Citation Nr: 21075282 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 13-19 690 DATE: December 20, 2021 ORDER Entitlement to service connection for chronic obstructive pulmonary disease (COPD), to include as secondary to service-connected hypertensive heart disease with chronic angina and hypertension is denied. REMANDED Entitlement to service connection for diabetes mellitus, type II, to include as secondary to service-connected hypertensive heart disease with chronic angina and hypertension, or secondary to exposure to contaminated water at Camp Lejeune is remanded. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's COPD is etiologically related to service or secondary to service-connected hypertensive heart disease with chronic angina and hypertension, CONCLUSION OF LAW The criteria for service connection for COPD are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1973 to September 1977. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2010 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded the case in January 2018 and March 2021 for further development. The requested development as to the claim adjudicated below has been completed to the extent possible, and no further action is necessary to comply with the Board's remand directives. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for COPD, to include as secondary to service-connected hypertensive heart disease with chronic angina and hypertension is denied. The Veteran is seeking to establish service connection for COPD. He contends his COPD is secondary to his service-connected hypertensive heart disease with chronic angina and hypertension. A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. § 1110. Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an 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, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 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 U.S.C. § 1131; 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). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra. 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). Turning to the evidence of record, service treatment records are silent for treatment for, complaints of, or diagnoses of COPD. The Veteran's August 1977 Report of Medical Examination upon his separation from service clinically evaluated his lungs and chest as normal. The Veteran was afforded a VA examination for COPD in November 2009. The Veteran expressed his belief that his COPD was caused by his hypertension. Following examination and review of the record, the VA examiner opined that the Veteran's condition was less likely than not caused by or occurred secondary to his service-connected hypertensive heart condition or hypertension, as hypertensive heart disease and hypertension were not known cause or risk factors for COPD. The Board notes that the Veteran was afforded another VA examination for his COPD in November 2019; however, in March 2021, the Board found the VA examination and opinion to be inadequate for adjudication purposes. Pursuant to the Board's March 2021 remand, the Veteran was afforded a VA examination for his COPD in October 2021. The Veteran reported a history of chronic cough and diagnosis of COPD in 2009. He noted he had never smoked and was not currently taking medication for his COPD. Following examination and review of the record, the VA examiner opined that the Veteran's COPD was less likely than not incurred in or caused by service. The examiner noted that the Veteran's discharge examination conducted in August 1977 reflected a normal lung and chest exam and he did not have any signs or symptoms of COPD. The examiner also noted that risk factors for COPD included smoking, exposure to air pollution, secondhand smoke, working with chemicals, dust, and fumes, a genetic condition called Alpha-1 deficiency, and a history or childhood respiratory infection. Therefore, the examiner opined that the Veteran's COPD was less likely than not caused or aggravated by his service-connected hypertensive heart disease with chronic angina and hypertension. The Board finds the VA medical opinions of record to be of great probative weight as the opinions were based on a review of the Veteran's claims file and examination. Further, there is no contrary medical opinion of record. The Board acknowledges that the Veteran believes his COPD is related to his service-connected hypertensive heart disease with chronic angina and hypertension. However, while lay persons are competent to provide opinions on some medical issues, the specific issue in this case, a relationship between COPD and hypertensive heart disease with chronic angina and hypertension, is outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). As such, the Board finds that the Veteran's lay statements are less probative than the November 2009 and October 2021 VA medical opinions, as the VA medical opinions were provided by medical professionals and are more detailed and reasoned, thus warranting greater probative value. For these reasons, the weight of the evidence does not support a finding that the Veteran's COPD is etiologically related to service or to the Veteran's service-connected hypertensive heart disease with chronic angina and hypertension. As a result, service connection for COPD is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, as the preponderance of the evidence is against the claim, the doctrine is not applicable. 38 U.S.C. § 5107(b). REASONS FOR REMAND 1. Entitlement to service connection for diabetes mellitus, type II, to include as secondary to service-connected hypertensive heart disease with chronic angina and hypertension, or secondary to exposure to contaminated water at Camp Lejeune is remanded. The Veteran is seeking to establish service connection for diabetes mellitus, type II. The Veteran contends his diabetes mellitus, type II, is secondary to his service-connected hypertensive heart disease with chronic angina and hypertension. Alternatively, he contends his diabetes mellitus, type II, is caused by exposure to contaminated water while serving at Camp Lejeune. The Veteran was most recently afforded a VA examination for diabetes in October 2021. The VA examiner opined that the Veteran's diabetes mellitus, type II, was less likely than not incurred in or caused by service, as service treatment records and an August 1977 separation examination did not reflect diabetes or elevated blood sugar. The examiner also explained that type II diabetes develops when the body becomes resistant to insulin or when the pancreas is unable to produce enough insulin. Exactly why this happens is unknown, although genetics and environmental factors such as being overweight and inactive seem to be contributing factors. The examiner went on to note that hypertensive heart disease with chronic angina and hypertension does not affect the production of insulin or the sensitivity to insulin. Therefore, the examiner opined that the Veteran's diabetes mellitus, type II, was less likely than not caused or aggravated by his service-connected hypertensive heart disease with chronic angina and hypertension. However, prior to the October 2021 examination, a VA medical opinion was issued in October 2019 that indicated an association between the Veteran's diabetes mellitus, type II, and his service-connected disabilities. The examiner noted that hypertension was among "major risk factors" associated with diabetes and that the Veteran's risk factors for the development of diabetes included his age, hypertension, dyslipidemia, obesity, and being of African American descent. As the October 2019 and October 2021 contain conflicting information regarding the relationship between hypertension and diabetes mellitus, type II, remand for an addendum opinion is warranted. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician, regarding the Veteran's diabetes mellitus, type II. The claims file and a copy of this remand must be made available to the examiner. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. The examiner should respond to the following: (a) Is it as least as likely as not (50 percent probability or greater) that the Veteran's diabetes mellitus, type II, was caused by or otherwise related to his active duty service. Please explain why or why not. (b) Is it as least as likely as not (50 percent probability or greater) that the Veteran's diabetes mellitus, type II, was caused by his service-connected hypertensive heart disease with chronic angina and/or hypertension. Please explain why or why not. (c) Is it as least as likely as not (50 percent probability or greater) that the Veteran's diabetes mellitus, type II, was aggravated by (worsened beyond natural progression) his service-connected hypertensive heart disease with chronic angina and/or hypertension. Please explain why or why not In forming his or her opinion on causation and aggravation, the examiner should address the October 2019 VA medical opinion noting that hypertension is a major risk factor in the development of diabetes mellitus, type II. 2. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran's claim should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, furnish the Veteran and his representative a supplemental statement of the case (SSOC) and return the case to the Board. KRISTI L. GUNN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Silverblatt, 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.