Citation Nr: 21076965 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 19-27 784 DATE: December 28, 2021 ORDER Entitlement to special home adaptation is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran's favor, his current respiratory condition likely resulted from an inhalation injury during his deployment in the Southwest Theater of Operations. CONCLUSION OF LAW The criteria for a special home adaptation grant have been met. 38 U.S.C. §§ 2101 (b), 5107 (West 2014); 38 C.F.R. § 3.809a. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1987 to July 1996. This matter is on appeal from an April 2018 rating decision. As a preliminary matter, the Board notes that the Veteran's claim for entitlement to specially adapted housing and special home adaptation were both denied in a January 2015 rating decision. That decision became final as the Veteran did not file a timely appeal. In April 2018, the AOJ reopened the claims for specially adapted housing and special home adaptation. The Veteran subsequently filed a timely Notice of Disagreement, listing only entitlement to special home adaptation. Pursuant to the July 2019 Statement of Case, the Veteran perfected the appeal for entitlement to special home adaptation, which was most recently reopened and remanded by the Board in June 2020. The Board may now proceed to the adjudication of the claim on its merits and determine whether eligibility for a special home adaptation may be granted. The Veteran contends that he is eligible for a special home adaptation grant due to his service-connected idiopathic pulmonary fibrosis and asthma. A veteran can qualify for a grant for necessary special home adaptations if he/she has a service-connected disability that results in blindness in both eyes with 20/200 visual acuity or less in the better eye with the use of a standard correcting lens or a limitation in vision fields such that the widest diameter of the visual field subtends an angle no greater than 20 degrees; such a disability need not be permanent and total in nature. Additionally, a special home adaptation grant is available for a veteran that has a permanent and total disability which: (1) includes the anatomical loss or loss of use of both hands; (2) is due to deep partial thickness burns that have resulted in contracture(s) with limitation of motion of two or more extremities or of at least one extremity and the trunk; (3) is due to full thickness or subdermal burns that have resulted in contracture(s) of one or more extremities or the truck; or, (4) is due to residuals of an inhalation injury (including, but not limited to, pulmonary fibrosis, asthma, and chronic obstructive pulmonary disease (COPD)). 38 C.F.R. § 3.809a (b). Qualification for special home adaptation based on a respiratory disorder requires more than a showing of permanent and total disability from a respiratory diagnosis such as pulmonary fibrosis, asthma or COPD. The diagnosis must have resulted from an inhalational injury caused by breathing steam or toxic fumes, gases and mists present in a fire environment (including, but not limited to, acrolein, chlorine, phosgene, and nitrogen dioxide). The Veteran is currently service connected for respiratory conditions to include idiopathic pulmonary fibrosis and asthma at a 100 percent rating, hypothyroidism at a 100 percent rating, degenerative changes of the lumbar spine at 10 percent, residual scar from an umbilical hernia at 10 percent, residuals of a left knee strain at 10 percent, and tinnitus at 10 percent. He is also service connected for a calcaneal spur of the right ankle, allergic rhinitis, status post-surgical repair of an umbilical hernia, and surgical scars associated with the respiratory condition, all at a noncompensable rating. The Veteran has asserted that his idiopathic pulmonary fibrosis and asthma were related to the environmental hazards that he encountered while in the Southwest Theatre of Operations. Further, his representative suggested that his pulmonary fibrosis was aggravated by his exposure to environmental hazards while in the Southwest Theatre of Operations. He argues that he requires a home that will provide security, amenities, and privacy to help him cope with his illness. The Board notes that pursuant to a January 2017 rating decision, the Veteran was assigned a 100 percent rating for his respiratory condition, to include idiopathic pulmonary fibrosis and asthma, effective April 24, 2013. The question now remains as to whether the Veteran's service-connected respiratory conditions are considered inhalation injuries that specifically resulted from breathing in steam or toxic fumes, gases and mists present in a fire environment during active service. The Veteran's military personnel record shows that he served in Southwest Asia from July 1991 to December 1991. Service treatment records show that in April 1987, the Veteran was seen for chest pains with no shortness of breath. He denied any history of asthma. An examination revealed slight congestion with wheezing. In May 1994, the Veteran continued to have difficulty breathing with wheezing. A clinical medical assessment of asthma was given. Another examination in August 1994 identified 'exertional asthma.' A respiratory evaluation in January 1995 noted low lung volumes combined with obstructive lung disease. Due to his condition, the Veteran underwent a Medical Evaluation Board (MEB) which noted that the Veteran first exhibited signs of a chronic respiratory condition in June 1990. He reported chest pain with exercise and shortness of breath. He was initially treated with prophylactic beta agonist. However, his symptoms continue to prevail. His symptoms worsened especially in the upper respiratory infections. Upon examination, the Veteran was noted to have bronchial asthma. He was unable to perform physical training without experiencing shortness of breath and wheezing. His condition had deteriorated over the course of a year with onset of upper respiratory infection or exposure to seasonal pollens. The MEB found that the Veteran had bronchial asthma, adult onset, due to exercise with an allergic component. Post service records showed that the Veteran's respiratory condition worsened. He underwent a VATS-assisted surgical lung biopsy in November 2012, which revealed an interstitial pneumonia consistent with a diagnosis of idiopathic pulmonary fibrosis. The physician found the results surprising in light of the Veteran's young age. While he noted that it was possible that his current fibrosis dates back to his time in service, the connection could not yet be established without additional evidence. The Veteran was afforded a VA examination in November 2016. There, the examiner identified 2 respiratory conditions: asthma, first diagnosed in 1996, and interstitial lung disease, diagnosed in 2012. His conditions require inhalation bronchodilatory therapy and inhalation anti-inflammatory medication on a daily basis. At that time, the examiner found that the Veteran's current pulmonary fibrosis was related to the Veteran in-service pulmonary symptoms. However, the examiner did not state what caused the Veteran's in-service pulmonary symptoms. A VA pulmonary treatment note in November 2016 indicated that the Veteran's pattern of lung pathology was most suggestive of a clinical diagnosis of idiopathic pulmonary fibrosis as the evaluation did not identify a specific exposure or autoimmune process as a causative factor. He was noted to have been exposed to smoke pits and burning oil fields in Iraq. These factors could be taken into consideration as possible contributing factors. While the physician was not aware of causal links between these exposure and usual interstitial pneumonia, there are, however, some associations between these exposures and asthma/reactive airways disease. In his May 2020 Appellate Brief, the Veteran, through his representative, asserted that while the Veteran's respiratory disorder may have predated his deployment to Southwest Asia Theater of Operations, the pre-existing respiratory disorder could have been aggravated and/or accelerated beyond its normal course of progression by exposures to the hazardous environment. A medical opinion was obtained in May 2021. The examiner found that it was at least as likely as not that the Veteran's idiopathic pulmonary fibrosis is a result of an in-service inhalation injury. In her rationale, the examiner noted that the Veteran was seen and treated multiple times for shortness of breath, which progressively became significantly worse over time. In a June 2021 medical opinion addendum, the examiner added that pulmonary fibrosis is a lung disease that occurs when the lung tissue becomes damaged and scarred. While the exact cause cannot be found, it is often caused by exposure to a number of toxins and pollutants. Given that the Veteran served in Southwest Asia from July 1991 to December 1991, where he was exposed to pollutants, it is at least as likely as not that the Veteran's pulmonary fibrosis resulted from it. However, the AOJ emphasized that the Veteran's service treatment records show that the approximate date of origin of bronchial asthma in 1990, which was prior to the Veteran's duty assignment in Turkey in July 1991 to December 1991. His idiopathic pulmonary fibrosis was diagnosed in December 2012. The Veteran asserted that he was exposed to burned pits but did not provide the specific location. The AOJ then requested yet another medical opinion addendum in July 2021 from the same examiner. The examiner subsequently issued a contradicting opinion, finding that it was less likely that the Veteran's pulmonary fibrosis resulted from his exposure to pollutants in Southwest Asia. She explained that the Veteran was first treated for shortness of breath in August 1990 and was diagnosed with bronchial asthma, which was prior to his assignment in Turkey. As these symptoms began prior to possible burn pit exposures, it is less likely than not that his pulmonary fibrosis resulted from his exposure to burned pits. The examiner also noted that the medical record was silent for any type of inhalation injury while in service. In support of his claim, the Veteran, through his representative, asserted that the July 2021 medical opinion failed to consider whether the Veteran's exposure to pollutants in Southwest Asia aggravated his asthma condition, diagnosed in 1990. While the Veteran was deployed to Southwest Asia, the Veteran was treated for bronchitis, which greatly affected his breathing, causing shortness of breath, triggering his restrictive airway disease as referenced by his service treatment records. Treatment records from October 1991 stated that he was treated for shortness of breath with a history of asthma, brought on by environmental changes or colds. According to the Mayo Clinic, the most common cause of chronic bronchitis is cigarette smoking. Air pollution, dust, and toxic gases in the environment or workplace can also contribute to the condition. The risk of developing bronchitis is greater if one is exposed to certain lung irritants, such as grains, textiles, or chemical fumes. In this case, the Veteran was not a smoker, but was exposed to environmental changes such as terrible air pollution, dust, and very likely toxic pollutants and gases during his deployment to Southwest Asia. Therefore, it is unlikely that the Veteran's respiratory condition was not aggravated by his service in Southwest Asia. See November 2021 Written Brief Presentation. In reviewing the record, the Board finds that entitlement to a special home adaptation is warranted in this case. The record clearly shows that the Veteran was diagnosed with asthma in service, shortly before his deployment to Southwest Asia, for which he has been granted service connection. Throughout his period of active duty since his initial diagnosis, the Veteran demonstrated reoccurrences and significant worsening of his respiratory condition, especially after his deployment to Southwest Asia. While his service treatment records did not specifically document an 'inhalation injury,' the Veteran was ultimately diagnosed with fibrosis, which suggests damage and injury to lung tissues. The claims file also contains both positive and negative opinions regarding whether the Veteran's current respiratory condition resulted from an inhalation injury in service. First, the examiner found that the Veteran's pulmonary fibrosis, a lung disease caused by lung tissue being damaged and scarred, is likely caused by the Veteran's exposure to pollutants during his deployment to Southwest Asia for several months. In contrast, the same examiner later found that the Veteran's condition was diagnosed prior to his deployment and therefore, is not likely caused by any possible exposure to pollutants in Turkey. In finding so, the examiner failed to address whether the Veteran's asthma and shortness of breath was worsened by his deployment, as asserted by the Veteran. The Board finds that the medical opinions of record are in relative equipoise. Therefore, the evidence must be resolved in favor of the Veteran that his current pulmonary fibrosis resulted from an inhalation injury sustained when he was stationed in Southwest Asia. Accordingly, entitlement to a special home adaptation grant is warranted. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Yeh, 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.