no evidence of active cardiopulmonary disease. In January 2011 PFT interpretation was of mild restrictive defect with moderate diffusion impairment. Findings were considered consistent with, but not diagnostic of, asbestosis. The Veteran was diagnosed as having restrictive lung disease consistent with asbestosis exposure, and COPD. The examiner opined that the pulmonary disorder was not due to the Veteran's exposure to asbestos in service. The examiner indicated that the Veteran served in the Navy from the early to mid 1960s, ending his Reserve career in approximately 1982. The examiner indicated that the Veteran's pulmonary disorder was not due to asbestos exposure in service. The examiner indicated that the claims folder did not reveal evidence of in-service asbestos exposure, and emphasized that the jacket which was labeled asbestos exposure contained training records, evaluations, and recommendations for promotion, without revealing information regarding asbestos exposure. In contrast, the examiner emphasized that the claims folder contained information of asbestos exposure during a long career as a maintenance employee with DuPont Textile. The examiner indicated that the Veteran was seen in the early-to-mid 2000s for pulmonary complaints, and diagnoses included COPD, pleural thickening, and asbestosis resulting from chronic tobacco use and working as a maintenance employee for DuPont from 1959 to 1993, with a break during active service. The examiner highlighted the Veteran's physical examinations from 1967 and 1968, which did not reveal a pulmonary condition, as well as the 1964 chest X-ray not revealing a pulmonary condition. The examiner highlighted the Veteran's own reports of handling asbestos for many years in his work for DuPont Textiles, during which time he was evaluated for exposure over time. The examiner was also cognizant of the Veteran's report of asbestos exposure while in the Reserve, specifically during annual training, involving ships and land fixed facilities. Importantly, the examiner also offered an alternate opinion that considered the likelihood of an in-service etiology presuming asbestos exposure in service. Specifically, the examiner indicated that opportunity, concentration, and duration of asbestos exposure, if it occurred during service, would be less than the already documented and admitted chronic duration of asbestos exposure that the Veteran had during his decades long civilian occupation. Additionally, the examiner noted the Veteran's long history of tobacco use, and indicated that this was a huge risk factor for developing COPD and impacting findings on PFT. The examiner indicated that current findings were consistent with asbestosis exposure, and other PFT results via local providers suggested COPD, with the claims folder revealing radiographic evidence of pulmonary fibrosis secondary to asbestosis. Following review of the claims folder, examination and interview of the Veteran, the examiner opined that the pulmonary disorder was not due to exposure to asbestos in service, and indicated that evidence of record revealed the Veteran's pulmonary fibrosis and PFT findings suggesting asbestosis were the result of his many-decades long non-military occupation. A March 2011 PIES response indicated that it was not determined whether the Veteran service in the Republic of Vietnam; however, the Veteran served aboard the USS ALAMO (LSD-33), which was in the official waters of the Republic of Vietnam in July 1965. The PIES response indicates that the record provides no conclusive proof of in-country service. A formal memorandum indicating a lack of information required to verify in-country service in Vietnam in connection to Agent Orange exposure claims was also filed in March 2011. A Dictionary of American Naval Fighting Ships Internet article regarding the history of the USS ALAMO was reviewed. In December 2011 the Veteran again contended that he was exposed to asbestos while on board ship in service, and that this contrasted with his work at DuPont where masks and protective measures were taken according to OSHA standards. He requested reasonable doubt be considered in his favor. These contentions were submitted along with a waiver of RO review, and request for expedited processing. The evidence of record shows current diagnoses include COPD., pleural thickening, pleural fibrosis, consistent with asbestosis, such that the Board in consideration of reasonable doubt, finds that there is a current pulmonary disease. Regarding whether there was an injury during service, a review of service treatment records does not show complaints related to the lungs or that the Veteran was ever treated for any inhalation or other lung injury. Although the Veteran reported a history of sinusitis, colds, and hay fever on entrance into service, his lungs were considered normal then as well as in subsequent chest X-rays, to include on separation, and, there is no indication of treatment for symptoms of or a diagnosis of any chronic pulmonary disease while in service. The Veteran contends that he was exposed to asbestos during military service. Service personnel records confirm that the Veteran served on the USS ALAMO (LSD-33), and as discussed above, according to Department of Veterans Affairs Asbestos Claims Memorandum (May 13, 2002) the probability of asbestos exposure for either a seaman or a gunner's mate is "minimal." The Board notes that the RO determined that the Veteran may potentially have had some exposure to asbestos during military service, but that his post-service occupations may potentially have involved some exposure to asbestos as well. Considering the Veteran's service aboard a Navy vessel and resolving reasonable doubt in his favor, the Board concedes some likely asbestos exposure during military service. Notwithstanding, it is necessary to determine whether the Veteran currently has pulmonary disability related to his military service, to include asbestos exposure. The December 2010 VA examiner provided a negative etiology opinion. Whether a physician provides a basis for his or her medical opinion goes to the weight or credibility of the evidence in the adjudication of the merits. Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Other factors for assessing the probative value of a medical opinion are the physician's access to the claims folder and the thoroughness and detail of the opinion. Prejean v. West, 13 Vet. App. 444, 448-9 (2000). The United States Court of Appeals for Veterans Claims (Court), however, held that claims file review, as it pertains to obtaining an overview of a claimant's medical history, is not a requirement for private medical opinions. Moreover, review of a claims file by a VA examiner, without more, does not automatically render the examiner's opinion competent or persuasive, and conversely, a private medical opinion may not be discounted solely because the opining clinician did not review the claims file. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). On review, the Board finds the VA medical opinion to be the most probative evidence of record, when considering the other medical professionals have not provided opinions regarding the etiology of pulmonary disease, aside from its relation to asbestos exposure. Additionally, the VA opinion was based on a review of the claims folder, to include available medical evidence, and discussed in detail the diagnostic testing of record and the differing extent of asbestos exposure in service and occupationally, as well as factors such as a history of smoking. The Veteran is competent to report respiratory symptoms such as coughing. Charles v. Principi, 16 Vet. App. 370, 374-75 (2002) (appellant competent to testify regarding symptoms capable of lay observation). Notwithstanding, there is no evidence of a chronic disorder during service and at separation his chest x-ray was normal. Additionally, the absence of a diagnosed disability or treatment for respiratory complaints for many years following discharge weighs against a finding of continuity. See Pond v. West, 12 Vet. App. 341, 346 (1999). In this regard, the Board notes that the Veteran did not claim entitlement to service connection for a pulmonary disease until October 2005, many years following discharge. Although the Veteran has reported respiratory symptoms experienced as early as the 1980s, the Board finds he is not a reliable historian where he has reported varying dates for the onset of such symptoms, ranging to the 2000s. As such, these reports are not considered to be credible. Further, the absence of documented respiratory complaints for many years post-service would damage the credibility of any assertion that the appellant has had chronic problems since discharge or in close proximity to such. Indeed, the appellant does not appear to contend continuity of symptomatology. Although the Veteran is competent to report his symptomatology, he is not competent, on the facts of this case, to render a medical opinion as to the etiology of his pulmonary disease. In this regard, the Board notes evidence may be competent to establish medical etiology or nexus. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). VA, however, "must consider lay evidence, but may give it whatever weight it concludes the evidence is entitled to." Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). Little probative value is given to the Veteran's etiological assertions as he is not competent to opine on such a complex medical question. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. West, 12 Vet. App. 460, 465 (1999). In summary, the more probative evidence of record indicates that the Veteran's current respiratory complaints are not related to active military service or events therein, to include any asbestos exposure. It seems clear that the more extensive and intense asbestos exposure was at work in the years post-service. The in-service duties did not suggest specific and intensive asbestos exposure, but rather more incidental contact. Thus, the preponderance of the evidence suggests a post-service etiology to the pulmonary pathology at issue. The preponderance of the evidence is against the Veteran's claim and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. ORDER Entitlement to service connection for a pulmonary disease, to include asbestosis, is denied. ____________________________________________ MICHAEL D. LYON Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs