Citation Nr: 21065961 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 20-10 018 DATE: October 28, 2021 ORDER Entitlement to service connection for pulmonary melioidosis is granted. FINDING OF FACT The evidence of record is at least in equipoise that the Veteran's pulmonary melioidosis was incurred during his active service. CONCLUSION OF LAW The criteria for entitlement to service connection for pulmonary melioidosis have been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1965 to January 1969. In August 2021, the Veteran appeared before the undersigned during a virtual Board hearing. A transcript of the hearing is associated with the claims file. Entitlement to service connection for pulmonary melioidosis Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to establish service connection for the claimed disorder, 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) medical, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence in light of the entire record. A layperson is competent to report on the onset and continuity of current symptomatology based on personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if the layperson: (1) is competent to identify the medical condition, (2) is reporting a contemporaneous medical diagnosis, or (3) is describing symptoms that support a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, at 1376-77 (Fed. Cir. 2007). 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; 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, the benefit of the doubt is afforded. The Veteran contends that he suffers from pulmonary melioidosis due to exposure to the disease during his active service in Thailand. During his August 2021 hearing, the Veteran stated that during his time in Thailand he developed symptoms of a disease that he believed to be influenza. "We just thought we got sick. The only difference was my friends would get better in a week or two and it took me three or four months. I did not realize that I had this lung issue that would debilitate me." The Veteran reported recurrence of yearly flu-like symptoms from that point forward. The Veteran stated that after he turned 50, his flu-like symptoms started to increase in severity and that skin lesions similar to chicken pox would also develop with the respiratory symptoms. The Veteran's service treatment records (STRs) from Thailand report that in December 1967 that the Veteran went to the dispensary for "cold-like" symptoms. Then, in December 1968, the Veteran reported complaints of a sharp pleuritic type pain left anterior chest. Additionally, on the Veteran's Report of Medical History prior to separation from service in January 1969, the Veteran noted a history of sinusitis and pressure in his chest and reported recent onset of sinus congestion and headaches. In June 2016, the Veteran underwent a CT of his chest without contrast. The radiologist reported findings of nodular infiltrates within the left lung, likely infectious in etiology. In August 2016, the Veteran was seen for a pulmonary consult at the West Palm Beach VA Medical Center (VAMC). The Veteran reported a history of severe colds lasting approximately a month, once per year for at least the past ten years. He reported history of lifelong chronic sinusitis, but no history of asthma or outdoor allergens. The Veteran provided a history of fevers and a skin rash over the back with each episode but denied contact with sick people at home and denied spreading the symptoms of his cold to others. The Veteran reported his belief that he suffers from melioidosis due to his service overseas; however, the physician did not provide a specific diagnosis. In November 2016, the Veteran's primary care physician, E.F., M.D., who is Board certified in internal medicine, completed a narrative on behalf of the Veteran. The physician stated that clinical visits, x-rays, and CT scans along with the patient's on-going symptoms supported a diagnosis of pulmonary melioidosis. The physician stated that, after reviewing the Veteran's medical records, that it is very likely that the Veteran suffers from pulmonary melioidosis due to exposure during his tour of service in Northeast Thailand. The physician stated that the Veteran's medical history did not demonstrate other risk factors for this condition and noted that information provided by the Center for Disease Control indicated that melioidosis is predominantly a disease of tropical climates with the greatest numbers of melioidosis cases reported in Thailand, Malaysia, Singapore, and Northern Australia. After review of the evidence of record, and resolving reasonable doubt in the Veteran's favor, the Board finds that service connection is warranted for pulmonary melioidosis. The Board finds that the medical evidence of record provides a current diagnosis of pulmonary melioidosis that has been determined to be at least as likely as not due to an incident of his period of active service. The Board finds probative the November 2016 diagnosis and medical opinion provided by E.F., M.D. The physician noted the Veteran's reported symptoms and diagnostic testing, including the 2016 CT that reported findings of nodular infiltrates within the left lung of likely infectious in etiology, supported a diagnosis of pulmonary melioidosis. The examiner also noted that the Veteran's medical history and information regarding pulmonary melioidosis supported an opinion that the Veteran likely suffers from pulmonary melioidosis due to exposure during his tour of service in Northeast Thailand. There is no evidence that the 2017 private physician was not competent or credible, and as the opinion was based on accurate facts and review of the Veteran's history, the Board finds this opinion is entitled to significant probative weight as to the etiology of the Veteran's disability. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board notes that there is no contrary medical opinion of record. While the 2016 VA physician does not provide a diagnosis of pulmonary melioidosis, the examiner did not rule out such a diagnosis. Further, the VA physician noted the Veteran's history of fevers and a skin rash over the back without contact with sick people at home and without evidence of signs of spread of the disease to others. Additionally, CT imaging conducted in 2016 supports a pulmonary diagnosis likely infectious in etiology. The Veteran's STRs also demonstrate complaints of cold-like" symptoms during his service in Thailand and subsequent complaints of a sharp pleuritic type pain of the left anterior chest a year later. Therefore, the Board finds that the evidence of record supports a nexus between a current diagnosis of pulmonary melioidosis and a nexus to an event or disease incurred during the Veteran's active service in Thailand. Accordingly, the Board finds that service connection for pulmonary melioidosis is warranted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.M. Johnson, 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.