Citation Nr: 21072605 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 16-28 774 DATE: December 3, 2021 ORDER Entitlement to service connection for dementia is denied. REMANDED Entitlement to service connection for a respiratory disorder is remanded. FINDING OF FACT The preponderance of the evidence is against finding that dementia began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for dementia are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United State Navy June 1956 to June 1960and in the United States Coast Guard from August 1960 to November 1967 including foreign and/or sea service. He died in January 2018. The Appellant is his surviving spouse. This case has been before the Board multiple times, most recently July 2021when it was remanded for additional development. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900. 38 U.S.C. § 7107 (a)(2). 1. Entitlement to service connection for dementia The appellant seeks service connection for the Veteran's dementia. She contends that the Veteran's dementia was related to exposure to methyl ethyl ketone and/or asbestos during active service. 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). 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 an in-service injury, event, or disease. Service personnel records show the Veteran worked as an engineering officer in the unit boiler. Likely exposure to asbestos and methyl ethyl toxins is conceded. Service treatment records are silent for complaints, diagnosis, or treatment of a cognitive or dementia disorder. Clinical findings at discharge showed normal psychiatric findings. Private clinic notes show the Veteran received treatment for Alzheimer's. Treatment notes showed the Veteran had moderate to severe dementia, and was unable to give any history whatsoever. A May 2017 buddy statement from the Veteran's neighbor indicated that she had been neighbors for 10 years. She reported that approximately two years after they met, the Veteran began to get more confused and agitated. She reported that as time went on, she saw more deterioration with memory, confusion, and agitation. A VA examiner reviewed the record in October 2020. The examiner opined the Veteran's dementia was less likely related to active service. However, the examiner's rationale address only the clinical findings related to the claim for a respiratory condition. A VA examiner reviewed the record in May 2021. The examiner opined the Veteran's demential was less likely related to service. The examiner noted that a thorough review of the record showed the Veteran was diagnosed with Alzheimer's disease in 2006, and had to be moved to a nursing home in July 2015. The examiner explained that the most common risk factor for Alzheimer's is aging, and there is evidence that many cases, although not all, have a genetic component. With respect to exposure to methyl ethyl ketone exposure, the literature did not support a nexus with dementia in general or with Alzheimer's disease in particular. The examiner concluded that the probability that exposure to environmental toxins contributed to dementia is far less than the 50 percent probability required. The Board concludes that, while the Veteran had a current diagnosis of dementia, and evidence shows that in-service environmental exposures, including asbestos and methyl ethyl ketone, occurred, the preponderance of the evidence weighs against finding that the Veteran's diagnosis of dementia began during service or is otherwise related to an in-service injury, event, or disease. The May 2021 VA examiner opined that the Veteran's dementia is not at least as likely as not related to an in-service injury, event, or disease, including asbestos or toxin exposure. The examiner explained that the medical literature did not support a nexus with dementia in general or with Alzheimer's disease in particular. The examiner also noted that age and, in some cases genetics, appears to play a role in the development of Alzheimer's disease. The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The appellant believes the Veteran's dementia was related to an in-service injury, event, or disease. The appellant in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the appellant in this case because the record does not show that she has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the May 2021 VA opinion. In sum, the preponderance of the competent evidence does not establish a causal nexus between the Veteran's dementia disability and service. The Board considered the doctrine of reasonable doubt, however, as the preponderance of the competent and probative evidence is against the claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection for dementia is not warranted. REASONS FOR REMAND 1. Entitlement to service connection for a respiratory disorder is remanded. The Board remanded the claim for a respiratory disorder in July 2021. The Board requested, in part, an addendum opinion on whether it is at least as likely as not any diagnosed lung disorder is related to exposure to asbestos or chemical agents. In September 2021, a VA examiner reviewed the claims file and offered an addendum opinion. The examiner indicated that the medical records did not contain documentation of a chronic lung disorder during or after military service, and therefore concluded the Veteran's diagnosed asthma and pneumonia were less likely related to service. However, the examiner did not clearly address exposures to methyl ethyl ketone or asbestos. Therefore, this opinion is inadequate, and the appeal must be returned. Stegall v. West, 11 Vet. App. 268, 271 (1998); Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's respiratory disorder is at least as likely as not related to asbestos exposure or chemical agents such methyl ethyl ketone during active service. The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why this is so. J. NICHOLS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Lauritzen, 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.