Citation Nr: 1319167 Decision Date: 06/12/13 Archive Date: 06/21/13 DOCKET NO. 06-35 978 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas THE ISSUES 1. Entitlement to service connection for chronic obstructive pulmonary disease (COPD) claimed as the result of asbestos exposure. 2. Entitlement to service connection for pulmonary alveolar proteinosis (PAP). 3. Entitlement to service connection for discoid (skin) lupus. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD J.B. Freeman, Counsel INTRODUCTION The Veteran had active service from August 1983 to August 1987 and additional duty with the Air Force Reserve. This matter came before the Board of Veterans' Appeals (Board) on appeal from a July 2006 rating decision of the Houston, Texas, Regional Office (RO) which, in relevant part, denied service connection for COPD, PAP, and discoid (skin) lupus. The Board has not only reviewed the Veteran's physical claims file but also the Veteran's file on the "Virtual VA" system to insure a total review of the evidence. In August 2011, the Veteran was afforded a hearing before the undersigned Veterans Law Judge in San Antonio, Texas. A hearing transcript was prepared and incorporated into the record. The Board has remanded the issues of service connection for COPD, PAP, and discoid (skin) lupus to the Appeals Management Center (AMC) for additional action in April 2012 and February 2013. The appeal returns for appellate consideration. FINDINGS OF FACT 1. The Veteran does not have a current diagnosis of COPD. 2. The Veteran has a current disability of PAP. 3. The Veteran's PAP was not present during service. 4. The Veteran was not exposed to asbestos during service. 5. The Veteran's PAP is not related to any injury or disease incurred during service. 6. The Veteran has a current disability of discoid lupus erythematosus. 7. The Veteran's discoid lupus erythematosus was not present during service. 8. The Veteran's discoid lupus erythematosus is not related to any injury or disease incurred during service. CONCLUSIONS OF LAW 1. COPD was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1101, 1112, 1113, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2012). 2. The Veteran's PAP was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1101, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2012). 3. The Veteran's discoid lupus erythematosus was not incurred in or aggravated by active service. 38 U.S.C.A. §§ 1101, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.303, 3.304 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duties to Notify and Assist VA has met all statutory and regulatory notice and duty to assist provisions as to the Veteran's claims for service connection. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326 (2012). When VA receives a complete or substantially complete application for benefits, it is required to notify the claimant and his representative, if any, of any information and medical or lay evidence that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). 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; and (3) that the claimant is expected to provide. Compliance with the first element requires notice of the five service connection elements: (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. See 38 U.S.C. § 5103(a); see also Dingess v. Nicholson, 19 Vet. App. 473, 490 (2006). June 2005 and March 2006 letters fully satisfied the duty to notify provisions prior to initial adjudication of the Veteran's claims in July 2006, including the asbestos theory of entitlement. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b)(1). The Board also concludes VA's duty to assist has been satisfied. Private medical records identified by the Veteran have been obtained, to the extent possible. The Veteran's Social Security Administration records have been associated with the file. The Board notes that the Veteran's June 1987 separation from service physical examination report was not located by the RO. The Veteran has insisted that this report proved his PAP claim. The RO followed appropriate procedures to determine whether the report could be located and concluded ultimately that the report was unavailable. The RO placed a memorandum of a formal finding of unavailability in the claims file. On review of the claims file, the Board found the June 1987 report on the microfiche copy of the Veteran's service treatment records. The Board has added a printed copy to the file for future reference. Apart from the June 1987 separation physical examination report, the Veteran has at no time referenced outstanding records that he wanted VA to obtain or that he felt were relevant to the claims. The Board finds the duty to assist in obtaining records has been discharged. The duty to assist also includes providing a medical examination or obtaining a medical opinion when such is necessary to make a decision on the claim, as defined by law. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c); McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006). If VA provides a claimant with an examination in a service connection claim, the examination must be adequate. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). The probative value of a medical opinion is derived from a factually accurate, fully articulated, and soundly reasoned opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 300 (2008). The Veteran was afforded a May 2012 medical examination to obtain an opinion as to whether his PAP, COPD, or discoid lupus was the result of service, to include asbestos exposure. This opinion was rendered by a medical professional following a thorough examination and interview of the Veteran and review of the claims file. It does not appear that the June 1987 separation physical examination report was reviewed by the examiner; but as it does not support the Veteran's claims, any error is harmless. The examiner obtained an accurate history and listened to the Veteran's assertions. The examiner laid a factual foundation and reasoned basis for the conclusions that were reached. Therefore, the Board finds that the examination is adequate. See Nieves-Rodriguez, 22 Vet. App. at 300. The Board is obligated by law to ensure that the AMC complies with its directives; where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). The Board remanded these issues in April 2012 and February 2013. The April 2012 remand instructed that the AMC ask the Veteran to supply a copy of the June 1987 separation physical examination report if he possessed one, contact the custodian of the Veteran's service treatment records to obtain a copy of the June 1987 examination report, to provide the Veteran with a VA examination to assist in determining whether the Veteran's COPD, PAP, or discoid lupus erythematosus were related to service, including to asbestos exposure, and to readjudicate the claims and issue a supplemental statement of the case (SSOC) if the claims remained denied. As discussed, the June 1987 report has been located. The Veteran was seen for a May 2012 VA examination and opinion which were adequate. A November 2012 SSOC continued the denials of the claims. The February 2013 remand instructed that the RO ask the Veteran to information enabling the RO to obtain private treatment records not already associated with the claims file, to obtain any outstanding VA treatment records after May 2012, and to readjudicate the claims and issue a SSOC if the claims remained denied. The AMC requested the Veteran submit directly or provide authorized release forms so that the AMC might obtain any outstanding private treatment records on his behalf in a February 2013 letter. The Veteran did not respond. The Veteran's VA treatment records were updated and associated with the Veteran's Virtual VA file. The AMC continued the denial of these claims in a March 2013 SSOC. The Board finds that the AMC complied substantially with April 2012 and February 2013 remand instructions. Although no additional private treatment records were obtained following the February 2013 remand, the Veteran did not cooperate in the development process. The duty to assist is not a one-way street. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). In the absence of his cooperation, the Board will proceed to adjudicate his claims. Further remand for additional development of the prior remand instructions is not warranted. See Stegall. During the August 2011 Board hearing, to assist the Veteran, the undersigned asked questions to help direct the Veteran's testimony, and discussed with the Veteran that additional medical evidence, including a medical nexus opinion from his pulmonologist, was needed to substantiate his claim. The undersigned left the record for 90 days after the hearing to enable him to submit additional records in support of his claim. These actions fulfilled the duties under 38 C.F.R. § 3.103 (2012). See Bryant v. Shinseki, 23 Vet. App. 488 (2010). Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131. Service connection connotes many factors but basically means that the evidence establishes that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisted such service, was aggravated therein. 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires competent and credible evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). PAP, COPD, and discoid lupus are not "chronic diseases" listed under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) does not apply. Walker v. Shinseki, 708 F.3d 1331, 1337 (Fed. Cir. 2013). The Board notes that systemic lupus erythematosus is a "chronic disease," but this is not the disability with which the Veteran has been diagnosed. This is discussed in greater detail below. The Veteran does not have the requisite medical knowledge or training to qualify as a medical expert. Accordingly, he is not competent to diagnose any medical disorder or render an opinion as to the cause or etiology of any current disorder. See Rucker v. Brown, 10 Vet. App. 67, 74 (1997). He may provide lay evidence. Lay persons are competent to provide opinions on some medical issues falling within the realm of common knowledge. See Kahana v. Shinseki, 24 Vet.App. 428, 435 (2011). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board has thoroughly reviewed all the evidence in the Veteran's claims folders. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claims. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the appellant). The Board must assess the competency, credibility and probative weight of the relevant evidence, both lay and medical, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible, or worthy of belief. See Barr v. Nicholson, 21 Vet. App. 303, 308 (2007) (observing that once evidence is determined to be competent, the Board must determine whether such evidence is also credible). The third step of inquiry requires the Board to weigh the probative value of the proffered evidence in light of the entirety of the record. Buchanan, 451 F.3d at 1336. Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service Connection for COPD The Veteran has alleged on several occasions that he has COPD. It is listed on his June 2005 claim, a July 2005 statement, and his July 2006 Notice of Disagreement. During his August 2011 testimony before the undersigned, the Veteran stated that he had originally been diagnosed with COPD before the diagnosis was changed to PAP. The Board finds that the Veteran is not able to diagnose himself with COPD. He has a different lung disorder, PAP, which accounts for his lay observable symptoms such as shortness of breath. The Veteran offers no basis in a lay observable symptom that would enable him to distinguish between COPD and PAP. As such, the diagnosis of COPD falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1377 n.4 (lay persons not competent to diagnose cancer). The Veteran is, however, competent to report that a medical professional diagnosed him with COPD. Id. These statements must be weighed against the remaining evidence of record. The medical evidence of record does not indicate a current or past diagnosis of COPD. The Veteran has been evaluated through VA for pulmonary disorders. A 2005 chest x-ray was normal. He underwent pulmonary function tests in 2006, which were normal. He did not receive a diagnosis of COPD at that time. The Veteran was seen for a May 2012 VA examination in connection with this appeal. The Veteran declined the chest x-ray and pulmonary function tests at that time, stating that he had just done those tests through a private provider. He insisted that he would provide the records. The examiner indicated that the 2004 and 2005 VA records did not support a diagnosis of COPD. The Veteran did not provide the private treatment records concerning a chest x-ray or pulmonary function tests. The Veteran's private treatment records also show that he has not been diagnosed with COPD in the past. The Veteran's initial workup for PAP resulted in a large number of differential diagnoses. A December 2000 CT scan report indicates that he had diffuse interstitial infiltration. The pattern was non-specific and the differential diagnosis included multiple etiologies such as bacterial pneumonitis, sarcoidosis, and PAP. A January 2001 pulmonary evaluation report listed a differential diagnosis with a broad range of possibilities including interstitial pneumonitis, connective tissue disorders, some pulmonary vasculitides, and atypical pneumonia with slow radiographic resolution. A February 2001 biopsy was ordered to determine the ultimate diagnosis, which was PAP. The Board notes that a differential diagnosis is not a confirmed diagnosis; instead it is an analytical tool used in medicine. Differential analysis requires listing all possible causes then eliminating all but one. McCullock v. H.B. Fuller Co., 61 F.3d 1038, 1044 (2d Cir. 1995). The Veteran's account of first being told of COPD, then PAP, is consistent with this process. Although COPD is not among them, the record demonstrates that a great many possible causes of his lung disorder were considered. These other potential causes were eliminated by testing until, finally, only PAP was left. COPD is not present because it was considered; COPD is present if it is the diagnosis left at the end of the differential process. The Veteran's report of a potential COPD diagnosis is competent and credible within the context of differential diagnosis, but it is ultimately of little probative value where the full analytic process is of record and does not support a final COPD diagnosis. In light of the record, the Board finds that the medical evidence of record greatly outweighs the Veteran's account of having been told that he had COPD. The Board finds that the preponderance of the evidence shows that the Veteran does not have COPD currently or has not had COPD at any time during the pendency of the appeal period. Absent proof of a present disability, there can be no valid claim. See, e.g., Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998) (38 U.S.C.A. § 1110 requires current symptomatology at the time the claim is filed in order for a veteran to be entitled to compensation). The requirement of a current disability "is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim and that a claimant may be granted service connection even though the disability resolves prior to [VA's] adjudication of the claim." McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Service connection is not warranted regardless of the theory of entitlement. See McClain, 21 Vet. App. at 321. As such, the Board finds that the preponderance of the evidence is against the Veteran's COPD claim. Consequently, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Service Connection for PAP The Veteran claims that he had "spots on his lungs" at separation from active duty in 1987. He contends that his present PAP is related to those spots. The medical evidence of record shows that the Veteran was diagnosed with PAP by biopsy in February 2001. The current disability is well established. See Shedden. As to the service incurrence element, the Veteran is competent to report what he has been told by a medical care provider. See Jandreau. He must also do so credibly. See Buchanan. The Veteran's service treatment records do not support his contentions of "spots on his lungs" at separation. A June 1987 separation from service physical examination report is of record. A chest x-ray was performed. Both the radiological consultation form and the main examination report state "NAD" or No Acute Disease. There are no references to "spots" or any other lung disorder at that time, although the Veteran was noted to be a tobacco user. In light of the June 1987 examination report, the Board finds the Veteran's account of having been told he had "spots on his lungs" at separation is not credible. The Board assigns much greater probative weight to the contemporaneous medical report. The Veteran has also alleged asbestos exposure during service. A July 2005 statement indicates that he was assigned to assist in refurbishing buildings with asbestos in them while stationed in MCAS Yuma, Arizona. He has stated that his duties during service included being assigned to bombing ranges and building roads with heavy equipment. He asserted in the July 2005 that asbestos exposure occurred on the bombing ranges. He offered no testimony regarding asbestos exposure during his hearing before the undersigned. The Veteran's service personnel records do not support his contentions. The Veteran's DD 214 shows that his Military Occupational Specialty (MOS) was as an Engineer Equipment Operator which he held for three years and six months. An Asbestos Medical Surveillance Respiratory Questionnaire, completed in April 1984, is included in his service treatment records and indicates that he had no exposure to asbestos. The Veteran held the same MOS in April 1984 as he did throughout his time on active duty apart from his basic training. Typical occupations and situations resulting in asbestos exposure are outlined in VBA's Adjudication Procedure Manual, M21-1MR, Part IV, Subpart ii, Chapter 2, Section C (M 21-1MR). Occupations involving asbestos exposure include mining and milling, shipyard and insulation work, demolition of old buildings, construction, manufacture and servicing of friction products such as clutch products and brake linings, manufacture and insulation of roofing and flooring materials, sheet and pipe products, and so forth. High exposure to asbestos and the high prevalence of disease have been noted in insulation and shipyard workers. The Board cannot assign significant probative value to the Veteran's allegations of in-service asbestos exposure. The M21-1MR does not provide any support for the assertion of asbestos exposure on a bombing range and the evidence does not demonstrate that the Veteran has actual knowledge that asbestos exposure occurred on a range. Moreover, the Veteran has asserted working on buildings with asbestos in them, but has not described how he knew that asbestos was present in these buildings. Given the contemporaneous evaluation during service into whether the Veteran would encounter asbestos in his duties and the vagueness of the Veteran's statements, the Board finds that the Asbestos Medical Surveillance Respiratory Questionnaire is of greater probative value than the Veteran's allegations of asbestos exposure. The Veteran described the onset of his symptoms, apart from the "spot on his lungs," during a May 2012 VA examination. He reported the onset of shortness of breath in November 2000. He said that he was initially diagnosed with a "lung infection" until he was found to have "pulmonary fibrosis" and was diagnosed with COPD. He was finally diagnosed with PAP after a biopsy. He asserted that his condition was related to asbestos exposure in service. The Veteran's private medical records do not demonstrate a relationship between the Veteran's present PAP and any incident of service. His military service was not mentioned in the medical records in the claims file. During his pulmonary evaluation in January 2001, the Veteran's post-service occupation as working on restaurant equipment was mentioned as a source of exposure to fine dust particulate matter. The May 2012 VA examination report is a relationship between the Veteran's present PAP and service. The examiner relied the Asbestos Medical Surveillance Respiratory Questionnaire for the proposition that the Veteran was not exposed to asbestos during service. The examiner indicated that there were no in-service symptoms of PAP and no symptoms within one year of service separation. The examiner concluded that the PAP was not at least as likely as not related to asbestos exposure. The Board finds that the PAP disability was not present during service or for many years after service and is not otherwise related to any incident of service. The Board has found the Veteran's allegations regarding "spots on his lungs" at separation and asbestos exposure to be of little probative value. There are no lay observable symptoms present on a recurring or persistent basis since service. The private treatment records show that lay observable symptoms began in 2000, approximately thirteen years after service separation. The Board finds that the PAP disability was neither incurred in nor is related to service. Service connection is not warranted. See Shedden. As such, the Board finds that the preponderance of the evidence is against the Veteran's PAP claim. Consequently, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. Service Connection for Discoid Lupus Erythematosus The Veteran has alleged that he has systemic lupus erythematosus as a result of service. For the reasons that follow, the Board finds that the Veteran has discoid, not systemic, lupus erythematosus which is not related to service. First, the Board must clarify the current disability. The Veteran began receiving treatment in 2004 for a skin rash that first appeared that April. By September 2004, a biopsy had been performed and he was diagnosed with discoid lupus erythematosus. A January 2006 VA dermatology consult note states that there was no evidence of systemic disease at that time. The Veteran testified in August 2011 that he was being treated to prevent the discoid lupus from becoming systemic. On the other hand, the Veteran claimed that he had systemic lupus erythematosus in submissions to the SSA. These diseases are distinct from one another in the VA Ratings Schedule. Cf. 38 C.F.R. § 4.88b, Diagnostic Code 6350, and § 4.118, Diagnostic Code 7809 (2012). The Veteran's statements in his SSA submissions contradict his statements and testimony in support of this appeal. The medical evidence states uniformly that he has discoid lupus and that it is not systemic. The Board finds that the Veteran does not have systemic lupus erythematosus, but has discoid lupus erythematosus. The Veteran's July 2005 Notice of Disagreement contains his main contentions regarding this claim. The Veteran contends that he has PAP as a result of service. He contends further that he must have discoid lupus as a result of service because both PAP and discoid lupus are autoimmune diseases. As discussed above, the Board has concluded that service connection for PAP is not warranted. A secondary service connection theory of entitlement is legally barred. See 38 C.F.R. § 3.310 (2012). The Veteran has also argued during his testimony before the undersigned that his claims are all intertwined. He testified that he was told that he had spots on his lungs at his separation physical examination or in the months preceding separation. He contends that all of his disabilities are related to these spots. The Board has already found his statements of "spots on his lungs" is not credible as discussed above. To the extent that the Veteran is asserting that discoid lupus, which is a skin disorder, could be related to "spots on his lungs" the Board finds that this assertion is not probative. The Veteran is not a medical expert and he has not stated that any medical expert has told him that such spots could or did result in his discoid lupus. The Veteran has not offered any lay observable symptoms by which he could know that the spots may have resulted in discoid lupus through personal knowledge. The Board finds that he did not have the in-service incurrence event which he has alleged and that his statements that his lupus is related to supposed "spots on his lungs" are not competent lay evidence of nexus. See Jandreau. The Veteran has made general allegations that he had asbestos exposure during service to which his disabilities may be related. The Veteran's asbestos exposure has not been established. His service treatment records show that he denied asbestos exposure in April 1984. Regardless of his allegations, the Board finds that the weight of the competent and probative evidence does not demonstrate that discoid lupus erythematosus is caused by asbestos exposure. The Veteran does not offer any basis in lay observable symptoms for the asbestos exposure contention. He has not indicated that a medical expert told him that discoid lupus erythematosus could be caused by asbestos. The Board finds that his contentions are not competent lay evidence. See Jandreau. There are no other lay statements of record which address this question. The VA Adjudication Manual notes that inhalation of asbestos fibers can produce fibrosis and tumors. M21-1MR IV.ii.2.C.9.b. The most common disease is interstitial pulmonary fibrosis (asbestosis). Asbestos fibers may also produce plural effusion and fibrosis, pleural plaque, mesotheliomas of pleura and peritoneum, lung cancer, and cancers of the gastrointestinal tract. The Manual also notes that lung cancer associated with asbestos exposure originates in the lung parenchyma, rather than the bronchi. Skin disorders, to include discoid lupus erythematosus, are not among those diseases associated with asbestos exposure in the VA Adjudication Manual. The Veteran had a May 2012 VA examination. The examiner indicated that there was no medical support for the proposition that discoid lupus erythematosus could be related to asbestos exposure. This is the only medical opinion of record to address this question. The Board finds that discoid lupus erythematosus is not related to asbestos exposure. The lay evidence is not competent. The Board assigns it no probative value. The May 2012 VA examination opinion is competent and weighs against this claim. The preponderance of the evidence is, therefore, against a nexus between discoid lupus erythematosus and alleged asbestos exposure. Although the Board has found the preponderance of the evidence is against the Veteran's contentions, the Board is also required to consider any reasonably raised theory of entitlement. The Veteran's medical records show that he was diagnosed after rashes began forming in April 2004, many years after his separation from service. He has not alleged and the record does not otherwise suggest that he has had symptoms of discoid lupus erythematosus persistently or reoccurring since his period of service. No event, injury or disease other than those discussed above has been suggested as a potential cause for his discoid lupus erythematosus. The Board finds that there are no other potential in-service events, injuries, or diseases to which his current disability may be related. The Board concludes that service connection is not warranted. See Shedden. As such, the Board finds that the preponderance of the evidence is against the appellant's claim. Consequently, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. (CONTINUED ON NEXT PAGE) ORDER Service connection for PAP is denied. Service connection for COPD is denied. Service connection for discoid (skin) lupus is denied. ____________________________________________ K.J. ALIBRANDO Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs