Citation Nr: 21074690 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 18-28 320 DATE: December 16, 2021 ORDER Service connection for an abdominal aortic aneurysm is granted. FINDING OF FACT The Veteran's aneurysm is causally related to his active service, including various chemical exposures. CONCLUSION OF LAW The criteria for service connection for an abdominal aortic aneurysm have been met. 38 U.S.C. §§ 1110, 1131, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from July 1975 to January 1979, including foreign service in Saudi Arabia and with additional National Guard and reserve service. He testified during a July 2021 virtual hearing. A transcript of this proceeding has been associated with the record. The Veteran has also perfected multiple service connection appeals under the modernized review system, known by the Board as the AMA. As these matters are governed by separate and distinct procedural laws and regulations, they must be addressed in a separate Board decision. 38 C.F.R. §§ 19.2, 20.202. Service Connection The Veteran is currently pursuing service connection for an aneurysm. He has offered multiple theories of entitlement during the period on appeal. In the interest of brevity, this decision will focus solely on those contentions which are relevant to the grant contained herein. Thus, service connection may be granted directly as a result of disease or injury incurred in service based on nexus using a three-element test: (1) The existence of a current 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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). As to the first element, the evidence clearly establishes the existence of a current disability in this case. Notably, the Veteran was diagnosed with an abdominal aortic aneurysm (AAA) during March 2016 VA examination. VA treatment records show a similar diagnosis in February 2017, as further documented in a July 2021 private treatment letter and concurrent treatment records. Accordingly, the first element of direct service connection is met. As to the second element, the Veteran has attributed his disability to a number of purported in-service exposures, including (but not limited to) environmental hazards while stationed in Saudi Arabia and various jet fuel/chemical exposures spanning the entirety of his service. See, e.g., July 2021 hearing transcript; Layno v. Brown, 6 Vet. App. 465, 469 (1994); Miller v. Wilkie, 32 Vet. App. 249 (2020). These exposures were conceded by VA in a September 2020 rating decision (awarding service connection for related basal cell carcinoma), and the Board finds no good cause to disturb VA's findings in this respect. Rather, the reported jet fuel exposure is consistent with the Veteran's military occupational specialty (MOS) as a tactical aircraft maintenance specialist. See DD Form 214. The claims file also contains extensive documentation as to the various contaminants present at Eielson Air Force Base (AFB), where the Veteran was known to be stationed, though the exact duty dates of such are unknown. Accordingly, the second element of direct service connection is met. As to the third and final element, the claims file contains a July 2021 letter from a private provider who reviewed the Veteran's service and subsequent treatment records. The examiner noted that the Veteran was not provided with appropriate protective gear in the performance of his in-service duties, such that he was "exposed to multiple chemicals primarily through inhalation, but also through dermal and ingest[ed] exposure." The Veteran was additionally exposed to water contamination during service. Post-separation, the Veteran did not smoke or show any risk factors or family history which would place him at an increased risk for developing an AAA. Rather, due to the lack of respiratory protection during the performance of his service duties, it was more likely than not that the Veteran was exposed to particulate matter which increased his risk for cardiovascular disease. Accordingly, it was more likely than not that the "heavy chemical and metal exposures suffered during the [V]eteran's military service" contributed to the development of his AAA. This opinion is probative evidence in support of the appeal. Importantly, the examiner offered a definitive opinion supported by a detailed rationale which included assessment of the Veteran's military and medical histories, to include the various in-service exposures. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that the probative value of a medical opinion comes from the "factually accurate, fully articulated, sound reasoning for the conclusion"). There is no indication that the examiner was not fully aware of the Veteran's past medical history or misstated any relevant fact in providing the above opinion. Instead, he possesses the requisite expertise to render a medical opinion regarding the etiology of the Veteran's AAA and had sufficient facts and data on which to base his conclusions. In this respect, the Board acknowledges that the examiner opined only that the Veteran's known exposures "contributed" to the development of his AAA, rather than identifying a direct nexus thereto. The Board does not find that this language undermines the overall probative value of the opinion, which clearly speaks to a causal relationship between the Veteran's disability and service. Moreover, there are no opinions of record which contradict the examiner's findings. Instead, the claims file also contains a letter received in December 2015 which indicates that the "combination of medications administered and several industrial carcinogenic chemicals that [the Veteran] was exposed to while in the military, has caused permanent and irreversible damage to his heart." Notably, the Veteran also possesses the medical training and expertise to offer a competent opinion in this matter, given his history as a licensed nurse for nearly three decades. See July 2021 hearing transcript. [CONTINUED ON NEXT PAGE] Accordingly, a nexus is found between the Veteran's current AAA and his military service. The preponderance of the evidence is for the claim, the benefit-of-the-doubt rule is applicable, and the appeal is hereby granted. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Kovarovic, 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.