Citation Nr: 18119985 Decision Date: 07/20/18 Archive Date: 07/19/18 DOCKET NO. 14-37 240 DATE: July 20, 2018 ORDER Entitlement to service connection for a lung disorder, to include calcified nodule granulomas, due to asbestos exposure is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, he has an asbestos-related lung disorder, to include asbestosis, as a result of his service on the USS Enterprise. CONCLUSION OF LAW The criteria for service connection for an asbestos-related lung disorder, to include asbestosis, are met. 38 U.S.C. §§ 1110, 1111, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a) (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the U.S. Navy from October 1969 to October 1973. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. The Veteran testified at an April 2018 Board videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is contained in the record. Entitlement to service connection for a lung disorder, to include calcified nodule granulomas, due to asbestos exposure The Veteran contends that he has developed a lung disorder as a result of asbestos exposure in service, during his stays aboard the USS Enterprise. Service connection means that a Veteran has a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease diagnosed after discharge when the evidence shows that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Entitlement to service connection is established when the following elements are satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or “medical nexus” between the current disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004)); see 38 C.F.R. § 3.303 (a). The Board notes there are no laws or regulations which specifically address service connection for disability due to asbestos exposure. However, the VA Adjudication Procedure Manual, M21-1, and opinions of the Court and General Counsel provide guidance in adjudicating these claims. VA’s M21-1 provides the following non-exclusive list of asbestos-related diseases/abnormalities: fibrosis, including asbestosis or interstitial pulmonary fibrosis; tumors; pleural effusions and fibrosis; pleural plaques, mesotheliomas of pleura and peritoneum; and cancers of the lung, bronchus, gastrointestinal tract, larynx, pharynx, and urogenital system (except the prostate). See M21-1, part IV, Subpart ii, Chapter 2, Section C, Topic 2(b). However, service connection is not automatic and a probative medical nexus opinion is still required. The M21-1 also provides the following non-exclusive list of occupations that have higher incidents of asbestos exposure: mining, milling, work in shipyards, insulation work, demolition of old buildings, carpentry and construction, manufacture and servicing of friction products such as clutch facings and brake linings, and manufacture and installation of roofing and flooring materials, asbestos cement sheet and pipe products, and military equipment. See M21-1, part IV, Subpart ii, Chapter 2, Section C, 2(d). The M21-1 provides that a clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal lung disease. Diagnostic indicators include dyspnea on exertion, end-respiratory rales over the lower lobes, compensatory emphysema, clubbing of the fingers at late stages, and pulmonary function impairment and cor pulmonale that can be demonstrated by instrumental methods. See M21-1, part IV, Subpart ii, Chapter 2, Section C, 2(g). The Veteran has testified regarding his exposure to asbestos aboard the USS Enterprise. He has also testified regarding his expertise in identifying and planning for remediation of asbestos through his job as an environmental engineer, as a civilian employee of the U.S. Navy. He described working in a composite shop of different trades on the USS Enterprise, where he was “the token ordinance man” in a shop of fire control technicians, aviation fire control technicians, aviation electronics technicians, and electricians. These are occupations listed as having a high probability of exposure to asbestos according to VA’s M21-1, Part IV, Subpart ii, Chapter 1, Section 1.3.d. The Veteran described that his shop on the USS Enterprise was located just one deck below the flight deck and catapult. The catapult was a steam catapult, and there was “a lot of insulation associated with protecting them from the steam.” The Veteran believed that there was asbestos material in the lagging associated with the catapult, and in a void area that was adjacent to his shop where they stored test equipment. During the Board hearing, the VLJ noted that the Veteran had the requisite knowledge to identify asbestos. And the Veteran described asbestos and the dust or debris from asbestos in his “shop” and as a large part of cleaning the ship prior to turning it over when their two 9-month cruises were completed. The Veteran also submitted “buddy” statements from men who served onboard the USS Enterprise with him and who carried the MOSs listed as having a high probability of exposure to asbestos in the M21. The men all noted that the Veteran worked along-side them during their time aboard the USS Enterprise, and was exposed to the same asbestos. As such, the Board finds that there is competent and credible evidence that the Veteran was exposed to asbestos in service. The medical records in this claims file are conflicting regarding the Veteran’s diagnosis. As early as 1981, the Veteran was noted to have calcified granuloma in his left upper lobe on x-ray. A December 1988 x-ray showed three calcified granulomas in the left upper lobe and minimal soft tissue thickening along the chest walls bilaterally which represented either fat deposition or pleural thickening. An August 1999 record noted the Veteran had “old granulomatous disease and prior exposure to asbestos.” The pleural thickening was noted to be “consistent with a history of prior exposure to asbestos.” An August 1999 CT noted an 8mm calcified nodule in the left upper lobe consistent with old granulomatous disease. There were no pleural effusions or pleural thickening or significant interlobular septal thickening. The radiologist indicated that the widening of the pleural stripe noted on x-ray was thought to be due to subpleural fat and intercostal musculature, rather than pleural thickening. However, records from the same private provider noted in September 2011 that x-rays from six years prior showed stable plaquing consistent with asbestosis. In April 2012, VA provided a chest x-ray in relation to the Veteran’s claim for a cardiac condition. The x-ray showed calcified granuloma in the left upper lobe. A June 2017 VA treatment record noted that the Veteran had “possible asbestosis” based on an abnormal 1999 chest x-ray, but that a 1999 CT found that there was no pleural thickening. Given that the Veteran’s private treatment providers found that his x-rays showed “stable plaquing consistent with asbestosis” in September 2011, the June 2017 VA treatment record noted possible asbestosis, and the Veteran has credibly asserted he was exposed to asbestos in service, the Board will resolve reasonable doubt in the Veteran’s favor and finds that he has an asbestos-related lung disorder, to include asbestosis, and that service connection is warranted. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M.H. Stubbs, Counsel