Citation Nr: 20008395 Decision Date: 01/31/20 Archive Date: 01/31/20 DOCKET NO. 14-13 966 DATE: January 31, 2020 ORDER 1. Entitlement to service connection for lung nodules is denied. 2. Entitlement to service connection for a skin disability, to include eczema and/or prurigo nodularis is denied. FINDINGS OF FACT 1. The weight of the evidence is against a finding that the Veteran’s claimed lung nodules are the result of his active service. 2. The weight of the evidence is against a finding that the Veteran’s claimed skin disability is the result of his active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for lung nodules have not been met. 38 U.S.C. § § 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a skin disability, to include eczema and/or prurigo nodularis have not been met. 38 U.S.C. § § 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from August 1960 to May 1964. This matter comes before the board of Veterans’ Appeals (Board) on appeal from a December 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously remanded by the Board in November 2017. As an initial matter, the Board finds that its November 2017 remand directives have been substantially complied with. A remand by the Board confers on the Veteran, as a matter of law, the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). In November 2017 the Veteran’s lung and skin disability claims were remanded to obtain an addendum to a May 2016 VA examination that reflected consideration of all the evidence of record. An addendum opinion to the May 2016 VA examination was obtained in March 2018. The March 2018 addendum reflects consideration of all of the evidence of record, to include the Veteran’s Service Treatment Records (STRs), post-service medical records, and the Veteran’s lay statements regarding the history of his symptoms and reported exposure to asbestos and other chemicals. In light of the foregoing, the Board finds that its November 2017 remand directives have been substantially complied with. SERVICE CONNECTION Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303. The Veteran’s DD 214 reflects that he served as a Fire Protection Specialist. As reflected in a February 2011 lay statement, the Veteran contends that he wore asbestos clothing during his active service. In an April 2012 statement, the Veteran reported that while in service, he was also exposed to carbon tetrachloride, chlorobromomethane, jet fuel spills, aviation gasoline, JP4, and fumes from burning jet fuel and aviation gasoline. 1. Entitlement to service connection for lung nodules is denied. An October 2010 CT scan reflected the presence of four nodules on the Veteran’s lungs. The Veteran contends that these nodules are the result of his active service as a firefighter, entailing alleged exposure to smoke, asbestos, and hazardous chemicals. The Board notes that at his September 2015 hearing the Veteran purported to be in possession of scientific literature supporting his contentions regarding chemical exposure. Following a January 2016 Board remand, in February 2016, VA requested that the Veteran provide this literature; the record does not reflect that the Veteran ever provided this literature to VA. In April 2011 a VA examiner stated that findings of asbestos are fibrotic changes, not nodular changes. The record does not reflect any clinical findings of fibrotic changes in the Veteran’s lungs during the period on appeal. As discussed above, in March 2018 a VA medical opinion as to the etiology of these nodules was obtained. The March 2018 VA examiner opined that it is less likely than not that the Veteran’s lung nodules were incurred in or caused by any illness, event, or injury that occurred during his active service. The March 2018 VA opinion reflects consideration of the Veteran’s Service Treatment Records (STRs), to include: January 1962 and October 1962 in-service reports of an upper respiratory infection; a November 1962 treatment note documenting flu; and an August 1963 note of pleuritic pain in the right chest with negative X-rays. The March 2018 examiner stated that lung nodules may be a manifestation of a prior infection; the examiner referenced past clinical characterizations of one of the Veteran’s nodules as a “calcified granuloma,” which they described as an “infection related” finding. The March 2018 examiner opined that there is no indication that any of the chemicals the Veteran reported exposure to would have resulted in the formation of nodules. The examiner stated that there is no literature supporting the development of lung nodules as the result of chemical exposure. The examiner further opined that, while the Veteran reports a history of exposure to asbestos, he has no pleural plaques or “any other hallmarks of imaging findings of asbestos exposure or biopsy-proven asbestos.” There are currently no competent medical opinions of record to support the Veteran’s contention that his lung nodules were incurred in, or otherwise etiologically related to, his active service. Given the foregoing, the Board finds that the weight of the evidence is against a finding that the Veteran’s lung nodules are etiologically related to his active service. Accordingly, service connection for lung nodules is not warranted on any basis. In reaching the above conclusions, the Board also considered the doctrine of reasonable doubt. 38 U.S.C. § 5107 (b). However, as the preponderance of the evidence is against the claim, the doctrine is not for application. See e.g. Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Therefore, service connection for lung nodules is denied. 2. Entitlement to service connection for a skin disability, to include eczema and prurigo nodularis is denied. A February 2019 dermatology note reflects that the Veteran has a current diagnosis of prurigo nodularis. An April 2016 VA examiner diagnosed eczematous dermatitis. The Veteran contends that these disabilities are the result of exposure to asbestos and hazardous chemicals while in service. As discussed above, in March 2018 a VA medical opinion as to the etiology of the Veteran’s skin disabilities was obtained. The March 2018 VA examiner opined that it is less likely than not that the Veteran’s claimed skin disabilities were incurred in or caused by any illness, event, or injury that occurred during his active service. The March 2018 VA opinion reflects consideration of the Veteran’s STRs, to include: an in-service report of a crusted abscess on the Veteran’s right thumb in November 1961; and of a rash in December 1961 thought to be secondary to a penicillin allergy. The March 2018 VA examiner opined that the record does not reflect an inflammatory dermatological disability such as eczema while in the military, or acute skin disability resulting from exposure to chemical contaminants. The examiner explained that eczema is related to a gene variation that affects the skin’s ability to provide protection, and that prurigo nodularis is not caused by chemical exposure, but rather is triggered by psychiatric conditions, reduced liver and kidney function, and/or skin disabilities such as eczema. Given the foregoing, the Board finds that the weight of the evidence is against a finding that the Veteran’s skin disabilities are etiologically related to his active service. Accordingly, service connection for a skin disability, to include eczema and/or prurigo nodularis, is not warranted on any basis. In reaching the above conclusions, the Board also considered the doctrine of reasonable doubt. 38 U.S.C. § 5107 (b). However, as the preponderance of the evidence is against the claim, the doctrine is not for application. See e.g. Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Therefore, service connection for a skin disability, to include eczema and/or prurigo nodularis is denied. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Cody Sametshaw The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.