Citation Nr: 21001068 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 19-32 203 DATE: January 6, 2021 ORDER Entitlement to service connection for pulmonary fibrosis is granted. FINDING OF FACT Resolving reasonable doubt in favor of the Veteran, the evidence is at least in equipoise as to whether a current respiratory disability is related to service. CONCLUSION OF LAW The criteria for entitlement to service connection for pulmonary fibrosis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1968 to September 1970. Service Connection Service connection may be established for disability caused by disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection for a claimed disability, there must be (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) evidence, generally medical, of a causal relationship between the claimed in service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247 (1999). For purposes of establishing service connection for a disability resulting from exposure to herbicide agents, a veteran who had active military, naval, or air service in the Republic of Vietnam during the Vietnam Era, beginning on January 9, 1962, and ending on May 7, 1975, will be presumed to have been exposed to an herbicide agent during that service, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 U.S.C. § 1116(f); 38 C.F.R. §§ 3.307(a), 3.309(e). The applicable criteria provide that a disease associated with exposure to certain herbicide agents, listed in 38 C.F.R. § 3.309(e), will be considered to have been incurred in service under the circumstances outlined in this section even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307(a). The enumerated diseases which are associated with herbicide exposure do not include idiopathic pulmonary fibrosis. 38 C.F.R. § 3.309(e). Nevertheless, the availability of presumptive service connection for a disability based on exposure to herbicides does not preclude a veteran from establishing service connection with proof of direct causation, or on any other recognized basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Entitlement to service connection for idiopathic pulmonary fibrosis, claimed as secondary to herbicide agent exposure The Veteran contends that a respiratory disability is the result of exposure to herbicide agents while in service. The medical records show a current diagnosis of pulmonary fibrosis. The Board notes an April 2007 rating decision conceded presumed exposure to herbicide agents during the Veteran’s service in Vietnam. As pulmonary fibrosis is not presumptively linked to exposure to herbicide agents, the establishment of service connection requires probative evidence linking a currently diagnosed respiratory disability to service. In September 2017, the Veteran’s primary care physician opined that it was more likely than not that herbicide agent exposure contributed to the development of pulmonary fibrosis. The physician stated that while the precise factors that initiate the histopathologic processes in pulmonary fibrosis are unknown, medical research had linked herbicide agents to the disease process. The physician stated that because there were no other contributing risk factors, the Veteran’s exposure to herbicide agents “started the inflammatory [process] and then the subsequent fibrotic disease processes.” The examiner cited to medical research in support of the findings. In March 2018, the Veteran obtained a private medical opinion in connection with the claim. The physician’s assistant stated that “medical and scientific evidence do not provide a substantial basis for a causal linkage (to a reasonable medical probability) between [the] Agent Orange exposure, which was quite substantial, and [the] current lung condition. However, I cannot say that this exposure was causally irrelevant to [the] lung fibrosis.” The Board is not free to substitute its own judgment for that of a medical expert. Colvin v. Derwinski, 1 Vet. App. 171 (1991). However, the Board is required to assess the credibility and weight to be given to evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, reasonable doubt is resolved in favor of the Veteran. The Board finds that the evidence for and against the claim are at least in relative equipoise. There is a plausible medical opinion that shows that pulmonary fibrosis is more likely related to herbicide agent exposure during service. Therefore, reasonable doubt is resolved in favor of the Veteran, and the Board finds that pulmonary fibrosis is at least as likely as not proximately due to or the result of exposure to herbicide agents during service. Accordingly, resolving reasonable doubt in favor of the Veteran, the Board finds that service connection for pulmonary fibrosis is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E.O., 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.