Citation Nr: A21018669 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 211013-191233 DATE: November 23, 2021 ORDER Service connection for idiopathic pulmonary fibrosis is granted. FINDING OF FACT There is at least a balance of evidence on whether the Veteran's idiopathic pulmonary fibrosis had its onset in service. CONCLUSION OF LAW The criteria for entitlement to service connection for idiopathic pulmonary fibrosis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Navy as a civilian, but with the Naval Investigative Service and is considered to have had active service from March 1969 to March 1972. This included duty in Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2021 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In the September 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. The Board cannot consider any evidence received after the August 2021 rating decision. Evidence was added to the claims file during a period of time when new evidence was not allowed. The Veteran submitted a medical opinion, three prior Board decisions, and a statement following the August 2021 rating decision. The Board has considered the Veteran's September 2021 statement, to the extent that it contained argument. However, the Board may not consider the prior Board decisions submitted after the August 2021 rating decision or the September 2021 medical opinion. Favorable findings identified by the RO in the August 2021 rating decision include that the Veteran has been diagnosed with idiopathic pulmonary fibrosis, that he has sufficient service to meet the minimum requirements for presumptive service connection, and that herbicide agent exposure due to the Veteran's service in Vietnam is conceded. As a preliminary matter, the Board notes that the Veteran does not have service treatment records. While VA has conducted searches, no records have been found, and the Veteran has explained that given the nature of his affiliation with the Navy, treatment records were not maintained. The Veteran contends that his idiopathic pulmonary fibrosis developed due to herbicide agent exposure during his service in Vietnam. Service connection may be granted 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. The three-element test for 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, 1166-67 (Fed. Cir. 2004). In addition, those Veterans exposed to an herbicide agent shall be service connected for the diseases listed at 38 U.S.C. § 1116(a)(2); and 38 C.F.R. § 3.309(e). Exposure to an herbicide agent is presumed for a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, absent affirmative evidence to the contrary. 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6)(iii). The Board concludes that while idiopathic pulmonary fibrosis is not a disease for which service connection may be presumed due to herbicide agent exposure, in this case there is at least balance of evidence on the question whether this Veteran's disability was incurred in service. The Veteran was diagnosed to have idiopathic pulmonary fibrosis in 2011. The Veteran's treating internal medicine practitioner provided an opinion regarding the cause of the Veteran's pulmonary disability in a December 2019 letter. In that letter he acknowledged the precise factors that initiate the histopathologic processes observed in the claimed disability were unknown, however, he considered it was likely the Veteran's herbicide agent exposure started the inflammatory process, and then subsequent fibrotic disease process. Therefore, he found the Veteran's agent orange exposure is more likely than not to have contributed to the Veteran's development of idiopathic pulmonary fibrosis. One of the Veteran's treating physician for his lung transplantation opined in a January 2020 letter that the precise factors that result in the fibrotic process seen in idiopathic pulmonary fibrosis were unknown, but that risk factors included cigarette smoking, viral infection, environmental pollutants, chronic aspiration, genetic predisposition, and drugs. The physician noted that the Veteran has no medical condition that would explain his interstitial pneumonia pattern and that the Veteran did not have a history of taking medications that were known offenders. The physician stated that he did not find a robust literature supporting a causal relationship between herbicide agent and idiopathic pulmonary fibrosis, but that he could not exclude the possibility there was a possible relationship. The Veteran was afforded a VA examination in August 2021. The examiner noted that the Veteran was diagnosed with idiopathic pulmonary fibrosis in 2011, and that he had a lung transplant in 2016. The examiner did not provide an opinion as to service connection. (Continued on the next page) Although not definitive, the medical opinions addressing whether the Veteran's herbicide agent exposure contributed to the development of his pulmonary fibrosis are sufficient to conclude with the resolution of reasonable doubt in the Veteran's favor, that service connection is warranted. While his disability is not among those presumed as due to herbicide agent exposure, that does not preclude an award of benefits where evidence in a particular case supports direct service connection. Here, that evidence has been presented where the Veteran's treating physician found it likely the Veteran's herbicide agent exposure initiated the disease process. This conclusion that has not been directly contradicted by any other medical source. In these circumstances the Board finds the evidence to be at least in equipoise on whether the Veteran's idiopathic pulmonary fibrosis was incurred in service. Accordingly service connection for idiopathic pulmonary fibrosis is granted. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Geer, 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.