Citation Nr: 21066913 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 17-14 018A DATE: November 2, 2021 ORDER Entitlement to service connection for a respiratory disability, claimed as chronic obstructive pulmonary disorder (COPD), is denied. Entitlement to service connection for a medically unexplained chronic multi-symptom illness of unknown etiology with fatigue, throat irritation, and chest pain is granted. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that a respiratory disability began during active service or is otherwise related to any event, injury, or disease in service. 2. The Veteran has a medically unexplained chronic multi-symptom illness of unknown etiology with fatigue, throat irritation, and chest pain. CONCLUSION OF LAW 1. The criteria for service connection for a respiratory disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a medically unexplained chronic multi-symptom illness of unknown etiology with fatigue, throat irritation, and chest pain are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 2003 to May 2004. These matters are before the Board of Veterans' Appeals (Board) on appeal from a September 2018 and October 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Veteran testified before the undersigned Veterans Law Judge. A copy of the hearing transcript is of the record. Entitlement to service connection for a respiratory disability, claimed as COPD Entitlement to service connection for a medically unexplained chronic multi-symptom illness of unknown etiology with fatigue, throat irritation, and chest pain The Veteran asserts that he is entitled to service connection for respiratory disabilities because they are the result of active service. More specifically, the Veteran asserts that he served in an area in Iraq that was used to process chemicals. The Veteran stated that the area was cloudy with dust and that he has experienced a chronic cough, shortness of breath, and restricted breathing since that time. Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. To establish service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be established for a disability that is proximately due to, or aggravated by, a service-connected disability. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to service, or any injury, event, or disease during service. The Board concludes that, while the Veteran was diagnosed with a respiratory disability during the pendency of this appeal, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to any injury, event, or disease in service At a September 2005 VA examination, the Veteran reported that respiratory symptoms began while in service. The Veteran stated that he used to smoke, but that he quit in 1987. He stated that while in Iraq he served in a building that had nuclear, biological, and chemical materials without a gas mask. The examiner opined that the Veteran had mild obstructive lung disease as a result of past smoking history, and calcified granuloma of right mid lung that was asymptomatic. The examiner stated that there was no specific evidence to relate the obstructive lung disease to any chemicals that the Veteran may have been exposed to in Iraq without resorting to speculation." In a September 2018 VA examination, the Veteran reported shortness of breath. The examiner noted a diagnosis of shortness of breath on examination. The examiner opined that the Veteran's shortness of breath was a mild obstructive disease due to past smoking. The examiner further noted that it was a diagnosable, but medically unexplained chronic multi-symptom illness of unknown etiology. The examiner opined that it was less likely than not that the Veteran's medical problems are related to a specific environmental exposure event experienced by the Veteran during service in Southwest Asia. The examiner noted that a pulmonary function test showed mild obstruction and mild obstructive disease, which the examiner opined was due to past smoking." A June 2019 Gulf War examination found chronic disability patterns that were diagnosable, but also had medically unexplained chronic multi-symptom illness of unknown etiology with fatigue, throat irritation symptoms, chest pain, and shortness of breath, without diagnostic findings to warrant a clear etiology. At an August 2019 hearing before the Board, the Veteran testified about experiencing shortness of breath and a cough since exposure to dust storms, burning feces, and jet fuel in service without a mask. The Veteran also testified that he had stopped smoking for about 14 years by the time he was 40 years old. The service medical records do not indicate any respiratory disability at entrance to service. In May 2021, the claim was remanded to obtain an opinion on whether the disability pre-existed service or was aggravated by service due to an examiner relying on the pre-existing smoking as the cause of the claimed disability. In a July 2021 VA examination, the examiner noted that while there was a 2004 diagnosis of COPD, there was no diagnosis on examination of COPD or any other respiratory disability. The examiner opined that the claimed disability did not pre-exist service, was not aggravated by service, and was not caused by the alleged in-service exposures. The examiner noted that the Veteran claimed the condition began while in service due to serving in a building that had nuclear, biological, and chemical materials without a gas mask. In support of that the examiner noted that the claimed respiratory condition was not noted on enlistment and was not present on examination to indicate aggravation. The Veteran has already established service connection for sinusitis. The evidence shows that the Veteran has been diagnosed with an obstructive lung disability as the result of smoking. Therefore, the Board finds that the respiratory disability is shown to be the result of a known medical causation. The Veteran's reported shortness of breath is shown to be due to the diagnosed respiratory disability. That disability is not shown to be due to or the result of service, or any incident in service. While the Veteran believes his respiratory disability is related to exposures to chemicals, dust, and smoke while in service, the Board finds that the preponderance of the evidence weighs against finding that the claimed disability began in or is related to active service or any event, injury, or disease during service. However, the June 2019 Gulf War examination found that the Veteran had a medically unexplained chronic multi-symptom illness of unknown etiology with fatigue, throat irritation symptoms, chest pain, and shortness of breath, without diagnostic findings to warrant a clear etiology. While the shortness of breath has been attributed to a known medical causation, the fatigue, throat irritation, and chest pain have not been attributed to a known medical causation. Therefore, the Board finds that service connection is warranted for a medically unexplained chronic multi-symptom illness of unknown etiology with fatigue, throat irritation, and chest pain. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Cross, 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.