Citation Nr: 21073645 Decision Date: 12/09/21 Archive Date: 12/09/21 DOCKET NO. 14-12 436 DATE: December 9, 2021 ORDER Entitlement to service connection for a pulmonary condition, to include asthma, emphysema, and chronic obstructive pulmonary disorder (COPD), as secondary to service-connected acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depressive disorder with psychotic features is denied. FINDING OF FACT A pulmonary condition, to include asthma, emphysema, and COPD, was not caused or aggravated by the Veteran's service-connected acquired psychiatric disorder. CONCLUSION OF LAW Entitlement to service connection for a pulmonary condition, to include asthma, emphysema, and COPD, as secondary to service-connected acquired psychiatric disorder have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1951 to July 1956. The Veteran was awarded the Purple Heart and Combat Infantryman Badge. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded the case in September 2017, January 2020, December 2020, and August 2021 for further development and it now returns to the Board for appellate review. 1. Entitlement to service connection for a pulmonary condition, to include asthma, emphysema, and COPD, as secondary to service-connected acquired psychiatric disorder. At the outset, the Board notes that the Veteran does not assert that his pulmonary condition began in or is related to his active-duty service. Nor does the probative evidence of record show such. Rather, the Veteran contends that his currently diagnosed pulmonary condition, to include asthma, emphysema, and COPD, is secondary to his service-connected acquired psychiatric disorder. In this regard, service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310 (b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). As an initial matter, as stated in the August 2021 Board appeal, VA medical opinions have been issued in October 2010, March 2018, and March 2020; however, each have been considered inadequate. In a February 2021 addendum opinion, the VA examiner opined that the Veteran's asthma was not caused or aggravated his service-connected psychiatric disorder. As rationale, the examiner explained that PTSD, depressive disorders with psychotic features, panic attacks, and asthma are disease entities with different pathophysiological processes, which are not etiologically related; thus, there are no aggravation effects. The examiner further explained that it was known that exacerbations might present autonomic symptoms which were not related to the pathophysiology of the asthma condition and did not aggravate his asthma. The examiner also stated that, based on a review of the Veteran's medical records, his asthma was stable, and his last pulmonary function tests revealed an increase in the post-bronchodilator FEV1, which was consistent with improvement of obstructive lung disease. Therefore, the examiner concluded that a review of the available medical records and medical literature did not support an etiologic or aggravating relation between the Veteran's PTSD and depressive disorders with psychotic features, and his asthma. However, in August 2021, the Board remanded the case in order to address the Veteran's COPD. In this regard, the Veteran was afforded a VA examination in October 2021. At such time, the examiner diagnosed the Veteran with asthma, COPD, and emphysema, and noted the Veteran's reports of fatigue and shortness of breath upon ambulating short distances. The examiner further noted that there was no objective evidence of an increase in medications for the Veteran's asthma, COPD, emphysema. The examiner concluded that it was less likely than not that the Veteran's asthma, emphysema, and COPD was caused or aggravated by his service connected acquired psychiatric disorders. As rationale, the examiner explained that asthma, COPD, emphysema, and PTSD and acquired psychiatric disorders are diseases with different pathophysiological processes that are unrelated to each other. Moreover, the examiner stated that there was no clinical and objective evidence to support that the Veteran had an exacerbation of asthma, COPD, and emphysema while he had a psychiatric exacerbation/attack. The Board accords great probative weight to the February 2021 and October 2021 examiners' opinions as it considered all of the pertinent evidence of record, to include the statements of the Veteran, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion...must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Importantly, there are no medical opinions of record to the contrary. The Board also acknowledges the Veteran's statements that pulmonary condition, to include asthma, emphysema, and COPD, is secondary to his service-connected acquired psychiatric disorder. However, the Board finds that the question regarding the potential relationship between the Veteran's current disorder and any instance of his service to be complex in nature. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). In this regard, while the Veteran is competent to describe his current symptomatology, the Board accords his statements regarding the causation of his disorder little probative value as he is not competent to opine on such a complex medical question. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. Brown, 7 Vet. App. 134, 137 (1994). In the instant case, the question of causation of his current disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. Therefore, as the Veteran does not have the appropriate medical training and expertise to offer an opinion as to the etiology of his current disorder, the lay assertions in this regard have no probative value. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a pulmonary condition, to include asthma, emphysema, and COPD, is secondary to his service-connected acquired psychiatric disorder. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Brennae L. Brooks, 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.