Citation Nr: 18149090 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 16-42 617 DATE: November 8, 2018 ORDER Entitlement to service connection for lung cancer, to include as due to service in Southwest Asia, is denied. FINDINGS OF FACT 1. The Veteran served in the Southwest Asia theater of operations during the Persian Gulf War. 2. Lung cancer has been attributed to a known etiology. 3. Lung cancer did not have its onset during the Veteran’s active service and is not otherwise etiologically related to such service, to include service in Southwest Asia; and lung cancer did not manifest to a compensable degree within a year of separation from service. CONCLUSION OF LAW The criteria for service connection for lung cancer, to include as due to service in Southwest Asia, have not been met. 38 U.S.C. §§ 1110, 1112, 1117, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.317 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active military service from February 1969 to August 1992, to include service in Southwest Asia. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Denver, Colorado. Entitlement to service connection for lung cancer The Veteran has asserted that he has lung cancer as a result of his service in Southwest Asia. Specifically, he asserted that the scarring on his lungs during active duty developed into lung cancer. He added that an in-service chest- X-ray revealed a growth abnormality in his right lung. Service treatment records are silent for any in-service complaints of, treatment for, or diagnosis of lung cancer. Several chest X-rays were conducted during service, to include a December 1983 chest X-ray for a reported history of abnormal findings in 1979. The chest X-ray findings were unremarkable for any significant abnormalities. In August 1987, the Veteran reported that he had smoked two packs per day for twenty-four years. Additionally, the Veteran indicated that he had shortness of breath at his post-deployment and retirement examinations in 1992. Post-service treatment records noted that the Veteran was diagnosed with right upper lobe lung cancer in January 2013 and had a history of chronic obstructive pulmonary disease. Prior to that, a February 2004 chest CT scan revealed an ill-defined right upper lobe density. A follow-up CT scan showed a small nodular scarring at the right apex of the upper lobe. The Veteran underwent a right upper lobectomy and lymph node dissection in March 2013. In August 2013, the Veteran was afforded a Gulf War VA examination. The Veteran reported that during his tour to Saudi Arabia and Iraq in 1990, he was occasionally exposed to smoke from burning oil wells, burn pit smoke, sand, and dust. He stated that he quit smoking in the late 1970s after having smoked two packs per day for twenty years. The examiner opined that the Veteran’s lung cancer was a disease with a clear and specific etiology and diagnosis, and was less likely as not related to a specific exposure event during the Veteran’s service in Southwest Asia. The examiner cited an Institute of Medicine of the National Academy of Sciences’ report which did not indicate that there was any higher occurrence rate of lung cancer in Gulf War-deployed veterans than in non-deployed Gulf War veterans. Additionally, the examiner opined that it was less likely as not that the Veteran’s lung cancer was a result of his military service. The examiner noted that the Veteran’s lung cancer did not develop until twenty years after his military discharge. The examiner stated that if the Veteran had lung cancer resulting from active duty, it would have become manifested before twenty years later. The examiner added that the Veteran had a history of heavy smoking which was at least as likely as not the primary cause of his lung cancer. In an October 2013 medical statement, the Veteran’s primary physician stated that, upon the Veteran’s re-deployment, it was noted that the Veteran had a nodule on his right upper lobe. The physician stated that the lesion was followed serially with chest X-rays during service. He noted that a chest CT conducted in 2012 was remarkable for changes in the upper lobe lesion that raised concern for lung cancer. He added that the lesion was deemed to be non-small cell lung cancer upon subsequent evaluation. The Veteran’s physician concluded that the lung cancer was related to service. He explained that although it was impossible to draw a firm cause and effect, considering the length and duration of the Veteran’s service, it was likely that exposure to burn pits and oil well fires during the Veteran’s deployment to the Gulf were factors in his lunger cancer. The Veteran was provided an additional VA examination in September 2014. The examiner opined that it was less likely than not that the Veteran’s lung cancer was related to service or to treatment for a breathing problem on and after June 1991. The examiner stated that the Veteran’s lung cancer did not develop until twenty years after his military discharge. The examiner explained that if the Veteran had lung cancer during active duty, it would have become manifest before twenty years later. In addition, the examiner noted that the Veteran had a history of heavy smoking, which was at least as likely as not the primary cause of his lung cancer. In November 2014, the Veteran underwent an additional Gulf War examination. The examiner’s findings were similar to the August 2013 VA examination report, and are incorporated herein. The Board finds the VA medical opinions highly probative as the rationales were based on the Veteran’s pertinent medical records and lay statements, and the examiners relied on their own training, knowledge, and expertise in rendering the opinions. Although the Veteran’s primary care physician concluded that the Veteran’s lung cancer was related to service, the Board finds the opinion has limited probative value, as the physician did not address the “length and duration” of the Veteran’s smoking. The Board acknowledges the lay assertions of record, including the Veteran’s sincere belief his lung cancer was related to his service. However, the Veteran is not competent to provide an opinion as to the etiology of his lung cancer, as that particular inquiry is within the province of trained medical professionals; it goes beyond a simple and immediately observable cause-and-effect relationship. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). In sum, although the Veteran reported a history of abnormal chest X-ray findings, he did not receive treatment for or have a diagnosis of lung cancer while in active service. Additionally, there is no evidence that lung cancer manifested within one year following the Veteran’s separation from active service. Consideration has been given to whether service connection is warranted under 38 C.F.R. § 3.317 due to the Veteran’s service in Southwest Asia. However, the abnormality in the Veteran’s right lung has been associated with a specific diagnosis for lung cancer, which the VA examiners opined was unrelated to his active service. While there is a medical opinion of record indicating that the Veteran’s lung cancer is related to his active service, that opinion has limited probative value. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for lung cancer is not warranted. 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Ware, Associate Counsel