Citation Nr: 21063716 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 13-05 126 DATE: October 15, 2021 ORDER Entitlement to service connection for a respiratory disability, to include chronic obstructive pulmonary disease (COPD), is granted. FINDING OF FACT The Veteran's respiratory disability is proximately due to exposure to aircraft exhaust and aircraft fuel in service. CONCLUSION OF LAW The criteria for entitlement to service connection for a respiratory disability, to include COPD, are met. 38 U.S.C. §§ 1110, 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from October 1959 to February 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2010 rating decision by an Agency of Original Jurisdiction (AOJ) of the Department of Veterans Affairs (VA). In February 2018 and September 2020, the Board remanded this matter for additional development. Additionally, the September 2020 Board decision and remand determined that the Veteran had been exposed to herbicide agents in service and granted entitlement to service connection for coronary artery disease. In October 2020, the AOJ granted entitlement to service connection for unspecified depressive disorder and granted an initial 30 percent rating effective November 5, 2009. Thus, the appeal as to that issue has been resolved, and the sole remaining issue on appeal is entitlement to service connection for a breathing condition, to include as secondary to exposure to herbicide agents. There has been substantial compliance with the February 2018 and September 2020 remand directives. The Board has determined that the Veteran was exposed to herbicide agents in service, and moreover an adequate medical opinion has been secured as to whether his breathing condition is due to this exposure. The Veteran asserts that his COPD is due to exposure to aircraft fumes and jet fuel in service. See October 2021 Informal Hearing Presentation. The Board agrees. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish entitlement to service connection, a veteran must show (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The VA has determined that service connection may be granted for certain diseases presumptively associated with exposure to herbicide agents. While COPD is not one of the diseases presumptively associated with herbicide agent exposure, service connection may still be granted if the evidence shows a direct relationship between COPD and exposure to herbicide agents. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Veteran has a current diagnosis of COPD. See August 2021 Respiratory Examination Report. Moreover, the Board found that he was exposed to herbicide agents in service, see September 2020 Board Decision and Remand, and the Board concedes exposure to jet fuel and exhaust as the Veteran's service personnel records show that he frequently worked near aircraft and the flight line. See Military Personnel Records (Performance Evaluations). Thus, as the evidence shows that he has a current disability and experienced exposures in service, the key question in this appeal is whether there is an etiological relationship, or "nexus," linking these exposures and his current respiratory disability. There are two relevant medical opinions of record, an October 2020 medical opinion in favor of the claim and a March 2021 opinion against the claim. In October 2020, a VA physician noted that the Veteran worked as an aircraft mechanic and his performance evaluations show that he spent most of his time on the flight line, where he would have been exposed to fuel, smoke, solvents, and chemicals. The examiner opined that the Veteran's COPD is as likely as not caused by the cumulative effects of these exposures. See October 2020 Medical Opinion. In March 2021, a VA-contracted nurse practitioner opined that the Veteran's COPD was less likely than not due to exposure to herbicide agents and cited the results of a VA study. The examiner opined that the Veteran's COPD is more likely than not due to exposure to cigarette smoke. See March 2021 Medical Opinion. Here, the probative evidence of record weighs in favor of the claim. Both examiners are competent to provide a medical opinion and both opinions are based on an accurate factual basis. However, the March 2021 examiner's opinion that COPD is less likely than not due to herbicide agents does not weigh against the October 2020 examiner's opinion that COPD is as likely as not due to the cumulative impact of exposure to jet fuel and exhaust. Moreover, the March 2021 examiner did not provide a rationale to support her opinion that COPD is likely due to exposure to cigarette smoke, nor did she explain whether the asserted exposures to cigarette smoke were in service or post-service, or secondhand or primary. Thus, as the most probative evidence of record shows that the Veteran's COPD is due to exposures to aircraft exhaust and jet fuel in service, the third and final element of entitlement to service connection for a respiratory disability, to include COPD, are met. Accordingly, the appeal is granted. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D.M. Badaczewski, 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.