Citation Nr: 18100743 Decision Date: 04/20/18 Archive Date: 04/20/18 DOCKET NO. 14-33 276 DATE: April 20, 2018 ISSUES DECIDED: 1 ISSUES REMANDED: 0 ORDER Entitlement to service connection for a lung disability, to include chronic obstructive pulmonary disease (COPD), is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran has a lung disability, to include COPD, due to a disease or injury in service, to include specific in-service event, injury, or disease. CONCLUSION OF LAW The criteria for service connection for a lung disability, to include COPD, are not met. 38 U.S.C. §§ 1110 (wartime), 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from November 1964 to October 1966. Lung Disability The Veteran asserts that he has a lung disability as a result of an in-service bout of pneumonia as well as exposure to chemicals, diesel, and gunpowder. Service treatment records show that the Veteran was hospitalized in April 1965 for chest pain, fever, and night sweats and diagnosed with and treated for pneumonia. He was discharged in May 1965. He still had a cough and sputum production as of June 1965 but chest x-ray was negative. An August 1966 chest x-ray taken for the Veteran’s separation examination was negative. At the September 1966 separation examination, the Veteran denied having any soaking sweats, asthma, shortness of breath, pain or pressure in the chest, or chronic cough. Evaluation of the lungs and chest was normal. The examiner noted that the Veteran had been hospitalized for pneumonia in May 1965 but stated that there were no complications or sequelae. Post service, private medical records show sporadic complaints of respiratory problems. A July 1990 record shows the Veteran’s report of having a life-long history of nasal congestion. The physician noted that the Veteran was a smoker who complained of tightness in the chest but that there was no real wheezing or conspicuous history of asthma and diagnosed the Veteran with nasal polyps and pansinusitis. A May 1995 record shows that the Veteran had an upper respiratory infection. An April 2004 record shows that the Veteran quit smoking at age 27 after smoking one pack per day for 10 years. A December 2005 record shows that he had bronchitis. A February 2006 record shows diagnoses of likely community acquired pneumonia and an upper respiratory infection. X-rays were reportedly normal for his age. A May 2007 record shows the Veteran’s complaints of an asthma exacerbation and the physician’s note that there was no prior history of asthma documented. An October 2007 record notes a history of pneumonia in 1965 but no mention of any continuing lung problems since that time. In a statement received in September 2012, the Veteran’s spouse stated that they have been married for 43 years and it seemed that he has been ill or not feeling well for most of their marriage. She stated that they had only been married a few months before she first saw him fall ill and she had never seen a person so ill with a lung and sinus infection. She stated that the Veteran’s illnesses have become more frequent over the years, getting lung congestion, a sinus infection, and flu-like symptoms several times per year. VA medical records show a history of asthma and chronic obstructive bronchitis but the most recent pulmonary function test revealed mild obstructive airway disease, or emphysema. The Board observes that emphysema is also known as COPD. Also of note, in September 2013, the Veteran asked his treating physician for an opinion on whether his current lung problems are related to the pneumonia he had in service in 1965. The treating physician replied that although he would like to help, he was not aware of any medical evidence supporting an association between the Veteran’s COPD and episode of pneumonia, particularly given the history of smoking 1 pack per day up until1969. The treating physician stated that smoking is far more likely to be the cause of the Veteran’s COPD but that prior to making any statement, he recommended additional testing including a chest x-ray and pulmonary function test, and potentially a chest CT scan. Given the Veteran’s history of pneumonia in service, the RO requested a medical opinion on whether any current lung disability is related to service. Based on a review of the Veteran’s claims file, in a September 2013 report, a VA examiner opined that the Veteran has COPD that was not incurred in or caused by service. The examiner noted that the Veteran had been diagnosed and hospitalized with pneumonia in service but at the time of separation both chest x-ray and lung examination were normal and the Veteran denied any symptoms of shortness of breath or cough. The examiner observed that the biggest risk factor for COPD is by far smoking of which the Veteran had a 4-year history. The examiner further observed that most cases of pneumonia heal without any permanent symptomatic lung sequelae. In June 2014, the Veteran submitted a medical treatise on the health benefits of quitting smoking that start within 20 minutes of quitting and increase over time. In September 2014, he submitted a medical treatise on pneumonia that indicates that most cases of pneumonia are caused by bacteria or viruses but may be caused by fungi, chemicals, and gases, and that full recovery is expected. Given the above, while the Veteran suffered from a bout of pneumonia in service, it resolved prior to discharge from service. The Veteran was treated as an inpatient in May 1965 and recovering as of June 1965 with no further complaints during the remainder of his service, including at his September 1966 separation examination, at which time examination and x-ray were normal. The first post service evidence of respiratory problems appears in a 1990 private medical record which reflects a life-long history of nasal congestion. While the Veteran complained of tightness in the chest at that time, examination revealed no wheezing or other symptoms indicative of a lung disability and he was diagnosed with nasal polyps and pansinusitis. While not dispositive, the passage of so many years between discharge from active service and the objective documentation of a claimed disability is a factor that weighs against a claim for service connection. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). While the Board appreciates the statement from the Veteran’s spouse regarding the chronicity of his infections, as a layperson, she is not competent to state whether he had a lower respiratory infection involving the lung or merely an upper respiratory infection involving the sinuses, a history of the latter being reported by the Veteran himself during the treatment of care. In that regard, while medical records reflect a long history of sinus problems, such long history of a lung disability is not seen, as reflected in the October 2007 record noting a history of pneumonia in 1965 with no mention of any continuing lung problems since that time. Moreover, a VA examiner opined that the Veteran’s lung disability, diagnosed as COPD, is not related to service, to include the bout of pneumonia in 1965. Even the Veteran’s own treating physician essentially opined that the in-service bout of pneumonia is not the cause of the Veteran’s COPD. While the VA examiner did not specifically address the Veteran’s alternative theory that his lung disability is due to in-service exposure to chemicals, diesel, and gunpowder, the observation that smoking is by far the biggest risk factor for COPD essentially rules out those exposures. While the Veteran has disputed the length of time he smoked as reflected in the record, the fact that he did smoke, but has not for many years, is not in dispute and that history was before the VA examiner when the opinion was rendered. Thus, the VA examiner’s opinion remains of great probative value. See Hayes v. Brown, 9 Vet. App. 67 (1996). With respect to the medical treatise evidence submitted by the Veteran, the Board observes that medical treatises can provide important support when combined with a medical professional’s opinion if they discuss generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion. Mattern v. West, 12 Vet. App. 222 (1999); Sacks v. West, 11 Vet. App. 314 (1998); Wallin v. West, 11 Vet. App. 509 (1998). However, in this case, there is no favorable medical opinion that discusses these medical treatises. Standing alone, the medical treatises submitted by the Veteran are too general to constitute a causal link that is more than speculative in nature. The medical opinion of record is based on the current medical knowledge regarding COPD and smoking, which not only the VA examiner but also the treating physician noted was by far the greatest risk factor for COPD. In light of all the above, the Board finds that the Veteran does not have a lung disability, to include COPD, due to service, to include his bout of pneumonia. Accordingly, service connection for a lung disability, to include COPD, is not warranted. As the preponderance of the evidence is against the claim, the claim must be denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. W. Kim, Counsel