Citation Nr: 20046972 Decision Date: 07/14/20 Archive Date: 07/14/20 DOCKET NO. 13-22 139 DATE: July 14, 2020 ORDER Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied. Entitlement to service connection for a respiratory disability, to include chronic obstructive pulmonary disease (COPD) and/or a restrictive disability, is denied. FINDINGS OF FACT 1. For the entire period on appeal, the Veteran’s PTSD has been manifested by no more than occupational and social impairment with reduced reliability and productivity. 2. The most probative evidence of record is against a finding that the Veteran has a current respiratory/pulmonary disability casually related to, or aggravated by, service and/or a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 50 percent for PTSD have not been met. 38U.S.C.§1155; 38C.F.R.§§4.7, 4.130, Diagnostic Code 9411. 2. The criteria for service connection for a respiratory/pulmonary disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS These matters were previously before the Board on several occasions. Most recently, in November 2019, the Board remanded the claim for an increased rating for the Veteran’s service-connected PTSD for compliance with a May 2019 United States Court of Appeals for Veterans Claims Joint Motion for Remand (JMR). The Board finds that there has been substantial compliance with its November 2019 remand directives, as well as substantial compliance with its September 2018 remand directives with regard to the claim for service connection for a respiratory disability. The May 2019 JMR noted that the Board failed to ensure that VA satisfied its duty to assist in obtaining outstanding private treatment records because it failed to request an authorization for a release of records from Christian Counseling Associates (CCA). The JMR further noted that the Board must ensure that the Veteran is asked to provide any outstanding private treatment record or a release for those records. Pursuant to the Board’s November 2019 remand, VA, in December 2019 correspondence, requested the Veteran to provide authorization for it to obtain the CCA clinical records, and provided him with the necessary form. In January 2020 correspondence, VA informed the Veteran that it was again requesting authorization to obtain CCA records and again provided him with the necessary form. The Veteran did not respond to either VA request. In a January 2020 brief, the Veteran’s accredited representative acknowledged that VA had made two attempts to obtain a signed VA Form 21-4142 from the Veteran, and there was no indication that the Veteran had replied. However, the representative contends that the RO failed to comply with the Board’s remand directive that if records are not obtained, it is to notify the Veteran. The Board notes, however, that this would be appropriate if the Veteran had actually submitted authorization and VA was thereafter unable to obtain the records with the authorization. In the present situation, the Veteran failed to reply to VA’s two recent requests for records and/or authorization. As noted in 38 C.F.R. §3.159, a claimant must cooperate fully with VA’s reasonable efforts to obtain relevant records from non-Federal custodians, and if necessary, must authorize the release of records; the Veteran has not done so. The duty to assist is not a one-way street. If a Veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Based on the foregoing, VA does not have a further duty to notify him or attempt to obtain the records. Increased Rating 1. Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) The Veteran’s PTSD is evaluated as 50 percent disabling effective from May 2012. He would be entitled to a higher rating if he had occupational and social impairment, with deficiencies in most areas (70 percent), and total occupational and social impairment (100 percent). The Board finds for the reasons noted below that a higher rating is not warranted for any period on appeal. PTSD is rated under the General Rating Formula for Mental Disorders, which provides for the following pertinent ratings with examples of symptoms: 100 percent rating (the maximum schedular rating) - Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. 70 percent - Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. 50 percent -- Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g. retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. When determining the appropriate disability evaluation to assign, the Board's primary consideration is a veteran's symptoms, but it must also make findings as to how those symptoms impact a veteran's occupational and social functioning. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, (2002). Because the use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Id. at 442; see also Sellers v. Principi, 372 F.3d 1318 (Fed. Cir. 2004). The Board has organized the rating period on appeal by year for ease of reading. Reference to the Veteran’s disability is presented in additional evidence of record beyond the most detailed pertinent evidence discussed by the Board in this decision. The additional evidence of record does not present findings concerning the Veteran’s disability that significantly expand upon, revise, or contradict the findings in the most detailed evidence discussed by the Board in this decision. 2012 A September 2012 VA mental health note reflects that the Veteran was employed as a part time school bus driver, and reported mild stress at work. It was noted that he had good eye contact, was appropriately dressed and groomed, had appropriate thought process and content, and had good insight and judgment. His memory was grossly intact, and there was no evidence of suicidal ideation/plan/intent, or homicidal ideation/plan/intent. The Veteran’s speech was normal, he was pleasant, polite, and cooperative, but his mood was anxious. At a September 2012 VA examination (D.T.), the Veteran reported that he lived with his wife, and had four children. He indicated that he was employed as a bus driver and that he performed his job well. The examiner noted that the Veteran works with children as a bus driver, and that when questioned about impulse control and ability to perform his job, it appeared that the Veteran was functioning well as a bus driver. The Veteran denied any hospitalization, and reported that he had never attended mental health counseling. The Veteran denied panic attacks, obsessive rituals, hallucinations, as well as suicidal or homicidal ideations. The examiner reported that the Veteran's PTSD was productive of depressed mood, anxiety, chronic sleep impairment, flashbacks, irritability, difficulty with concentration, mild memory loss, feelings of detachment, and avoidant behavior. The examiner noted that the Veteran reported periods of irritability or outbursts of anger, but there was no statement as to how often or when this had occurred and no evidence of a significant effect on work and family relations such as to find that it was so severe as to warrant a higher rating. To the contrary, the evidence reflects that the Veteran was doing well at work. The examiner opined that the Veteran's PTSD was most productive of occupational and social impairment due to mild transient symptoms which decrease work efficiency and ability to perform occupational tasks. The examiner’s findings equate with a 10 percent disability rating under the General Rating Formula for Mental Disorders. An October 2012 VA record reflects that the Veteran reported that he and his wife are very involved with the Mason organization, that he is involved with events twice a week, and that he has many friends through this organization. He reported that he has a good marriage and has a close relationship with his four children. He also reported that he sees his son and grandson on a weekly basis. He stated that he and his wife are seldom at home because they are “always on the go”. He denied any difficulty going places (although he does not like crowds and sits facing the door at restaurants). He reported feeling depressed at times and stated that he will go without shaving or bathing for a few days at a time but not for any extended period. The Veteran attended counseling sessions in December 2012 and was on time, attentive, engaged, alert, oriented, and demonstrated a clear and coherent thought process. The evidence as a whole is against a finding that a rating in excess of 50 percent is warranted. Notably, the Veteran did not have significant social impairment as evidenced by his weekly visits with his son and grandson, his close relationship with his four children, his good marriage, and his involvement in a fraternal organization. In addition, he did not have any significant occupational impairment as evidenced by his ability to maintain part-time employment as a school bus driver which required interaction with children, intact memory, and following directions/routines/schedules, without any evidence of missed work or reprimands. Although the Veteran indicated that he might go a few days without bathing or saving, this “neglect of personal appearance and hygiene” is only an example of what may be considered as a deficiency which may warrant a 70 percent rating. Importantly, it is not merely the Veteran’s symptoms that are for consideration in assigning a rating, but how those symptoms affect him socially and occupationally. There is no evidence that his neglect of hygiene for a few days has adversely impacted him either socially or occupationally to any significant extent; thus, it does not warrant a 70 percent rating. 2013 An April 2013 CCA report reflects that the Veteran reported that in his present job, “he still has trouble with people ‘getting on his nerves’.” He also reported that he has a sleep disorder, exaggerated startle response, feels misunderstood, cannot get close to others, feels anxious in crowds, has difficulty expression his emotions to his family, and becomes physically or verbally aggressive if pushed too far. The evidence does not support that he cannot get close to others, that he is abusive, or that he has difficulty expression his emotions to family; the records consistently note that he has relationships with his family and that his wife is supportive of his needs. The CCA report also notes that this “man” is “probably perceived by others as a difficult, bitter, and a demanding person, and has a “typical grumbling”, however, there is no evidence in the records to support this. Rather, the Veteran has been shown to be polite, pleasant, and/or cooperative in VA clinical records. The Board finds that the paragraph does not refer specifically to this Veteran but to a person with a mental health disability in general. The Board notes that the CCA report contains several sections, such as the above paragraph, which are not specific to the Veteran (i.e. do not provide specific examples) but appear to have been taken word for word from “Disorders of Personality: Introducing a DSM”. In other words, the pages provide a description of possible symptoms of someone with PTSD. As noted above, the Veteran has failed to provide VA with the complete examination report. Thus, the pages associated with the clinical record which do not appear specific to this Veteran but are instead copied from medical literature lack significant probative value. VA records in 2013 reflect that the Veteran reported that his medications are helping with his mood, anxiety, and PTSD symptoms. He reported that he was sleeping better, that his flashbacks had reduced, and that did not have suicidal or homicidal intent. He also had logical thought processes, a grossly intact memory, fair insight, and fair judgment. He was noted to have hobbies/recreational activities of woodworking and golf (see January, September 2013). The evidence as a whole is against a finding that a rating in excess of 50 percent is warranted. Notably, the Veteran reported that he was doing better with his symptoms with the help of medication. The use of medication to control symptoms is considered in the criteria for a 10 percent rating.   2014 A January 2014 record reflects that the Veteran reported that he was feeling somewhat better and that his medications help, but that he would like to try a higher dose of one of them. It was noted that his nightmares were down in intensity and frequency. He denied suicidal and/or homicidal ideation. A May 2014 record reflects that the Veteran reported that he was feeling “fair” and again that he felt that the medication helped with his mood and anxiety. Nightmares were at baseline. He again denied suicidal and/or homicidal ideation and was noted to have a logical thought process. A July 2014 record reflects that the Veteran reported that he had mild memory problems for approximately five years, but he denied problems with directions and denied remembering the names of close family members. There are no clinical findings/test results noting significant impaired memory A September 2014 record reflects that the Veteran reported that he was “fair” and that nightmares had lessened. There is no competent and credible evidence from 2014 that indicates that a rating in excess of 50 percent is warranted. There is not clinical evidence of deficiencies in most occupational and social areas. 2015 Records in 2015 reflect that the Veteran’s wife had been seriously sick for a while but that the Veteran had coped with the stress, and was back to baseline (January), and that he had no deep depression. His medication continued to help with mood anxiety, sleep, and nightmares. He had fair insight and judgment (January, July, October), was oriented (January, July, October), had intact memory (January, July, October) and denied suicidal and/or homicidal intent (January, July, October). 2016 In a March 2016 private examination report (Disability Benefits Questionnaire (DBQ)), the Veteran's psychiatrist reported that the Veteran's PTSD was productive of anxiety, chronic sleep impairment, mild memory loss, difficulty in understanding complex commands, avoidant behavior, hypervigilance, exaggerated startle response, irritability, difficulty in establishing and maintaining effective work and social relationships, and difficulty adapting to stressful circumstances. The psychiatrist opined that the Veteran's PTSD was most productive of occupational and social impairment with deficiencies in most areas. This would equate with a 70 percent rating; however, the Board finds that the report lacks significant probative value. The clinical finding that the Veteran has difficulty in maintaining social relationships is at odds with the Veteran’s prior and subsequent reports of relationships with family members. For “relevant social/marital/family history”, the examiner wrote “financial stresses” with no acknowledgement of the Veteran’s family and ability to maintain relationships with them, and no reference to the Veteran’s several social activities. Moreover, with regard to “relevant occupational history”, the examiner did not note that the Veteran was employed but instead listed that the Veteran was sober since 1984, quit tobacco use 24 years earlier, and did not have illicit drug use, which does not reflect that the examiner considered the Veteran’s ability to maintain employment with no significant functional impairment. The Board finds that this report does not have as much probative value as those which give specific examples/include more detail as to the Veteran’s symptoms and its effects. At a July 2016 VA examination, the Veteran reported that he had a good relationship with his wife, with whom he had been married for 30 years. He reported that he enjoys his grandchildren although he does not seem much of them. (The reason for this appeared to be because his former wife (mother of his children) had returned to the area and the Veteran’s children preferred going there as they did not see the Veteran’s wife as their mother; thus, it was not related to his PTSD). He reported that he maintained several friendships, he was active in the Masonic Lodge, he liked to golf, and he rode a motorcycle with a group. He also indicated that he was comfortable around his friends and fellow members of the Masonic Lodge. However, he reported that he did not like big crowds. He reported that he was still employed as a bus driver. He also reported that socially “he remains fairly active”. He reported an episode at work where he lost his patience with another driver who was hassling him about being a veteran, and the Veteran finally slammed his cane down on a table. He reported having had other incidents where he came close to losing his temper, but did not. The 2016 VA examiner (psychologist B.T.) reported that the Veteran's PTSD was productive of depressed mood, anxiety, avoidant behavior, suspiciousness, chronic sleep impairment, impaired impulse control, hypervigilance, exaggerated startle response, and irritability. Although the Veteran reported mild memory loss, upon testing, he had normal remote, recent, and immediate memory. At the examination, the Veteran presented as appropriately groomed and dressed. He was personable and cooperative, and made good eye contact. He was alert to person, place, and time; and judgment and insight appeared intact. The Veteran denied panic attacks, obsessive rituals, hallucinations, as well as suicidal or homicidal ideations. The examiner opined that the Veteran's PTSD was most productive of occupational and social impairment with reduced reliability and productivity; this would equate with a 50 percent rating. The Board acknowledges the Veteran’s report of irritability or outburst of anger, however, there does not appear to be more than a single incident of him becoming angry enough to slam his cane down, and he reported that he had been provoked; thus, the Board finds that this does not rise to the level of severity of symptoms so as to warrant a 70 percent or higher rating. An October 2016 VA clinical record notes that the Veteran was still working as a bus driver, and riding a motorcycle with a group. 2017 A February 2017 VA record reflects that the Veteran is “enjoying his retired life”, spends time in his garage, his relationship is going well, his sleep is fair, and his nightmares are down. It was noted that his wife seems very supportive. 2018 April, July, and October 2018 VA records for medication follow up appointments reflect that the Veteran reported that he was “feeling fair”, his mood was stable, his medications are working, and his anxiety was manageable. He was fairly groomed, oriented, had regular speech, average eye contact, logical and goal directed thought processes, grossly intact memory, fair insight, and fair judgment. He denied suicidal ideation, homicidal ideation, hallucinations, and delusions. 2019 A January 2019 record reflects that the Veteran enjoys riding his motorcycle, golfing, and woodworking. A June 2019 DBQ (psychologist D.B.) reflects that the Veteran’s PTSD is best summarized as causing occupational and social impairment with deficiencies in most areas; this would equate with a 70 percent rating; however, the Board notes that the opinion of the examiner is not binding on the Board. Rather, the Board must look at the evidence as a whole. In this regard, the Board notes that the examiner found deficiencies in most areas such as family relations, but the report also notes that the Veteran has been married for 34 years (albeit they have been experiencing increased martial discord due to his mental health and her declining health), that he and his wife are active in state and local Masonic activities, that they enjoy traveling to other lodges for activities, that they eat out and attend church together, and that he enjoys golf (when his physical impairments do not hinder it). The Board finds that the Veteran’s relationships and activities are against deficiencies in most areas. The report also reflects that the Veteran last worked in 2014; however, the other records reflect that he was still working in 2016. It was noted that the Veteran was casually dressed, with good grooming and hygiene, and good eye contact, but that his memory was slowed, his affect was flat, and he was emotionally constricted. The examiner also found that the Veteran’s speech required redirection. A February 2019 VA clinical record notes that the Veteran reported no new issues or issues with medication. He denied suicidal and/or homicidal intent or plans. He denied use of illicit drugs. He was fairly groomed, oriented, had normal speech, had a fair mood, had no hallucinations or delusions, had a logical and goal directed thought procession, and had fair insight and judgment.   2020 A March 2020 DBQ reflects that the Veteran reported that he has difficulty expression loving emotions with his wife and feels numb and wonders if he loves her. He reported that he will go to family gatherings, but he is “still not there”. He reported that he has friendships but his interest in friendships has diminished. It was noted that he can functional socially, but he chooses to not participate. He reported trouble with remembering dates and uses his phone for reminders. He reported that he is easily irritated but not violent (he once slammed a cane on a table; as noted this incident was reported at the July 2016 examination; thus, there have been no examples in the last four years of impaired impulse control). He reported that he can experience an anxiety attack over minor issues and is quick to express irritation. He reported that since 2013, the intensity of his anxiety has increased. The 2020 examiner (Dr. W.R.) considered all of the Veteran’s symptoms (e.g. depressed mood, anxiety, suspiciousness, panic attacks more than once a week, choreic sleep impairment, impairment of memory, impaired judgment, disturbances of motivation and mood, difficulty in stabling and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, obsessional rituals which interfere with routine activities, impaired impulse control, spatial disorientation, intermittent inability to perform activities of daily living, disorientation to time and place), whether or not in the rating criteria, and opined that the Veteran’s symptoms were best summarized as causing occupational and social impairment with reduced reliability and productivity; this equates with a 50 percent rating. The Board notes that there were no examples of obsessional rituals interfering with routine activities, there are no clinical records noting this, and no prior examiner has found this, and the Veteran specifically denied it in 2016. Thus, the Board holds that a finding of obsessional rituals interfering with routine activities is not adequately supported by the record. In addition, the evidence does not support a finding of retention of only highly learned material; rather, the Veteran stated that he has trouble with dates and has to use his phone to remember appointments; the Board finds that this does not rise to the level of retention of only highly learned material; notably, he had taken over the family finances from his wife. With regard to impaired impulse control and irritability, the example noted was from more than three years earlier. Regardless, the examiner considered the Veteran’s reported symptoms and still found that the overall picture was best summarized as occupational and social impairment with reduced reliability and productivity; which equates with a 50 percent rating. Conclusion While the Veteran’s symptoms may have increased over the years, the evidence does not support that his symptoms have risen to the level which warrants a higher rating. Notably, he was assigned a 50 percent when his symptoms only warranted a 10 percent according to a VA examiner, and currently although his symptoms have risen, they now equate with no higher than that 50 percent rating. He has not been shown to have gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; memory loss for names of close relatives, own occupation or own name; speech intermittently illogical, obscure, or irrelevant; or near continuous panic or depression affecting the ability to function independently, appropriately and effectively; nor has he had symptoms of similar severity. The Board acknowledges the various opinions of the examiners that the Veteran’s disability picture most nearly approximates ratings of 10 percent (September 2012), 70 percent (March 2016), 50 percent (July 2016), 70 percent (June 2019), and 50 percent (March 2020). However, the Board finds that boxes checked by the examiners with regard to symptoms which are not consistent with the record or supported by the record lack significant probative value. Although the Veteran has reported that he does not like crowds and has anxiety, he has been able to attend (and enjoy) group activities (Masonic events), and ride motorcycles with a group. He has stated that he enjoys his retirement, and it has been noted that he attends church, golfs, does woodworking, and eats out at restaurants. He continues to be married to his wife of more than three decades, and has good relationships with his children and grandchildren. He has not required mental health hospitalization, has not been arrested for violence, has not abused illicit drugs or alcohol to self-medicate, and has not attended consistent therapy. He has always been cooperative/polite with clinicians, and consistently denied suicidal and homicidal ideation. His nightmares are reduced with medication, and no clinician has recommended in-patient hospitalization or found him to be a threat to himself or others. Although the Veteran reported that he once choked his grandson in October 2016, the indication is that this was due to a possible neurological issue where he “spaced out” (see 2017 and 2018 VA records and MRI which revealed chronic microvascular disease) and not his PTSD. The probative evidence as a whole simply does not support that his symptoms are of such severity as to warrant a rating in excess of 50 percent. When determining the appropriate disability evaluation to assign, the Board's primary consideration is a veteran's symptoms, but it must also make findings as to how those symptoms impact a veteran's occupational and social functioning. The Board finds that a 50 percent rating adequately compensates the Veteran for his symptoms and impairment; his disability picture does not more nearly approximate what is required for a higher 70 percent or 100 percent for any period on appeal. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 2. Entitlement to service connection for a respiratory disability, to include chronic obstructive pulmonary disease (COPD) The Veteran contends that he has a respiratory disability (to include restrictive and obstructive disabilities) due to service, to include asbestos exposure while working as a mechanic, herbicide exposure, and exposure to fumes. The Veteran’s DD 214 reflects that his military specialty was as a vehicle repairman. His military personnel records indicate service in Vietnam in 1969 and 1970; thus, he is presumed to have been exposed to an herbicide agent. See 38 C.F.R. §3.307(a)(6)(iii). The Board acknowledges that the Veteran has been diagnosed with current respiratory disabilities (restrictive lung disease/asthma, emphysema, and chronic obstructive pulmonary disease (COPD)); however, the most probative evidence is against a finding that he has a disability which is as likely as not casually related to active service. In general, establishing service connection requires medical evidence or, in certain circumstances, lay evidence of the following: (1) a current disability; (2) in-service incurrence or aggravation of a relevant disease or an injury; and (3) a nexus between the disease or injury in service and the present disability. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). In addition, if a Veteran was exposed to an herbicide agent during active service, several diseases shall be service-connected if the requirements of 38 C.F.R. §3.307 (a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. §3.307 (d) are also satisfied. However, the Veteran’s respiratory disabilities are not those which warrant presumptive service connection under 38 C.F.R. §3.309. Thus, the Board will consider whether service connection is warranted on a non-presumptive basis. The Veteran’s Report of Medical History for entrance purposes reflects that he reported that he had previously had shortness of breath and pain/pressure in the chest. The Veteran had service from September 1968 to September 1971. His service treatment records (STRs) reflect that he had pneumonia (March 1969), a cough, running nose, vomiting, and headache (March 1970), and a respiratory infection with bronchitis and diffuse chest rhonchi (October 1970). His July 1971 Report of Medical Examination for separation purposes reflects that his lungs and chest were normal upon evaluation. His August 1971 Statement of Medical Condition reflects that there had been no change in his medical condition since his July 1971 examination. There are no clinical records in the next three decades noting respiratory complaints. The lapse of time between service separation and the earliest documentation of current disability is a factor for consideration in deciding a service connection claim. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Post service, the Veteran worked in construction for 7 years (finishing wood), in tire repair for 27 years, in retail for two years, in security for four years, and as a bus driver for more than five years. The Veteran has reported that he quit smoking in approximately 1992, and that he smoked 2 packs a day for 10 years or up to 2-3 packs a day for 15 years, which would equate with up to 45 pack year history. A September 2012 VA examination repot reflects that the Veteran does not have a current restrictive respiratory disability causally related to service. The examiner noted that the in-service conditions were treated in service, and there is no evidence to support that restrictive lung disease is caused by acute chest infections such as bronchitis or pneumonia. A December 2015 DBQ (Dr. E.W.) reflects that the Veteran has “COPD, as likely as not, to be caused by chemical exposure during military service.” No rationale was provided. As there is no rationale whatsoever, the Board finds that the opinion lacks significant probative value. March 2016 private correspondence (Oklahoma Heart Hospital Physicians) reflects that the Veteran had two chest x-rays in January 2016 which showed that he has emphysema/COPD; there was no etiology with rationale. A July 2016 VA examination report (DBQ) reflects that the Veteran smoked two packs of cigarettes a day for 10 years and quit smoking in 1992. He reported that he had previously worked as an automobile mechanic with asbestos exposure. The examiner found it less likely as not that the Veteran’s COPD is due to service. The examiner noted that cigarette smoking is the leading cause of COPD, and that there is no medical research evidence to support that COPD is related to exhaust fumes from trucks, tanks, or other heavy vehicles. In addition, the examiner found that clinical evidence does not support that the Veteran has asbestosis, or an asbestos-related diseases. A December 2015 CT thorax examination did not demonstrate findings consistent with an asbestos-related disease. The examiner also found that there is no medical evidence to substantiate that COPD is due to an herbicide exposure, no evidence that the Veteran had a chronic respiratory disease in service, and no evidence to support a positive nexus between the Veteran’s service and a current disability. A July 2019 VA DBQ reflects the opinion of the examiner that it is less likely as not that the Veteran has a current respiratory disability due to service. The examiner’s opinion was based, in part, on the Veteran’s STRs which do not show a chronic respiratory condition. The examiner opined that the Veteran’s in-service conditions were self-limited. The examiner noted that restrictive lung disease can be inherited, caused by hazardous chemicals, and is prominent in former and current smokers. The examiner opined that the Veteran’s long smoking history is most likely the cause of his current respiratory disorders. The examiner noted that the Veteran’s respiratory disabilities are not caused by the Veteran’s service-connected coronary artery disease (CAD), which is a building up in the arteries and not a respiratory disease. The Board also notes that there is no competent and credible evidence that the Veteran’s CAD aggravates the Veteran’s respiratory diseases. The 2019 examiner found that there are no current respiratory disabilities resulting from exposure to exhaust fumes from trucks, tanks or other heavy vehicles, that the medical records are silent for chronic cough or frequent episodes of shortness of breath during service (which could indicate the development of a chronic respiratory illness), and the baseline criteria for COPD is a chronic cough of two months or greater, which the Veteran did not have in service. The examiner also noted that a chest x-ray from July 2019 showed no asbestos. With regard to herbicide exposure, the 2019 examiner noted that the medical literature is silent for a connection between agent orange/herbicide exposure and the development of COPD, asthma, and restrictive lung disease. The examiner noted that smoking is a known main contributor for the development of asthma, COPD and restrictive lung disease. The examiner further noted that a left lung nodule which had been seen on diagnostic testing was due to scarring and was insignificant. The examiner opined that there is no relationship between the nodule and the Veteran’s in-service pneumonia and upper respiratory infection treatment. The opinion was based on the facts that the Veteran had routine surveillance of nodule with CT scans which showed that it was insignificant, that the Veteran would have to have chronic episodes of pneumonia to cause extensive lung damage, and the STRs are silent for chronic treatments of pneumonia or any episodes of COPD exacerbations. The Veteran has not been shown to have the experience, training, or education necessary to make an etiology opinion to the claimed disabilities. Although lay persons are competent to provide opinions on some medical issues, the Board finds that a lay person is not competent to provide a probative opinion as to the specific issues in this case in light of the education and training necessary to make a finding with regard to the complexities of lung conditions, to include restrictive conditions, obstructive conditions, and nodules. (Moreover, the Veteran himself has given various alleged etiologies.) The Board finds that such etiology findings fall outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board finds that any contention as to chronic symptoms in service or since service is less than credible given the record as a whole. As noted above, there were no complaints in the Veteran’s last 10 months of service and his examination for separation purposes reflects normal lungs. Moreover, there are no clinical records in the next several decades noting respiratory complaints. A February 2010 private record reflects that the Veteran has a history of remoting smoking, obesity, hyperlipidemia, hypertension, anxiety, GERD, hypertriglyceridemia, and CAD. It was noted that he complained of exertional shortness of breath and dyspnea on exertion. If the Veteran had chronic respiratory complaints since service (to include when not on exertion), it seems reasonable that such a length of time would have been noted. In sum, the most probative evidence of record reflects that the Veteran’s respiratory disabilities are not due to service, but more likely due to his history of smoking. The evidence does not reflect that the Veteran smoked in service. Regardless, for claims, as here, filed on or after June 9, 1998, there even is an express prohibition against granting service connection for any disability resulting from injury or disease attributable to chronic smoking. 38 U.S.C. § 1103 ; 38 C.F.R. § 3.300 . (Continued on the next page)   As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C.A. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). ROBERT C. SCHARNBERGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Wishard 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.