Citation Nr: 21006253 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 15-00 480 DATE: February 3, 2021 ORDER Service connection for spontaneous pneumothorax is granted. Service connection for chronic obstructive pulmonary disease (COPD) with interstitial lung disease, however, is denied. FINDINGS OF FACT 1. The Veteran’s spontaneous pneumothorax is as likely as not related to his service. 2. But the preponderance of the evidence is against finding that his COPD with interstitial lung disease began during his service or is otherwise related or attributable to his service. CONCLUSIONS OF LAW 1. The criteria are met for entitlement to service connection for spontaneous pneumothorax. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria conversely as not met for entitlement to service connection for COPD with interstitial lung disease. Id. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from January 1967 to October 1970. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service in the line of duty. 38 U.S.C. § 1110; 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 an injury; and (3) a causal relationship (“nexus”) between the current disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). 1. Service connection for spontaneous pneumothorax is granted. The Board finds that service connection for spontaneous pneumothorax is warranted. In so finding, the Board concludes the probative (meaning competent and credible) evidence is at least in relative equipoise regarding the required attribution of this condition to the Veteran’s service. And, in this circumstance, this reasonable doubt is resolved in his favor and the claim granted rather than denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Specifically, in July 2019, a VA examiner completed physical examination of the Veteran, reviewed the claims file, and concluded that it is at least as likely as not his spontaneous pneumothorax is related to his service. This examiner explained that, according to medical literature, the Veteran had several risk factors for developing spontaneous pneumothorax. While he first experienced symptoms following service, he had risk factors in service for development of this condition, including a June 1970 X-ray showing old calcific granulomatous disease of his right lung, submarine escape and rescue training requiring a sudden increase in pressure, and exposure to ionizing radiation onboard a submarine.   On the other hand, in October 2020, a VA examiner found it less likely than not the Veteran’s spontaneous pneumothorax is related to his service, surmising there is insufficient evidence to substantiate his contentions regarding this posited correlation. This additional examiner determined the Veteran’s pneumothorax is now resolved and likely related, instead, to his lung granulomas and significant smoking history. Then, in November 2020, a VA opinion addendum was obtained, at which time the VA examiner stated that to say that rescue diving would likely lead to spontaneous pneumothorax was a huge leap, given that it is a very rare residual of rescue diving. Thus, it is less likely than not the Veteran’s spontaneous pneumothorax is from rescue diving or the old granulomas first identified in 1970. When considering these medical opinions that are both for and against the claim, the Board finds they are in relative balance in terms of probative value. All three medical opinions were provided by physicians who have similar medical training and expertise. And, although the most recent November 2020 VA examiner provided an unfavorable opinion regarding nexus, the rationale appears to be a mere difference of opinion. The October 2020 VA examiner’s opinion is also somewhat unclear, in that this examiner does relate the Veteran’s spontaneous pneumothorax to his numerous lung granulomas even when providing a negative conclusion. Given that the unfavorable opinions provided appear to be somewhat less persuasive than, or certainly no more persuasive than, the July 2019 supporting VA opinion, the Board finds there is the needed balance of evidence to grant rather than deny the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996) (indicating "absolute" etiology is not a condition precedent to granting service connection, nor is "definite" or "obvious" etiology). Rather, this need only be an "as likely as not" proposition, which in this instance it is. The evidence shows the Veteran’s service included working on a submarine and completing diving and rescue trainings, and the records also include the 1970 chest X-ray from during his service showing granulomas. As well, the records show that he has suffered from spontaneous pneumothorax for many years. In November 1995, he reported spontaneous pneumothorax episodes that he had had for many years. On 2019 VA examination, he reported ongoing symptoms related to this condition. Thus, the Board finds that service connection for spontaneous pneumothorax is warranted. 2. Service connection for COPD with interstitial lung disease is denied. The Board finds that the preponderance of the evidence contrastingly is against finding that COPD with interstitial lung disease is owing to the Veteran’s service. For one, the Veteran has not provided any specific contentions relating this additional lung disability to his service. He originally filed a claim for service connection for what was described as a collapsed lung, and on VA examination he described his trouble breathing and history of spontaneous pneumothorax. Thus, it is unclear whether he believes there is an etiological link between his COPD with interstitial lung disease and his service. But, even aside from that, the probative medical evidence weighs heavily against finding that the Veteran’s COPD with interstitial lung disease is related or attributable to his service. The November 2020 VA examiner concluded that the Veteran’s COPD with interstitial lung disease, instead, is most likely related to his significant smoking history. The October 2020 VA examiner also found the Veteran’s smoking history to be significant and found that his lung granulomas were likely related to his chronic smoking. There are no other medical opinions, or medical evidence, of record relating the Veteran’s COPD and interstitial lung disease to his service. Moreover, for claims, as here, filed on or after June 9, 1998, there is an express prohibition against granting service connection for any disability resulting from injury or disease attributable to chronic smoking. 38 U.S.C. § 1103; 38 C.F.R. § 3.300. Precedent Opinions of VA's General Counsel have discussed the cause-and-effect correlation between chronic smoking and the eventual development of certain disorders, including COPD (emphysema). See VAOPGCPREC 2-93 (Jan. 13, 1993) and VAOPGCPREC 19-97 (May 13, 1997). The Veteran contends that he suffers from a respiratory disability related to asbestos exposure while in service. However, although he reports being exposed to asbestos while in service, the competent medical opinions of record indicate he has not been diagnosed with an asbestos-exposure-related disease. The records also do not suggest that the circumstances of his service resulted in occupational exposure to asbestos. See M21-1, part IV, Subpart ii, Chapter 2, Section C, Topic 2(b). Thus, absent any credible indication he has been diagnosed with an asbestos-exposure-related disease or was likely exposed to asbestos during his service, the Board finds that this theory of entitlement does not further trigger the duty to assist to further develop the claim. Furthermore, none of the VA examiners suggested or opined that the Veteran’s COPD with interstitial lung disease was caused or aggravated by his spontaneous pneumothorax, nor does the evidence of record otherwise suggest that association. See 38 C.F.R. § 3.310(a) and (b); Allen v. Brown, 7 Vet. App. 439 (1995). For these reasons and bases, the Board finds that service connection for COPD with interstitial lung disease is not warranted. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Erdheim 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.