Citation Nr: 21009616 Decision Date: 02/23/21 Archive Date: 02/22/21 DOCKET NO. 09-42 267 DATE: February 23, 2021 ORDER Entitlement to service connection for a pulmonary disorder, to include as due to in-service exposure to asbestos or herbicides, including Agent Orange is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his pulmonary disorder, is at least as likely due to in-service exposure to asbestos or herbicides, including Agent Orange. CONCLUSION OF LAW The criteria for entitlement to service connection for a pulmonary disorder, to include as due to in-service exposure to asbestos or herbicides, including Agent Orange are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1966 to March 1967, and from May 1968 to September 1969, including service in Vietnam. In November 2019, the Board most recently remanded the issue below on appeal for further development, and the case has since been returned to the Board. The Board finds that the agency of original jurisdiction (AOJ) has substantially complied with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) Entitlement to service connection for a pulmonary disorder, to include as due to in-service exposure to asbestos or herbicides, including Agent Orange The Veteran contends that his pulmonary disorder is to his Agent Orange exposure in Vietnam. The Veteran's personnel records, including his form DD 214 record of discharge, indicate that he served as part of a combat engineer battalion in Vietnam. His personnel records also indicate that he was an M60 machine gun expert. A June 1969 memorandum recommending the Veteran for a certificate of achievement notes that he participated in the upgrading of Highway 20 from Di Linh to B'sar, Lan Dong Province, Vietnam, from September 1968 through August 1969. The record also includes an article published in The National Guardsman magazine in May 1969 documenting how the Veteran's combat engineer battalion not only helped to build Highway 20 but cleared at least 137,300 square meters of jungle and excavated some 85,000 cubic yards of earth. The article specified that an important aspect of the Highway 20 assignment was clearing the jungle 50 to 100 meters to each side of the road. In a May 2008 statement, the Veteran reported being exposed to asbestos while at Fort Leonard Wood, Missouri when asbestos dust was blown into the barracks while the furnace and part of the duct work were being replaced. He also reported being exposed to asbestos while working as a machine gunner on a jeep-mounted M60, which required the use of a heat-resistant asbestos glove to change the gun's hot barrel. He stated that the glove was not in very good shape and was falling apart, but that no one knew at that time that asbestos was bad. In his May 2008 statement, the Veteran also reported exposure to Agent Orange while providing security for a land clearing team. In addition, he reported being given about one carton of cigarettes every week while in Vietnam. In a lay statement provided in August 2015, the Veteran reiterated that he had been exposed to asbestos in his barracks at Fort Leonard Wood in January and February 1967. He stated that he inhaled powder from the deteriorated asbestos glove used as protective equipment when changing the barrels of the M60 machine gun. He also reported that he had been assigned to help clear land that was previously sprayed with defoliant, and that he had extensive contact with dust from the vegetation that had been sprayed. Medical records reflect that the Veteran smoked about one pack of cigarettes per day, or about 80 packs per year, for about 45 years until he quit smoking in October 2006. In May 2007, the Veteran received emergency treatment for dyspnea. The Veteran then underwent a CT scan, after which private physicians diagnosed him with mild peripheral fibrosis throughout the lung bases. The CT scan indicated diffuse, centrilobular emphysema changes, primarily throughout lung apices, and suggested he might have usual interstitial pneumonitis. Other findings included mild peripheral areas of increased reticular opacities within the lung bases, with minimal, thickened areas of honeycombing throughout the lung base. No abnormal adenopathy or pleural effusion was observed. X-ray findings from May 2007 included diffuse interstitial or alveolar infiltrates noted in both lungs, along with some subtle Kerley B lines and thickening in the minor fissure. A treating physician who had not seen the X-ray images, but heard them described over the telephone, suspected interstitial disease based on the reported observation of reticular type infiltrate in the bilateral bases of the lungs. A May 2007 pulmonary function test resulted in a diagnosis of pulmonary obstruction, with a physician noting that this was probably related to tobacco use. Another record of a private evaluation conducted in October 2007 reflected probable diagnoses of emphysema and pulmonary fibrosis. Private treatment records from May 2007 show that the Veteran reported his occupation as building manager, and that he previously worked in the construction trades for 30 years and was exposed to asbestos. Another private treatment record from October 2007 similarly reflects that the Veteran worked as a carpenter for 30 years, having retired 15 years prior. The Veteran used unknown harsh chemicals when working with wood. He reported significant exposure to asbestos beginning approximately 45 years prior, lasting 15 years, but no more specific details were provided. He also indicated that he was exposed to insecticides while growing up on a farm. During these particular treatment episodes, no note was made of exposure to Agent Orange or other defoliants during his time in Vietnam. He later reported exposure to Agent Orange in October 2010, according to a private treatment record from that time. An August 2010 private treatment record indicated that the Veteran was experiencing some interstitial congestion consistent with his history of pulmonary fibrosis. A radiography report from May 2012 indicated pleural abnormalities, specifically, pleural plaques, consistent with pneumoconiosis. The record contains no additional detail, impressions, or opinions regarding these observations. A check of pulmonary functions by a private physician in December 2013 showed moderate obstructive pulmonary disease and hypoxemia, and normal lung volumes. The treating physician noted these findings to be consistent with a history of tobacco use. The Veteran was provided with negative opinions by VA on the etiology of his pulmonary disorder in January 2014, September 2017, and August 2019 that were all deemed inadequate by the Board in previous remands. In December 2020, as required by the latest November 2019 Board remand, the Veteran was provided an addendum opinion. The examiner opined that the Veteran’s condition was at least as likely as not incurred in or caused by the claimed inservice injury, event, or illness. The rationale provided was: Veteran served in Vietnam and he is presumed to have been exposed to Agent Orange. Pulmonary disorders have been associated with Agent Orange. The pulmonary diseases are not specific. Even though patient has a significant smoking history, Agent Orange can not be excluded as a contributing factor to his lung diseases. There have been studies showing a connection between COPD and herbicide exposure/Agent Orange. Patient is listed to have severe COPD throughout his medical record, however his COPD is moderate and is not the only cause of his very severe defect in diffusion capacity and hypoxemia. COPD severity is based on PFT's, not CT scan reads. Patient has a significant smoking history, but this does not automatically give him a diagnosis of severe COPD. Patient has direct connection to Agent Orange during his time in Vietnam. It is least as likely as not that his pulmonary disease comes from his service exposure as it is from his smoking history. The Board has considered the medical and lay evidence of record. Indeed, the only medical opinion of record deemed adequate, the December 2020 opinion, is positive. Consequently, the most probative evidence of record is at least in equipoise as to whether the Veteran’s pulmonary disorder is due to his service. After resolving all doubt in the Veteran’s favor, service connection for a pulmonary disorder is granted. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. A. Elliott II, 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.