Citation Nr: 20021843 Decision Date: 03/27/20 Archive Date: 03/27/20 DOCKET NO. 18-20 655 DATE: March 27, 2020 ORDER Entitlement to service connection for a heart disability, to include as due to exposure to asbestos in service, is denied. Entitlement to service connection for a lung disability, to include as due to exposure to asbestos, is remanded. FINDINGS OF FACT 1. The Veteran’s heart disability was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that the Veteran’s lung disability began during active service, or is otherwise related to service, to include in-service exposure to asbestos. CONCLUSIONS OF LAW 1. The criteria for service connection for a heart disability, to include as due to exposure to asbestos in service, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a lung disability, to include as due to exposure to asbestos in service, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps from October 1959 to October 1963. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a September 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). 1. Service connection for a heart disability is denied. The Veteran asserts that he has a heart disability that is etiologically related to his active service. Specifically, the Veteran contends that he developed a heart disability as a result of exposure to asbestos insulation during his service aboard the USS Oglethorpe. The Board notes that the Veteran initially asserted that his heart disability is related to the consumption of contaminated water at Camp LeJeune during service. See, e.g., June 2017 VA Form 21-526EZ; October 2017 notice of disagreement. However, in his April 2018 VA Form 9, the Veteran asserted that he was not claiming that his heart disability was related to the consumption of contaminated water at Camp LeJeune during service, and requested that VA consider his claim on the basis of asbestos exposure. Accordingly, the Board will not address the theory of service connection for a heart disability as due to the consumption of contaminated water at Camp LeJeune during service. See AB v. Brown, 6 Vet. App. 35, 39 (1993) (a claimant may limit his appeal to particular issues if he expresses a clear intent to do so). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of coronary arterial atherosclerotic calcification as evidenced by the January 2018 VA heart conditions examination report. Coronary arterial atherosclerotic calcification is a form of cardiovascular disease, which is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. The Veteran has not alleged that symptoms of heart disease were chronic in service, continuous after service separation, or manifested to a compensable degree within one year of service separation. The Veteran does not contend, nor do the Veteran’s service treatment records reflect, complaints of, treatment for, or diagnosis of a heart disability during service. The October 1963 service separation examination report shows a normal clinical evaluation of the heart, and the Veteran did not otherwise report any heart symptoms at service separation. Post-service treatment records show the Veteran was not diagnosed with a heart disability until 2017, decades after his separation from service and decades outside of the applicable presumptive period. Service connection for coronary arterial atherosclerotic calcification may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s heart disability and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. With respect to the Veteran’s contention that his heart disability was caused by asbestos exposure in service, the Board finds that the weight of the lay and medical evidence of record is in relative equipoise as to whether the Veteran was exposed to asbestos in service. The Veteran’s service personnel records reflect that he served aboard the USS Oglethorpe. VA has acknowledged that ships built during the World War II era, such as the USS Oglethorpe contained asbestos. Resolving reasonable doubt in the Veteran’s favor on this question, the Board finds that the Veteran was exposed to asbestos in service. The January 2018 VA examiner opined that the Veteran’s heart disability is not at least as likely as not related to an in-service injury, event, or disease, including asbestos exposure. The rationale was that asbestos exposure is not known to cause coronary calcinations, which can be classified as atherosclerotic plaque progression. The examiner explained that atherosclerotic heart disease is caused by risk factors such as smoking, hypertension, and hyperlipidemia, and that the Veteran has these major risk factors. The examiner concluded that the Veteran’s coronary calcification and atherosclerotic heart disease is at least likely related to known risk factors such as smoking, hypertension, and hyperlipidemia. The Board finds that that the January 2018 VA opinion is highly probative with respect to service connection for a heart disability, and is adequately based on objective findings as shown by the record, and accordingly, the Board concludes that the medical opinion rendered was based upon a full and accurate factual premise, including the Veteran’s history, and provided a thorough and adequate rationale for the opinion given. Barr v. Nicholson, 21 Vet. App. 311 (2007); Reonal v. Brown, 5 Vet. App. 458, 461 (1993); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Therefore, the Board finds that the January 2018 VA opinion provides competent, credible, and probative evidence which shows that the current heart disability is not related to service, to include exposure to asbestos in service. While the Veteran believes that his heart disability is related to service, including exposure to asbestos, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical education, knowledge of the interaction between coronary arterial atherosclerotic calcification and exposure to asbestos decades earlier, and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the January 2018 VA opinion, which attributes the Veteran heart disease to his history of smoking, hypertension, and hyperlipidemia. For these reasons, the Board finds that a preponderance of the evidence is against the claim of entitlement to service connection for a heart disability, to include as due to exposure to asbestos in service. As such, the benefit of the doubt rule does not apply, and the claim must, therefore, be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Service connection for a lung disability is denied. The Veteran asserts that he has a lung disability that is etiologically related to his active service. Specifically, he contends that he developed a lung disability as a result of exposure to asbestos insulation during his service aboard the USS Oglethorpe. The record reflects that the Veteran has a current lung disability. See, e.g., January 2018 VA examination report (showing a diagnosis of interstitial lung disease). Accordingly, the service connection element of a current disability is established. Moreover, as noted above, the Board finds that the evidence is in relative equipoise as to whether the Veteran was exposed to asbestos in service The Board concludes, however, that the preponderance of the evidence a finding that the currently diagnosed lung disability began in service or is otherwise causally or etiologically related to service, to include in-service exposure to asbestos. The Veteran does not contend, nor do the Veteran’s service treatment records reflect, any complaints of, treatment for, or a diagnosis of interstitial lung disease or any lung disorder during service. The October 1963 service separation examination report shows a normal clinical evaluation of the lungs and chest, and an x-ray of the chest was noted as normal, and the Veteran did not report any lung symptoms at service separation. The record reflects that the Veteran was not diagnosed with lung disease until 2017, decades after his separation from service. See, e.g., April 2017 private treatment record; January 2018 VA examination report (noting that the Veteran was diagnosed with interstitial lung disease in 2017). The multi-year gap between discharge from active duty service and when the Veteran sought medical care for his lung disease is a factor that weighs against in-service onset. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). The Veteran was afforded a VA respiratory conditions examination in January 2018. The VA examiner noted a diagnosis of interstitial lung disease, and opined that the Veteran’s lung disability was less likely than not incurred in service or related to his active service, to include exposure to asbestos insulation. The rationale was that computed tomography (CT) scan results were consistent with a usual interstitial pneumonia (UIP) pattern of interstitial disease, and did not show any evidence of pleural involvement, including pleural plaques. The examiner referenced a scholarly article, which noted that the presence of certain radiographic clues, including the presence of pleural disease such as pleural plaques and pleural thickening, may be helpful in diagnosing asbestos-related lung disease. The examiner indicated that, as per the article, in the absence of pleural plaques, the diagnosis of asbestosis is less likely as pleural plaques is pathognomic for previous asbestos exposure. The Board finds that that the January 2018 VA opinion is highly probative with respect to service connection for a lung disability, and is adequately based on objective findings as shown by the record, and accordingly, the Board concludes that the medical opinion rendered was based upon a full and accurate factual premise, including the Veteran’s history, and provided a thorough and adequate rationale for the opinion given. Barr, 21 Vet. App. 311; Reonal, 5 Vet. App. 458 at 461; Nieves-Rodriguez, 22 Vet. App. at 304. Therefore, the Board finds that the January 2018 VA opinion provides competent, credible, and probative evidence which shows that the current lung disability is not related to service, to include exposure to asbestos in service. There is otherwise no competent medical attributing the Veteran’s lung disability to in-service asbestos exposure. The Veteran believes that his lung disability is related to exposure to asbestos in service. However, he is not competent to provide a nexus opinion in that regard. The issue is medically complex, as it requires knowledge of the respiratory system and the relationship between interstitial lung disease and asbestos exposure decades earlier. Moreover, interstitial lung disease is diagnosed primarily on clinical findings and physiological testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau, 492 F.3d at 1377 n.4; see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the January 2018 VA opinion. For these reasons, the Board finds that a preponderance of the evidence is against the claim of entitlement to service connection for a lung disability, to include as due to exposure to asbestos in service. As such, the benefit of the doubt rule does not apply, and the claim must, therefore, be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. J. Ragheb Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, Associate Counsel 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.