Citation Nr: 21003617 Decision Date: 01/22/21 Archive Date: 01/22/21 DOCKET NO. 14-19 201 DATE: January 22, 2021 ORDER Service connection for idiopathic pulmonary fibrosis is denied. FINDING OF FACT The preponderance of the evidence is against finding that idiopathic pulmonary fibrosis had its onset in service or is otherwise related to an in-service injury, disease, or exposure to herbicides, asbestos, or other chemicals. CONCLUSION OF LAW The criteria for service connection for idiopathic pulmonary fibrosis are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1965 to June 1969; he died in July 2014. The Appellant is his surviving spouse. This case is before the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). The Appellant’s September 2014 request for substitution was granted in April 2020. The Board remanded this case in July 2020 for further development. As the requested development has been completed, no further action to ensure compliance with the remand directives is required. Stegall v. West, 11 Vet. App. 268, 271(1998) Service connection will be granted for a current disability that resulted from an injury, disease, or aggravation while in active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, service connection requires (1) a present disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the present disability and the in-service incurrence or aggravation of a disease or injury. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran is competent to report symptoms and experiences he can observe. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). VA must give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990); 38 C.F.R. § 3.102. The Veteran contended that his idiopathic pulmonary fibrosis was caused by in-service exposure to herbicides, asbestos, and other chemical agents; exposure is conceded. The record contains a competent diagnosis of idiopathic pulmonary fibrosis; accordingly, evidence of a disability during the period on appeal is found. See 08/16/2020, C&P Exam. As idiopathic pulmonary fibrosis is not one of the diseases set forth in 38 C.F.R. § 3.309(e), a presumption based on in-service herbicide agent exposure is not warranted; however, whether there is evidence of actual direct causation of his idiopathic pulmonary fibrosis due to herbicide agent exposure will be considered. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). The preponderance of the evidence weighs against finding that the Veteran’s diagnosis of idiopathic pulmonary fibrosis began during service or is otherwise related to an in-service injury or disease. The Appellant does not assert that the Veteran’s idiopathic pulmonary fibrosis had onset in active service, and the available service treatment records are negative for any entries related to complaints, findings, or treatment for any respiratory or related issues. See 07/14/2011, STR–Medical. There is no evidence that idiopathic pulmonary fibrosis manifested within one year of separation from service. There is no factual basis for presumptive service connection for a chronic disease. 38 C.F.R. §§ 3.307(a), 3.309(a). The cause of idiopathic pulmonary fibrosis is scientifically unknown. See 08/16/2020, C&P Exam; 08/10/2013, Medical Treatment Record (MTR)–Non-Government Facility (NGF). Private treatment records show the Veteran experienced an onset of dyspnea symptoms on exertion in August 2009, and idiopathic pulmonary fibrosis was diagnosed in May 2010, four decades after his separation from service. These records also note the Veteran used to work in the air conditioning industry and was exposed to asbestos throughout his work life, and he smoked one pack of cigarettes a day for over 40 years, quitting in either 1997 or 2004. See 08/10/2013, MTR–NGF. In May 2010, before idiopathic pulmonary fibrosis was diagnosed, a private pulmonary pathologist speculated the etiology of the chronic fibrosing, stating it could include infection, collagen vascular disease, environmental or inhalational exposure, drug toxicity, oxygen toxicity, pancreatitis, sepsis, chronic hypersensitivity, and idiopathic causes. Id. In October 2010, a private physician observed the Veteran had a “significant history of gastroesophageal reflux disease. In addition, left lung predominance and his lying on the left side while sleeping raises the role of gastroesophageal reflux disease/silent aspiration in the etiology of his [idiopathic pulmonary fibrosis].” 06/17/2011, MTR–NGF. The May 2013 VA examiner opined idiopathic pulmonary fibrosis was less likely than not incurred in or caused by in-service asbestos exposure. The examiner provided the rationale that the cause of idiopathic pulmonary fibrosis is not known, and studies have not shown a consistent connection to asbestos exposure. 05/08/2013, VA Examination. The August 2020 VA examiner performed a thorough review of the medical literature and explained that the etiology of idiopathic pulmonary fibrosis is unknown, but according to most authoritative medical literature on the subject, smoking remains the major risk factor. Cigarette smoking is most strongly associated with idiopathic pulmonary fibrosis. Patients with idiopathic pulmonary fibrosis are typically 60 years or older, and most have a history of cigarette smoking. The examiner highlighted that the Veteran had over 40 years of smoking history. The examiner, thus, opined that it is not at least as likely as not that the claimed idiopathic pulmonary fibrosis had its onset in service or was caused by, or otherwise related to, the Veteran’s service, including exposure to herbicides, asbestos, or flight-line chemical solvents. 08/16/2020, C&P Exam. Taken together, the opinions from May 2010, October 2010, May 2013, and August 2020 establish that the Veteran’s idiopathic pulmonary fibrosis is not at least as likely as not related to an in-service injury or disease, including exposure to herbicides, asbestos, or flight-line chemical solvents. The combined opinions are probative because they are based on an accurate medical history and provide an explanation that contains supporting data that medical research does not support a finding that exposure to herbicides, asbestos, or flight-line chemical solvents cause idiopathic pulmonary fibrosis. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Further, the Veteran, by the May 2010 diagnosis of idiopathic pulmonary fibrosis, had risk factors unrelated to service, found to result in idiopathic pulmonary fibrosis: being over the age of 60 years and a long history of smoking cigarettes. Although the Veteran was competent to report formally diagnosed conditions such as idiopathic pulmonary fibrosis, he was not competent to relate his idiopathic pulmonary fibrosis to active-duty exposure to herbicides, asbestos, or flight-line chemical solvents. Idiopathic pulmonary fibrosis is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). As such, the Veteran was not competent to provide an opinion as to the etiology of his idiopathic pulmonary fibrosis, and his statements in this regard lack weight. Consequently, without any competent evidence supporting the Veteran’s contention, more probative weight is given to the competent medical evidence. The Board fully acknowledges the Veteran’s honorable service to our country and is sympathetic to the Appellant. Unfortunately, however, the laws must be applied as it exists. See Owings v. Brown, 8 Vet. App. 17, 23 (1995). The preponderance of the evidence is against the issue of service connection for idiopathic pulmonary fibrosis. The benefit-of-the-doubt rule has been considered, but the weight of the evidence is against the claim. See Gilbert, 1 Vet. App. at 57-58; 38 C.F.R. § 3.102. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Costa, 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.