Citation Nr: 18154663 Decision Date: 12/03/18 Archive Date: 11/30/18 DOCKET NO. 16-56 528 DATE: December 3, 2018 ORDER Service connection for the cause of the Veteran’s death is denied. FINDINGS OF FACT 1. The Veteran died in January 2013, and the primary cause of death was due to an idiopathic pulmonary fibrosis. The contributing causes of his death were coronary artery disease, hypertension, and hyperlipidemia. 2. At the time of his death, the Veteran did not have any service-connected disabilities. 3. The Veteran’s idiopathic pulmonary fibrosis, coronary artery disease, and hypertension were not shown in service or many years after service; and, the preponderance of the evidence fails to establish that these disorders are related to service; hyperlipidemia is not a disability for VA compensation purposes. CONCLUSION OF LAW The cause of the Veteran’s death is not attributable to a disability incurred in and/or aggravated by service. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 1131, 1310, 5103, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.312. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1961 to May 1981. He died in January 2017. The appellant is his surviving spouse. Entitlement to service connection for the cause of the Veteran’s death In this case, the appellant asserts that the Veteran’s cause of death was related to service. In order to establish service connection for the cause of the Veteran’s death, applicable law requires that the evidence show that a disability incurred in or aggravated by service either caused or contributed substantially or materially to death. For a service-connected disability to be the cause of death it must singly, or with some other condition, be the immediate or underlying cause, or else be etiologically related. For a service-connected disability to constitute a contributory cause, it is not sufficient to show that it casually shared in producing death, but rather it must be shown that there was a causal connection. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. In order to constitute the principal cause of death, the service-connected disability must be one of the immediate or underlying causes of death, or is etiologically related to the cause of death. 38 C.F.R. § 3.312(b). A contributory cause of death is inherently one not related to the principal cause. In determining whether the service-connected disability contributed to death, it must be shown that it contributed substantially or materially; that it combined to cause death; that it aided or lent assistance to the production of death. It is not sufficient to show that it casually shared in producing death, but rather it must be shown that there was a causal connection. 38 C.F.R. § 3.312(c)(1). Service-connected diseases or injuries involving active processes affecting vital organs should receive careful consideration as a contributory cause of death, the primary cause being unrelated, from the viewpoint of whether there were resulting debilitating effects and general impairment of health to an extent that would render the person materially less capable of resisting the effects of other disease or injury primarily causing death. 38 C.F.R. § 3.312(c)(3). Where the service-connected condition affects vital organs as distinguished from muscular or skeletal functions and is evaluated as 100 percent disabling, debilitation may be assumed. Id. There are primary causes of death which by their very nature are so overwhelming that eventual death can be anticipated irrespective of coexisting conditions but, even in such cases, there is for consideration whether there may be a reasonable basis for holding that a service-connected condition was of such severity as to have a material influence in accelerating death. In this situation, however, it would not generally be reasonable to hold that a service-connected condition accelerated death unless such condition affected a vital organ and was of itself of a progressive or debilitating nature. 38 C.F.R. § 3.312(c)(4). In the alternative, service connection for the cause of death may be warranted where the evidence indicates that the cause of the Veteran’s death should have been service-connected. That is to say that, to establish service connection for a particular disability found to have caused his death, the evidence must show that the disability resulted from disease or injury which was incurred in or aggravated by service or, in the alternative, is secondary to another service-connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303, 3.304. In this case, the Veteran died in January 2017, and according to his death certificate, the primary cause of death was due to an idiopathic pulmonary fibrosis. Further, “significant conditions” materially “contributing” to his cause of death included coronary artery disease, hypertension, and hyperlipidemia. At the time of his death, he was not service connected for any disabilities. Next, the Board considers whether the Veteran’s idiopathic pulmonary fibrosis (primary cause of death), and his coronary artery disease, hypertension, and hyperlipidemia (materially contributing to the cause of death) were related to service. Of note, the appellant asserts that the Veteran’s pulmonary fibrosis was related to exposure to hazardous environmental chemicals, including asbestos and cigarette smoke. Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). After a review of the evidence, the Board finds that service connection for an idiopathic pulmonary fibrosis, coronary artery disease, and hyperlipidemia is not warranted. As an initial matter, the Board notes that while hyperlipidemia was a contributing cause of the Veteran’s death, hyperlipidemia is a laboratory finding and not a disability for VA compensation purposes. Therefore, standing alone, without a diagnosed or identifiable underlying malady or condition, it does not in and of itself constitute a disability for which service connection may be granted. See Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). With respect to asbestos exposure, there is insufficient evidence to concede that the Veteran was exposed asbestos while in service. Specifically, asbestos exposure was generally confined to military specialties that performed maintenance involving removal and handling of potentially asbestos-containing material, such as mining, milling, shipyard work, insulation removal, construction and demolition and manufacture of products. Here, the Veteran’s military specialty, musician, is not a specialty likely to be exposed to asbestos. See also M21-1, Part IV.ii.1.I.3.c. (May 23, 2018). Further, the Board notes that the Veteran’s medical treatment records indicate that he was exposed to asbestos during service. Nevertheless, these findings appear to be based primarily on the Veteran’s assertions rather than on a review of his in-service treatment records or any evidence related to service. Additionally, the Board notes that even if the Veteran was present in buildings and ships in which asbestos was used (as asserted by the appellant), this is not sufficient proof to demonstrate that he was actually exposed to asbestos. Next, the Board acknowledges that the majority of the Veteran’s service treatment records are unavailable. Moreover, even giving the appellant the benefit of the doubt, it does not appear, nor does she assert that the Veteran had a respiratory disorder, hypertension, and/or a heart disorder during service, nor are there any records indicating that the Veteran had such disorders during his era of service or shortly thereafter. In fact, the post-service evidence does not reflect symptoms related to these disorders for many years after the Veteran left active duty service. In this case, the records first document the Veteran’s symptoms and diagnosis of a heart disorder and hypertension in 2010. Further, the first indication of a respiratory disorder was first observed in approximately 2011, and diagnosed as interstitial lung disease. The Veteran was subsequently diagnosed with an idiopathic pulmonary fibrosis in July 2012. As part of this claim, the Board recognizes that while the appellant is not competent to make a diagnosis related to a respiratory disorder, including pulmonary fibrosis, as well as a heart and vascular disorder, as they may not be diagnosed by their unique and readily identifiable features, and thus requires a determination that is “medical in nature,” she is nonetheless competent to testify about the presence of observable symptomatology, which may provide sufficient support for a claim of service connection, if credible, regardless of the lack of contemporaneous medical evidence. Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007); See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). However, she has not asserted that the Veteran has had symptoms of these disorders since service. Further, while the Veteran did not have continuous symptoms of his disorders since service, service connection may nonetheless be established if a relationship is otherwise demonstrated by competent evidence, including medical evidence and opinions. In this case, however, the competent evidence fails to establish a relationship between active duty and the Veteran’s current symptoms. Here, the Board places significant probative value on the opinions from the VA examiners that performed a detailed review of the Veteran’s service and medical treatment records, as well as the medical literature. Specifically, the November 2013 VA examiner opined that the Veteran’s idiopathic pulmonary fibrosis was not related to service. In support, he noted that aside from the appellant’s assertions, there is not sufficient evidence to indicate that the Veteran was actually exposed to asbestos. Moreover, he opined that based upon the medical literature, even if the Veteran was exposed to “minimal asbestos” and the Veteran had a significant history of second-hand smoke, these environmental exposures did not cause his pulmonary fibrosis, nor is it related thereto. Similarly, in a September 2016 VA opinion, the examiner determined that there was no evidence that the Veteran had a respiratory condition during service, and opined that his interstitial lung disease, diagnosed over 30 years later, was not related to service. He also determined that given the fast progression of the Veteran’s idiopathic pulmonary fibrosis, his disorder could not have occurred or been otherwise related to service. In arriving at this conclusion, the Board acknowledges that the appellant submitted an online article indicating that an idiopathic pulmonary fibrosis may be related to certain exposures, including cigarette smoke and asbestos. However, the Board finds this article to be of little probative value as it does not specifically address the Veteran’s situation, and the appellant merely attempts to establish a medical nexus between service and a disease or an injury solely by generic information contained in a medical article. See Sacks v. West, 11 Vet. App. 314, 317 (1998). With respect to a heart and vascular disorder, the Veteran’s treatment records first document symptoms and a diagnosis of these disorders in 2010. As such, the medical evidence is not sufficient to otherwise demonstrate a nexus between these disorders and active service. Further, the appellant has not provided sufficient evidence, including private opinions and/or medical evidence to establish a nexus between the Veteran’s heart/vascular disorders and active service. As part of this claim, the Board recognizes the statements from the appellant, regarding the relationship between the Veteran’s disorders and active service. Nevertheless, while she is competent to provide testimony regarding observable symptomatology such as shortness of breath, she is not competent to provide a nexus opinion in this case. These issues are also medically complex, as it requires knowledge of the interaction between multiple systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Therefore, the unsubstantiated statements regarding the claimed diagnosis and etiology of the Veteran’s disorders are found to lack competency. In light of the above discussion, the Board concludes that the preponderance of the evidence is against the appellant’s claim of service connection for the cause of the Veteran’s death, and there is no doubt to be otherwise resolved. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Therefore, the appeal is denied. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Meyer, Associate Counsel