Citation Nr: 21011689 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 14-27 946 DATE: March 2, 2021 ORDER Entitlement to service connection for chronic obstructive pulmonary disease (COPD), to include as secondary to service-connected asthma, is denied. FINDING OF FACT The Veteran’s COPD is not secondary to her service-connected asthma and is not otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for entitlement to service connection for COPD, to include as secondary to service-connected asthma, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1986 to September 1988. She appeals a July 2011 rating decision denying entitlement to service connection for COPD. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. §§ 3.303(a), 3.304, 3.307, 3.309, 3.310. Generally, the evidence must show: (1) the existence of a present 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 or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). A disability may also be found service connected on a secondary basis by demonstrating that the disability is either (1) proximately due to or the result of an already service-connected disease or injury or (2) aggravated by an already service-connected disease or injury. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310 (2017). 1. Entitlement to service connection for COPD, to include as secondary to service-connected asthma. The Veteran contends that her service-connected asthma developed into COPD. After review of the evidence, the Board finds that service connection is not warranted. As an initial matter, the Board notes that the Veteran is not claiming that her COPD is directly related to active service. Moreover, review of her service treatment records does not show treatment for any respiratory condition aside from her preexisting asthma, and she was not diagnosed with COPD until more than a year after separation from active service. As such, entitlement to service connection for COPD on a direct basis is not warranted. As to service connection on a secondary basis, VA examiners have consistently opined that her COPD is likely a direct result of smoking rather than any incident of active service. Upon examination in September 2019, the VA examiner opined that not only is the Veteran’s COPD most likely caused by her smoking, but it is less likely than not related to or otherwise aggravated by her service-connected asthma. To be specific, the examiner stressed that asthma and COPD function independently of each other. As to causation, the September 2019 VA examiner explained that asthma is a disease of the “upper airways”, whereas COPD is a disease of the lower airways. Asthma is a reactive airway disease whereupon the smooth muscle fibers surrounding the large and medium size bronchioles constrict in response to an allergen in the airways. It can be avoided by avoiding the allergen and is a reversible disease. COPD, however, is a permanent, generally irreversible enlargement of lung structures that are beyond the conducting airways that involve asthma. The Board independently takes notice that VA regulations place these two disorders into separate and distinct categories. See 38 C.F.R. § 4.97. Thus, the examiner opined, asthma does not result in or secondarily cause COPD. The reactive airway pathology is not even the same histology/region of tissue and COPD is at the "exchange airways" (lower airways) and involves the loss of elastance and cell wall destruction, typically from smoking. The examiner further opined that the Veteran’s smoking history and attempts at quitting are consistent with the etiology of her COPD. As to aggravation, the examiner noted that COPD and asthma function independently of each other. The examiner reasoned that the Veteran’s COPD was diagnosed in approximately 1999-2000 as "mild COPD" and has progressed in parallel with her total increase in tobacco burden over that same timeline. Such progression represents the normal course of loss of elastance and alveolar destruction and her PFTs are consistent with this same "natural timeline" of COPD progression and continuation. Her asthma on the other hand, shows a separate and independent pathology and in years where she has "less asthma attacks" she does not show "less COPD". Conversely, in years where her asthma is worse, her PFTs do not indicate a sudden "aggravation" or increase in COPD. In arriving at this conclusion, the Board recognizes the statements from the Veteran regarding the relationship between her COPD and service-connected asthma. However, while she is competent to provide testimony regarding observable symptomatology, she is not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the unsubstantiated statements regarding the claimed etiology of her COPD are found to lack competency. In summation, review of the medical and lay evidence of record does not demonstrate that the Veteran’s COPD is etiologically related to her service-connected asthma or any other instance of active service. As the Board finds the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990). For these reasons, the claim is denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Daniel Ballinger, Associate Counsel