Citation Nr: 18147391 Decision Date: 11/05/18 Archive Date: 11/05/18 DOCKET NO. 14-05 940 DATE: November 5, 2018 ORDER Entitlement to service connection for a respiratory disability, to include chronic obstructive pulmonary disease (COPD) stage II and upper respiratory infection and residuals thereof, is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran has a respiratory disability, to include COPD and an upper respiratory infection and the residuals thereof, due to a disease or injury in service. CONCLUSION OF LAW The criteria for service connection for a respiratory disability, to include COPD and an upper respiratory infection and the residuals thereof, are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1966 to November 1970 and June 1971 to June 1987. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2010 rating decision. This matter was previously before the Board in November 2017, when it was remanded for further development. Service Connection Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires 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 current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Veteran contends that his current COPD condition is the result of exposure to asbestos in service. The Veteran’s service treatment records show he sought treatment for upper respiratory infections and flu-like symptoms in 1976 and 1977. A subsequent periodic medical examination in 1978 found that the Veteran had normal chest and lung function, and the accompanying medical history denied a history of cough or other pulmonary symptoms. Chest x-rays in December 1981, March 1982, and October 1983 showed the presence of calcified nodes in the Veteran’s left lung with no other significant findings. In March 1987, around the time of the Veteran’s separation from service, his treatment records noted complaints of chest pain without shortness of breath. As a result, chest x-rays and pulmonary function tests (PFTs) were ordered as part of the Veteran’s separation examination. These tests found the previously identified calcified nodes with no additional findings and pulmonary function within normal limits. A December 2009 VA examiner diagnosed COPD, Stage II, based on PFTs that showed the Veteran had moderately severe obstructive airflow limitation. A chest x-ray found a calcified granuloma, described as a left Ghon complex, consistent with x-rays noted in service and no other significant findings. The examiner provided no nexus opinion as part of the examination report. An April 2010 VA examination confirmed the diagnosis of COPD and determined that the Veteran’s current condition was not related to his in-service chest x-ray findings. Rather, the examiner opined the current COPD condition was the result of a history of tobacco use. The examiner further opined that the Ghon complex shown in x-rays in and after service was consistent with a healed tuberculosis infection, usually from childhood exposure and was unrelated to the development of obstructive lung disease. The examiner also based this opinion on the normal PFTs and chest x-ray results noted at separation. Following the Board remand, an August 2018 VA examiner confirmed the earlier VA examination findings. The examiner also noted that recent treatment records indicated the Veteran’s condition had been stable with treatment using an inhaler regimen since the diagnosis of COPD. While noting recent treatment for allergies and sleep apnea, the examiner determined that these were etiologically unrelated to the Veteran’s obstructive respiratory condition. In agreeing with the April 2010 examination opinion, the examiner further noted that service treatment records did not indicate the presence of any chronic respiratory condition. She stated that x-ray findings in service were consistent with infectious exposure and were also commonly seen in persons who had lived in rural areas and done farming as an occupation, as the Veteran had in his youth. Ultimately, she concluded that these x-ray findings were not consistent with or indicative of COPD, and in the absence of medical evidence of asbestosis, she could not find any association between the Veteran’s current chronic respiratory condition and military service. The examiners’ reports are competent and credible, as the reports were based on reviews of the Veteran’s medical records and in-person examinations of the Veteran, and are therefore entitled to significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In support of his claim, the Veteran has asserted that he was exposed to asbestos while performing construction duties in service as the result of tearing down buildings that used asbestos insulation. The Veteran also asserts that he has experienced a daily coughing since 1987, often accompanied by white sputum, which he associates with his current COPD condition. While the Veteran is competent to report observable symptoms of respiratory difficulties, he does not possess the requisite skill or training to address more complex medical questions such as etiology or causation for a medical condition like COPD. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). The only current respiratory disorder diagnosis supported by medical evidence of record is COPD, which was first diagnosed in 2009. There is no evidence that links COPD to an injury or disease in service other than the Veteran’s assertions. A conclusory generalized lay statement that an event or illness in service caused a complex condition, such as COPD, is insufficient to establish medical etiology or a nexus to service. See Waters v. Shinseki, 601 F.3d 1274 (2010). As previously noted, the expert medical evidence in this case indicates the claimed disability is more likely the result of the Veteran’s history of cigarette smoking. The respiratory infections noted in service were acute conditions that resolved prior to the Veteran’s separation, and the calcified granuloma in the Veteran’s lung as shown by multiple x-rays in the record is unrelated to his current COPD condition. In summary, the preponderance of evidence is against the claim for entitlement to service connection for a respiratory disability. As the preponderance of evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied. See Gilbert v. Derwinski, 1 Vet. App 49 (1990). A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Pitman, Associate Counsel