Citation Nr: 21068433 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 19-11 326 DATE: November 10, 2021 ORDER Entitlement to service connection for chronic bronchitis is granted. Entitlement to service connection for reactive arthritis is denied. FINDINGS OF FACT 1. Resolving all reasonable doubt in the Veteran's favor, the Veteran's chronic bronchitis is related to service. 2. The preponderance of the evidence is against finding that the Veteran's reactive arthritis was incurred in or caused by service, including his exposure to herbicide agents. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for chronic bronchitis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for entitlement to service connection for reactive arthritis have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1963 to August 1971. This matter comes before the Board of Veterans' Appeals (Board) from an April 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The case was last before the Board in November 2020, and has returned to the Board for further appellate review. This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.902(c). Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Generally, to prove service connection there must be: (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, 1166-67 (Fed. Cir. 2004). Service connection may also be established for a disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. Allen v. Brown, 7 Vet. App. 439 (1995). The RO conceded that the Veteran was exposed to Agent Orange. For veterans exposed to certain herbicide agents during the Vietnam era, certain diseases, 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). VA has determined that there is no positive association between exposure to herbicide agents and any other condition for which it has not specifically been determined that a presumption of service connection is warranted. As bronchitis and reactive arthritis are not listed among the diseases enumerated under 38 C.F.R. §§ 3.309(e), the herbicide agents' presumptive provision of 38 C.F.R. § 3.307 do not apply as to that disability. Nevertheless, the United States Court of Appeals for the Federal Circuit has determined that a claimant who suffers from a disability that is not listed among those for which presumptive service is afforded based on exposure to herbicide agents is not precluded from establishing service connection for such disability as due to herbicide agent exposure with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). 1. Entitlement to service connection for chronic bronchitis The Veteran seeks service connection for chronic bronchitis, which he contends is related to service, to include exposure to herbicide agents, dust, jet fuel, and other airborne contaminates while serving in Thailand. Alternatively, the Veteran asserts that his chronic bronchitis was caused by his service-connected asthma. The Veteran underwent a VA examination in June 2021, at which time the examiner found that the Veteran had a diagnosis of chronic bronchitis. The examiner explained that chronic obstructive pulmonary disease (COPD) is a term that includes chronic bronchitis; therefore, they are considered equivalent. The Board further notes that in July 2020, a VA examiner opined that the Veteran's COPD is at least as likely as not proximately due to or the result of his service-connected asthma. The Veteran is already service connected for COPD. As the June 2021 VA examiner found that the Veteran's chronic bronchitis is part of his COPD diagnosis, service connection for chronic bronchitis is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for reactive arthritis The Veteran seeks service connection for reactive arthritis. The Veteran asserts that his reactive arthritis was caused by exposure to herbicide agents, and that his in-service complaints of diarrhea, cramping, dysuria, and/or numbness in the great toe were manifestations of undiagnosed reactive arthritis. As an initial matter, VA treatment records reveal the Veteran has a current diagnosis of reactive arthritis. Accordingly, the first element of service connection, a current disability, is met. Thus, the remaining question becomes whether such condition is related to service. Service treatment records reveal that the Veteran complained of diarrhea and nausea in October 1968. In February and March 1969, the Veteran sought treatment for dysuria, and a February 1970 service treatment record notes the Veteran complained of diarrhea. Thereafter, despite seeking treatment for various other conditions, including acute viral syndrome in September 1969 and numbness of the right great toe in October 1969, subsequent service treatment records show no relevant complaints and service treatment records reveal no diagnosis of reactive arthritis. Moreover, the Veteran denied neuritis; digestion, stomach, liver, or intestinal problems; arthritis or rheumatism; bone, joint, or other deformity; lameness; painful shoulder or elbow; trick or locked knee; and frequent or painful urination in his July 1971 separation report of medical history. In July 2020, a VA examiner indicated that the Veteran's reported episodes of diarrhea and urethritis during service were more than one year prior to discharge and that his reactive arthritis was diagnosed several years after service. The examiner explained that reactive arthritis occurs at a minimum of several days and a maximum of several weeks after the antecedent infection. The examiner further explained that the Veteran did not report any of the possible symptoms and was never found to have the very specific organisms that have been identified as causing the underlying infection which results in reactive arthritis. As such, the examiner opined that the Veteran's reactive arthritis was less likely than not incurred in or caused by service. The Veteran underwent a VA examination in June 2021. The examiner opined that the Veteran's reactive arthritis is less likely than not related to service, including his in-service exposure to herbicide agents. Citing medical literature, the examiner explained that reactive arthritis is triggered by an infection in another part of the body; however, herbicide exposure is not a typical risk factor for reactive arthritis. The examiner further opined that the numbness the Veteran experienced in his great toe during service was less likely than not represented the in-service onset of reactive arthritis. The examiner explained that symptoms of reactive arthritis include eye inflammation, urinary problems, inflammation of soft tissue, swollen toes or fingers, skin problems, and low back pain; however, numbness and peripheral neuropathy are not part of the symptomology of reactive arthritis. There is no medical opinion of record linking his current reactive arthritis disability with service. To the extent the Veteran believes that his reactive arthritis is related to service, as a lay person, he has not shown that he has specialized training sufficient to render such an opinion. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this regard, the diagnosis and etiology of reactive arthritis are matters not capable of lay observation and require medical expertise to determine. Thus, the opinion of the Veteran regarding the onset and etiology of his reactive arthritis is not competent medical evidence. In sum, the Board concludes that the most probative evidence of record is against the claim, and service connection is denied. In reaching the above conclusion, the Board has considered the applicability of the benefit of the doubt doctrine. As the preponderance of the evidence is against the claim, the doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Lance, 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.