Citation Nr: 21070601 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 17-65 377 DATE: November 24, 2021 ORDER Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is denied. Entitlement to service connection for coronary artery disease (CAD) is denied. FINDINGS OF FACT 1. The Veteran's COPD did not manifest during service and is not otherwise etiologically related to service. 2. The Veteran's CAD did not manifest during service and is not otherwise etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for COPD have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for coronary artery disease as secondary to hypertension have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Army, on active duty from January 1965 to October 1966. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board in May 2019, when it remanded them for VA examinations. The claims returned to the Board in March 2021, when it remanded the claims for new VA examinations consistent with its Remand directives. The Board is now satisfied there was substantial compliance with this Remand. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Specifically, new VA opinions were obtained, which the Board finds adequate for adjudication purposes. Accordingly, the Board finds that the Remand directives were substantially complied with and, thus, there is no Stegall violation in this case. Service Connection Generally, to establish service connection for a present disability, "the veteran must show (1) the existence of a present disability; (2) 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, 1166-67 (Fed. Cir. 2004). In addition to the regulations cited above, service connection is warranted for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury. 38 C.F.R. § 3.310. Any additional impairment of earning capacity resulting from an already service-connected condition, regardless of whether or not the additional impairment is itself a separate disease or injury caused by the service-connected condition, should also be compensated. Allen v. Brown, 7 Vet. App. 439 (1995). 1. Entitlement to service connection for COPD 2. Entitlement to service connection for CAD The Veteran asserts that he developed COPD and CAD due to his military service. Specifically, that his work as a repairman while stationed at Fort Greely, Alaska, exposed him to refrigeration systems which contained asbestos, chemicals, and other contaminants. As the Veteran's theory of service connection is the same for both conditions, the Board will address them together below. In this case, the Board finds that service connection is not warranted for the Veteran's COPD and CAD. As an initial matter, the Board concedes the Veteran has current diagnoses for COPD and CAD, as found during his December 2019 VA examinations. Thus, entitlement to service connection for these two disabilities turns on whether the disabilities were noted in and since service, and/or whether a causal relationship or nexus exists between the Veteran's COPD and CAD, and his active service. First, the Veteran's service treatment records and periodic examinations do not mention COPD or CAD symptoms while in-service. This includes his August 1966 separation examination report and his report of medical history. The first noted indicated of COPD is an August 2012 medical record, and the first record of heart related symptoms is open heart surgery in 1994. With respect to both disabilities, indications were not noted for many years after the Veteran separated from service. Therefore, there is no clinical evidence of continuous symptoms since service. Indeed, it does not appear that the Veteran has asserted that continuous symptoms have existed since service. Next, the competent medical evidence does not indicate a nexus, or a relationship, between the Veteran's current diagnoses and his active service. Specifically, the Veteran underwent a VA examination in December 2019 to determine the etiology of the claimed disabilities. While the Board found this examination, and the associated July 2020 addendum opinion, to be inadequate, they nevertheless contain some probative evidence. In particular, the examiner noted the Veteran's history of smoking cigarettes every day for the past 45 years, and how both disabilities are likely the result of his smoking. Next, the Veteran underwent a VA examination in June 2021, and was subsequently provided an August 2021 addendum opinion, in which the examiner concluded that his COPD and CAD were not related to service. Specifically, the examiner noted his minimal exposure to refrigerator systems and their associated chemicals, his statements, as well as the submitted medical journal article which suggests prolonged exposure to refrigeration chemicals has been documented to cause irregular heart rhythms. However, the examiner opined against service connection for both disabilities. In support, they wrote that no symptoms of either COPD or CAD were reported during service. Further, the examiner highlighted that his exposure to the claimed chemicals was "minimal" as opposed to "prolonged", which is the level used in the medical article. Finally, the examiner wrote that there is not objective medical evidence or literature which would support a finding of minimal chemical exposure to the Veteran's COPD and CAD, and thus, it is less likely than not that these disabilities are related to service. In arriving at this conclusion, the Board acknowledges the Veteran's statements relating his current disorders to active service. The Federal Circuit has held that "[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (quoting Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this case, however, the Veteran is not competent to testify regarding the etiology of diseases such as COPD and CAD. See Jandreau, 492 F.3d 1372 at 1377, n.4. Because such disorders are not diagnosed by unique and readily identifiable features, they do not have a simple identification that a layperson is competent to make. The Veteran is not competent to identify a nexus between his service and his current disorders. While the Board does not dispute the credibility of the Veteran's lay statements in describing his symptoms, the weight of the medical evidence is against a finding that they are etiologically related to his active service. Therefore, any Veteran's lay statements regarding the cause of his current disorders are found to lack competency. In support of his claim, the Veteran submitted a medical journal article that suggests prolonged exposure to refrigerator chemicals and/or contaminants has been documented to cause respiratory disease and irregular heart rhythms. Such an article is probative and does support the Veteran's appeal. However, the Board finds this article focused on prolonged exposure, which is still general in nature, is outweighed by the opinions provided by the VA examiner. Specifically, unlike this article, the VA examiners were able to interview the Veteran, and make specific conclusions based on the Veteran's specific history. Moreover, the Veteran's exposure to such chemicals and/or contaminants is noted to be minimal, as opposed to prolonged. Therefore, greater weight must be placed on the VA examiners' opinions. While the article referenced by the Veteran is certainly evidence in his favor, the Board finds the VA opinions to be more thorough and convincing in their supporting logic. In sum, the most probative evidence of record shows no link between the Veteran's COPD and CAD to any event, injury, or disease incurred that is in service or related to service. Based on the evidence of record, the Veteran's claim must be denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. McDonald