Citation Nr: 1318827 Decision Date: 06/10/13 Archive Date: 06/21/13 DOCKET NO. 06-12 723 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for asthma. 2. Entitlement to service connection for chest pain secondary to asthma. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant and his spouse ATTORNEY FOR THE BOARD G. E. Wilkerson, Associate Counsel INTRODUCTION The Veteran served on active duty from July 1965 to July 1968. These matters initially came before the Board of Veterans' Appeals (Board) on appeal from a December 2005 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In July 2006, the Veteran and his spouse testified before a Decision Review Officer (DRO) at the RO. A transcript of the hearing is of record. In May 2008, June 2010, August 2012, and December 2012, the Board remanded the claims for additional development. For the reasons stated below, the RO/AMC complied with the Board's remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). A review of the Veteran's Virtual VA electronic claims file reveals no additional records. FINDINGS OF FACT 1. The Veteran's asthma did not manifest in service and is unrelated to service. 2. A disability manifested by chest pain is not shown by the record. CONCLUSIONS OF LAW 1. Asthma was not incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2012). 2. Chest pain is not proximately due to, the result of, or aggravated by a service-connected disability, and was not incurred in or aggravated by service. 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. The Veterans Claims Assistance Act The Veterans Claims Assistance Act of 2000 (VCAA), Pub. L. No. 106-475, 114 Stat. 2096 (Nov. 9, 2000) (codified at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002 & Supp. 2012)) redefined VA's duty to assist the Veteran in the development of a claim. VA regulations for the implementation of the VCAA were codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2012). Under the VCAA, VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; (3) that the claimant is expected to provide; and (4) must request that the claimant provide any evidence in his possession that pertains to the claim. Pelegrini v. Principi, 18 Vet. App. 112, 120-21 (2004); 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). The United States Court of Appeals for Veterans Claims (Court) has also held that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: 1) Veteran status; 2) existence of a disability; 3) a connection between the Veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). In a January 2005 pre-rating letter, the RO notified the Veteran of the evidence needed to substantiate the claims for entitlement to service connection. Additionally, a June 2008 letter provided him with the general criteria for the assignment of an effective date and initial rating. Id. Ideally, the notice required by 38 U.S.C.A. § 5103(a) should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004); see also Mayfield v. Nicholson, 19 Vet. App. 103 (2005). Although that was not done in this case, the Board finds that this error was not prejudicial to the appellant because the actions taken by VA after providing the notice have essentially cured the error in the timing of notice. Not only has the appellant been afforded a meaningful opportunity to participate effectively in the processing of his claim and given ample time to respond, but the AOJ also readjudicated the case after the notice was provided. See Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006) (where notice was not provided prior to the AOJ's initial adjudication, this timing problem can be cured by the Board remanding for the issuance of a VCAA notice followed by readjudication of the claim by the AOJ). For these reasons, it is not prejudicial to the appellant for the Board to proceed to finally decide this appeal as the timing error did not affect the essential fairness of the adjudication. The VCAA also requires VA to make reasonable efforts to help a claimant obtain evidence necessary to substantiate his claim. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c), (d). This "duty to assist" contemplates that VA will help a claimant obtain records relevant to his claim, whether or not the records are in Federal custody, and that VA will provide a medical examination or obtain an opinion when necessary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4). In this case, VA obtained the Veteran's service treatment records and all of the identified post-service private and VA treatment records as well as Social Security Administration records. Pursuant to the Board's December 2012 remand instructions, the RO/AMC requested treatment records dated through December 2012 from the Dallas VA Medical Center, and copies of these records are associated with the Veteran's claims file. In addition, the Veteran was afforded VA examinations in August 2009 and January 2012 to determine the etiology of the claimed asthma and chest pain, as instructed in the Board's previous remands. The January 2012 examiner provided the requested opinions thus complied with the Board's remand instructions in this regard as well. Stegall, 11 Vet. App. at 271. For the reasons set forth above, the Board finds that VA has complied with the VCAA's notification and assistance requirements. The claims for entitlement to service connection for asthma and chest pain secondary to asthma are thus ready to be considered on the merits. II. Factual Background The Veteran's service treatment records reflect that he endorsed asthma on a July 1965 report of medical history upon service entrance. It was noted that he had no asthma since he was 9 or 10 years old. No abnormalities with respect to asthma or chest pain were found on entrance examination. In June 1967, the Veteran complained of left chest pain, worse with movement. There was anterior chest wall tenderness on examination. His lungs were noted to be clear, and a chest x-ray was normal. On June 1968 discharge examination, the lungs and chest were noted to be normal. A chest x-ray was also normal. While the Veteran again endorsed asthma on his report of medical history at discharge, the examiner remarked that the Veteran's asthma had been corrected and that he had not experienced asthma while in the Army. Following the Veteran's discharge from service, VA treatment records include reports of chest x-rays from August 1994 and October 1997 reflecting no abnormalities. In an October 2003 VA outpatient treatment report, the Veteran reported occasional exertional chest pain resolved with rest. In February 2004, the Veteran presented with atypical chest pain that was described as a constant, non-pleuritic, slight discomfort that was not related to exertion and was aggravated by lying on his side. On VA treatment in March 2004, the Veteran reported waking up most mornings with substernal chest pressure relieved by rubbing. A March 2004 VA outpatient treatment report reflects that the Veteran complained of chest fullness when he walked. An August 2005 treatment report reflects that that the Veteran still had some atypical chest pain, but that his cardiac catheterization showed no significant coronary artery disease. In a March 2005 statement, Dr. D. from the VA North Texas Health Care System indicated that he reviewed the Veteran's service records, and in his opinion, fumes from welding more likely than not aggravated the Veteran's asthma. A March 2005 VA outpatient treatment report reflects that the Veteran used Primatene mist for his asthma. It was recommended that the Veteran discontinue use of this medication and Albuterol was prescribed. On VA examination in June 2005, the examiner noted that the Veteran's asthma history was classic for childhood asthma starting at age five and typical of occult gastroesophageal reflux in the preschool age group. It was noted that the Veteran had a lot of trouble with asthma when he first went to school, but that he got better spontaneously at about age 15, which the examiner noted was an often-observed pattern. The Veteran reported that his asthma got worse in service. The examiner noted the opinion of Dr. D., and indicated that he could not rule the opinion out, but he thought it was "begging the issue." The examiner noted that the Veteran not only had classic gastroesophageal reflux with aspiration bronchitis and reactive airway disease when he was 5 year old, at age 27 he was seen at the VA for severe gastritis and substernal pyrosis classical of gastroesophageal reflux disease. The Veteran remembered numerous episodes of reflux aspiration and mucus in the throat at night. Examination revealed chronic pharyngitis which was also classical in a nonsmoker. The examiner also noted that the Veteran had been seen for atypical chest pain. His heart was extensively studied with nuclear studies and a strong suspicion of ischemia was reported, although it was reversible. On physical examination, there was a tight chest with significant high-grade air trapping, variable, more on the right side than on the left, which was typical of a little more aspiration getting into the right side than the left. Pulmonary function tests revealed an obstructive pattern with no impairment, but he had a significant bronchodilator response. He started using Primatene mist when he was a child, and indicated that his wife sent it to him while he was in service. The Veteran reported that he used this until one of the VA staff doctors asked him to quit and put him instead on Albuterol. The examiner indicated that the Veteran had exercise-induced asthma and constitutional gastroesophageal reflux disease with recurrent aspiration throughout his lifetime, mostly occult but often identifiable later on ending up with reactive airway disease presenting as bronchial asthma. The examiner noted that this condition was possibly aggravated by welding but not very likely. In various written statements, the Veteran's wife and family members reflect their observations that while the Veteran had asthma prior to service, he had not had any attacks in the years leading up to his service. They indicated that the Veteran's asthma returned during his service and continued to this day. The Veteran's wife reported that he wrote to her within a few months of his overseas duty informing her that his asthma had returned and requesting that she send him his inhaler. He also informed her that he was having chest discomfort and pain because of his asthma. During the Veteran's July 2006 DRO hearing, he reported that while he did not go on sick call for his asthma in service, welding fumes from his in-service duties aggravated his asthma. He indicated that his wife had to send him his inhaler in service. He reported that he was first diagnosed with asthma when he was 5 years old. He received treatment at the VAMC in Dallas and took Albuterol. With respect to chest pain, the Veteran noted that he received treatment for complaints of chest pain on one occasion during service, around the time when he first started getting his asthma back. He expressed his opinion that his breathing difficulties caused his chest to hurt. In a July 2006 statement, private physician Dr. S. indicated that he reviewed the Veteran's service records and opined that the Veteran's asthma condition is more than likely a result of his military service. He noted that nothing the Veteran did after service would have caused or aggravated this condition. A June 2008 statement from VA physician Dr. D. reflects that the Veteran had been his patient since August 2007. He noted that the Veteran began having asthma at age 5 and continued to have asthma attacks until age 15. He enlisted at age 17 with no asthma. He noted that the Veteran was sent to Thailand as a welder, and after 3.5 months of welding, his asthma returned. Dr. D. opined that the welding fumes more likely than not caused the return of his asthma. On VA examination in August 2009, the examiner noted that the Veteran had a history of asthma beginning at age 5, which resolved by age 15, but resumed in service when the Veteran was serving as a welder. It was noted that welding dust caused him to have asthma exacerbations that required inhalers. The Veteran reported current symptoms of shortness of breath on exertion that required Albuterol at least 3 times per week. After examination, a diagnosis of exercise-induced asthma, presently stable on Albuterol, was assigned. Pulmonary function tests showed obstructive pattern, mild impairment. There was a significant bronchodilator response. Diffusion was within normal limits. In a January 2010 addendum opinion, the August 2009 VA examiner indicated that he reviewed the claims file. He opined that the Veteran's asthma did not get severe in service beyond the natural progression of the disease. In February 2010, the Veteran submitted a copy of the August 2009 VA examination and addendum opinion noting that while his father also had asthma, his asthma resolved at age 17 and never returned. He reported that while his own asthma resolved at age 15, it returned at age 18 due to welding fumes. He also pointed out that he was exposed to fumes from using electric welding rods, and not dust. On VA treatment in September 2010, the Veteran reported a tired sensation in his chest at rest since he had to stop taking vitamins due to expenses. Continued VA outpatient treatment records dated through 2012 reflect that the Veteran's asthma was stable and that he continued to be prescribed Albuterol. On VA examination in January 2012, the examiner indicated that he reviewed the Veteran's entire claims file. Of note, he reviewed the Veterans ambulatory care clinic visits from 2001 to 2011, which included lung exams. These examinations reported clear lungs with no wheezing. These records also revealed that the Veteran had been on Metoprolol since at least August 2007 and on a beta-blocker since 2002. The examiner also noted the Veteran's in-service and post-service complaints of chest pain and treatment for asthma. The examiner found it more likely than not that the Veteran's asthma preexisted service, given the Veteran's endorsement of asthma noted at entrance. The examiner noted that while the Veteran was seen for one complaint of chest pain in service, he was listed as having no cough or dyspnea. On the June 1968 report of medical history, the Veteran reported that he was in good health and it was indicated that he was not treated for asthma while in service. In July 1968, the Veteran was listed as having no change in medical conditions. Each of these forms was signed by the Veteran. Post-service records also reflect the Veteran's report that his asthma pre-dated service. The examiner noted that each of these records indicates that the Veteran's asthma pre-dated, and was pre-existing, at the time of service. They also indicated that that the Veteran did not have any aggravation of his asthma, or increased symptomatology from his time in the service, despite his later memory of such. As for whether the Veteran's asthma was permanently worsened due to service, the examiner found such a relationship less likely than not. In so finding, the examiner noted that the Veteran's examination in 1968 documents that he was in good health and the history recorded by the physician suggests that the Veteran had no asthma while in service. The examiner also noted that the Veteran had a number of physical examinations, none of which reported wheezing. It was noted that the Veteran had been on a beta-blocker since 2002, which was significant since asthmatics normally have exquisite sensitivity to beta blockade, developing exacerbations when exposed to this class of medication. The Veteran's asthma would thus be considered mild at worst and would more likely fall into the non-atopic, intermittent category. As for whether the Veteran has a diagnosis related to his claimed chest pain, the examiner also noted that such a diagnosis was less likely than not. The examiner noted that the chest pain described by the Veteran in 2003, 2004, and again in 2010 was a transient musculoskeletal discomfort. The chest pain was recorded as non-pleuritic and relieved by rubbing. The examiner determined that this was unlikely to be associated with asthma in any way, and unlikely to have been aggravated directly or indirectly by his active military service. He noted that there were at most 4 visits to the ambulatory care clinic that recorded this discomfort, and most of the other treatment records report no additional pain or no aches. III. Analysis As an initial matter, the Board notes that the appellant did not engage in combat with the enemy. Therefore, the combat provisions of 38 U.S.C.A. § 1154 (West 2002) are not applicable. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Service connection may also be granted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Additional laws and regulations apply, however, when there is evidence that a disability preexisted service. Every Veteran is presumed to have been in sound condition at entry into service, except as to defects, infirmities, or disorders noted at the time of such entry, or where clear and unmistakable evidence demonstrates that the injury or disease existed before entry and was not aggravated by such service. Only such conditions as are recorded in examination reports are to be considered as noted. 38 U.S.C.A. § 1111; 38 C.F.R. § 3.304(b). Determination of the existence of a preexisting condition may be supported by contemporaneous evidence, or recorded history in the record, which provides a sufficient factual predicate to support a medical opinion, see Miller v. West, 11 Vet. App. 345, 348 (1998), or a later medical opinion based upon statements made by the Veteran about the pre-service history of the condition. Harris v. West, 203 F.3d 1347 (Fed. Cir. 2000). The burden is on VA to rebut the presumption of soundness by clear and unmistakable evidence that the Veteran's disability was both preexisting and not aggravated by service. Wagner v. Principi, 370 F.3d 1089, 1094-96 (Fed. Cir. 2004). Temporary or intermittent flare-ups during service of a preexisting injury or disease are not sufficient to be considered aggravation in service unless the underlying disability, as opposed to the symptoms of that disability, has worsened. Beverly v. Brown, 9 Vet. App. 402, 405 (1996) (citing Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991)). Under 38 C.F.R. § 3.310, service connection may also be granted for disability that is proximately due to or the result of a service-connected disease or injury. That regulation permits service connection not only for disability caused by service-connected disability, but for the degree of disability resulting from aggravation of a nonservice-connected disability by a service-connected disability. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). The Veteran contends that his asthma, which pre-existed his entrance into service, was permanently worsened in service due to his exposure to welding fumes. He also alleges that he experiences chest pain related to his asthma. In this case, there is clear and unmistakable medical evidence that the Veteran's asthma preexisted service. While not noted on entrance examination, the July 1965 pre-induction report of medical history reflects prior diagnosis of asthma. The Veteran has also consistently reported that he had been diagnosed with asthma at the age of 5, and the January 2012 VA examiner specifically determined that the Veteran's asthma pre-existed service. There are no other treatment records indicating otherwise. Generally, the remaining issue is whether there is clear and unmistakable evidence that the preexisting disability was not aggravated by service. As noted in Hunt, the Secretary may show a lack of aggravation by establishing, with clear and unmistakable evidence, that there was no increase in severity or that any increase in severity was due to natural progress of the preexisting disorder. Horn v. Shinseki, 25 Vet. App. 231, 235 (2012) (citing Wagner, 370 F.3d at 1096). However, we find that a recent decision of the Court is controlling. Recently, the Veteran has reported that he actually had asthma during service and was supplied medication by a family member. Such lay evidence is inconsistent with the service treatment records, the separation examination, and his denial of pathology during service. The lay evidence that he had pathology during service is not credible and medical opinions based upon this factual premise are equally inapplicable. As the Gilbert court has established, the presumption of soundness is not a sword for the veteran to fulfill the second element of service connection without any evidence of the manifestations of an in-service disability. Otherwise stated, before the presumption of soundness is for application, there must be evidence that a disease or injury that was not noted upon entry to service manifested or was incurred in service. Gilbert v. Shinseki, 26 Vet. App. 48 (2012). Here, the Board finds that there was no increase in severity during service because there were no manifestations during service. The Veteran's service treatment records reveal no complaints of asthma. Aside from the entrance examination report, the only mention of asthma is the report of medical history at discharge, where it is noted that the Veteran did not have asthma during service. The Board acknowledges that there are competing opinions with respect to whether the Veteran's current asthma is related to service. While the Veteran submitted 3 statements from private and VA physician suggesting such a relationship, the January 2012 VA examiner found such a relationship less likely than not. It is the responsibility of the Board to assess the credibility and weight to be given the evidence. See Hayes v. Brown, 5 Vet. App. 60, 69-70 (1993) (citing Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1992)). The probative value of medical evidence is based on the physician's knowledge and skill in analyzing the data, and the medical conclusion the physician reaches; as is true of any evidence, the credibility and weight to be attached to medical opinions are within the province of the Board. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). When reviewing such medical opinions, the Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). However, the Board may not reject medical opinions based on its own medical judgment. Obert v. Brown, 5 Vet. App. 30 (1993); see also Colvin v. Derwinski, 1 Vet. App. 171 (1991). In assessing medical opinions, the failure of the physician to provide a basis for his opinion goes to the weight or credibility of the evidence in the adjudication of the merits. See 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 file and the thoroughness and detail of the opinion. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000). A medical opinion may not be discounted solely because the examiner did not review the claims file. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In this case, the Board finds that the January 2012 VA examiner's opinion is more probative. In so finding, the Board points out that the January 2012 opinion is supported by medical rationale-such as the fact that the Veteran's asthma is considered to be only mild-and is consistent with the medical evidence of record. Unlike the January 2012 examiner, the VA physicians and private physician who provided the opinions in support of the Veteran's claim failed to address the lack of treatment or complaints related to asthma in service, the notation that the Veteran had not had asthma during service noted at discharge, and the normal findings on discharge examination. The Board acknowledges that 3 VA and private medial opinions reflect review of the claims file; however, none of the physicians provided any rationale or reasoning for the conclusions reached. Thus, the most persuasive opinion on the question of whether there exists a medical nexus between the Veteran's asthma and service weighs against the claim. The Board has also considered the Veteran's written statements and hearing testimony, as well as those statements from his spouse and from family members, to the effect that his asthma increased in severity and was aggravated in service. The Veteran is competent to testify as to his observations, but this testimony must be weighed against the other evidence of record. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). Here, we are presented with a pre-service history of asthma, normal findings as to asthma during service, a denial of asthma pathology during service, and only a remote onset of asthma years after service. The assertions of in-service onset and on-going symptoms are inconsistent with the contemporaneous records and thus the lay evidence is not credible. To the extent that the Veteran advances his own interpretation of his medical condition indicating that his asthma is related to the alleged in service worsening and return symptom in service, the Board acknowledges that lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (Board's categorical statement that "a valid medical opinion" was required to establish nexus, and that a layperson was "not competent" to provide testimony as to nexus because she was a layperson, conflicts with Jandreau). In any event, the probative value of the Veteran's general assertions in this regard is outweighed by the probative value of the specific, reasoned opinion of the physician who performed the January 2012 VA examination. Furthermore, we find the lay evidence, to include that of his spouse and family members, to be inconsistent with his own report at separation and the normal findings at separation. Such lay evidence is not credible. The Veteran has also submitted a prior Board decisions which he contends support his claim for service connection for asthma. Pursuant to 38 C.F.R. § 20.1303, decisions of the Board are considered nonprecedential as each case is decided on the basis of the individual facts in light of the applicable law and regulations. Apart from the lack of precedential value, because different evidence in cases of other veterans affects the outcome of each individual case, prior Board decisions do not compel the conclusion that the facts in this case calls for a grant of service connection. While the Board has considered the prior Board decision, it is not binding and does not carry controlling weight over the outcome of this appeal; rather, the facts of this particular case alone are determinative. In sum, the evidence establishes that the current asthma was first manifest years after service and is unrelated to service. Therefore, entitlement to service connection for asthma must be denied. As regards the claim for service connection for chest pain, no definitive diagnosis has been assigned related to the complaints of chest pain. While the Veteran has complained of chest pain on treatment, no diagnosis has been provided and a cardiac catheterization yielded normal results. The January 2012 VA examiner likewise found no diagnosis associated with the alleged chest pain, and instead described the complaints as transient musculoskeletal discomfort. The Board observes that the Court has held that a symptom, alone, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability. The mere fact of a veteran reporting subjective symptoms, such as pain does not necessarily warrant a finding that he has met the disability due to disease or injury requirement. Rather, an underlying disease or injury is required. Sanchez-Benitez v. Principi, 259 F. 3d 1356 (Fed. Cir. 2001). In this case, an underlying disease or injury has not been shown. The Board emphasizes that Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C.A. § 1110. See also McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Accordingly, where, as here, competent medical evidence indicates that the Veteran does not have the disability for which service connection is sought, there can be no valid claim for service connection for the disability. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Notwithstanding the lack of diagnosis, the Board's denial of entitlement to service connection for asthma precludes entitlement to service connection for chest pain as secondary to asthma, the only theory advanced by the Veteran and his representative. See 38 C.F.R. § 3.310(a), (b) (providing for service connection for a disability only where such disability is proximately due to, the result of, or aggravated by, a disease or injury that is already service-connected); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). For the foregoing reasons, the preponderance of the evidence is against the claims for service connection for asthma and chest pain secondary to asthma. The benefit-of-the-doubt doctrine is therefore not for application, and the claim must be denied. See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102; Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). ORDER Entitlement to service connection for asthma is denied. Entitlement to service connection for chest pain is denied. ____________________________________________ H. N. SCHWARTZ Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs