Citation Nr: 21011982 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 20-00 236 DATE: March 3, 2021 ORDER Service connection for pulmonary fibrosis is denied. Service connection for pulmonary hypertension is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against the finding that the Veteran’s pulmonary fibrosis had its onset in service or is otherwise causally related to service. 2. The preponderance of the evidence is against the finding that the Veteran’s pulmonary hypertension had its onset in service or is otherwise causally related to service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for pulmonary fibrosis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.655. 2. The criterial for entitlement to service connection for pulmonary hypertension have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.655. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from November 1950 to November 1970. This matter is before the Board of Veterans’ Appeals (the Board) on appeal from the January 2019 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. In June 2020, the Board remanded the claims for further development and adjudication. The requested actions have been completed and the case is once again before the Board. Service Connection Service connection may be established for a disability resulting from personal injury suffered or disease contracted in the line of duty or for aggravation of preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Generally, to establish service connection, there must be lay or medical evidence of (1) a current disability, (2) incurrence or aggravation of a disease or injury in service, and (3) a nexus between the in-service injury or disease and the current disability. See 38 U.S.C. § 1110 (2012); Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). The United States Court of Appeals for the Federal Circuit (Federal Circuit) has clarified that lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The credibility and weight of all the evidence, including the medical evidence, should be assessed to determine its probative value, and the evidence found to be persuasive or unpersuasive should be accounted for, and reasons should be provided for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. It is the Board’s responsibility to determine whether a preponderance of the evidence supports the claim or whether the evidence is in relative equipoise, with the veteran prevailing in either event, or whether there is a preponderance of evidence against the claim, in which case the claim must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Then, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102 (2020). 1. Entitlement to service connection for pulmonary fibrosis. 2. Entitlement to service connection for pulmonary hypertension. The Veteran seeks service connection for pulmonary fibrosis and pulmonary hypertension. The Veteran’s service treatment records (STRs) do not contain complaints, treatments, or diagnosis for pulmonary fibrosis or pulmonary hypertension. The Veteran’s private treatment records indicate that he was diagnosed with pulmonary fibrosis in March 2018 and with pulmonary hypertension in August 2018. A September 2019 letter from the Veteran’s private physician, Dr. R.J. indicates that the Veteran has been diagnosed with nonspecific intestinal pneumonia (NSIP) and pulmonary fibrosis. The letter indicates that NSIP can be present alone or in combination with other idiopathic interstitial pneumonias. Dr. R.J. states that he reviewed the Veteran’s records and opines that it is more likely than not that the Veteran’s pulmonary condition was contributed to by his military service after multiple investigations by several different private physicians, including a pulmonologist, an ENT physician, a cardiologist, and a rheumatologist could not determine the source of his restrictive lung disease. Dr. R.J. further stated that it is more likely than not that the Veteran developed a hypersensitivity that caught up with him over time and that this started in service and was aggravated by the Veteran’s service. Pursuant to the June 2020 remand, the Veteran was scheduled to undergo a VA examination for his claim. A review of the Veteran’s file indicates that the VA examination was cancelled upon the Veteran’s request. A September 2020 VA Form 27-0820, report of general information indicates that the Veteran was called for clarification on the VA examination cancellation. The form indicates that the Veteran stated that he no longer wishes to pursue his appeal. The Veteran was notified of the actions needed to withdraw the appeal. The RO sent the Veteran correspondences in September 2020 and October 2020, informing him that his request to withdraw the appeal must be made in writing, enclosing all appropriate forms. To date, the Veteran has not responded to the correspondences. At the outset, the Veteran cancelled a scheduled examination because he did not wish to pursue his appeal. In essence, the Veteran failed to report for a VA examination without a good cause. See 38 C.F.R. § 3.655. When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. Id. Moreover, the Veteran’s September 2020 oral statements do not satisfy the requirements for withdrawal of an appeal. See 38 C.F.R. § 19.55(b)(1). As such, the claims will be decided based on the evidence of record. Based on the review of the entire record, the preponderance of the evidence is against the claims. The Veteran’s pulmonary fibrosis and pulmonary hypertension did not have their onset in service and are not otherwise causally related to service. As such, the claims are denied. The Veteran’s disabilities did not have their onset in service. The Veteran’s STRs do not contain complaints or treatments relating to pulmonary fibrosis or pulmonary hypertension. The Veteran’s private treatment records indicate that he was not diagnosed with pulmonary fibrosis and pulmonary hypertension until 2018, approximately 38 years after service. The September 2019 letter from Dr. R.J. indicates that the Veteran’s pulmonary disability developed in service and was aggravated by his service time. The September 2019 letter is not afforded probative value. Although Dr. R.J. indicated that the Veteran’s pulmonary disability developed in service and is as likely as not related to service, there is no rationale to support these conclusions. In order for a medical opinion to be assigned probative value, the opinion must provide a full rationale for the conclusions reached. See Stefl v. Nicholson, 21 Vet. App. 102, 124-25 (a medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (a medical report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two). While the September 2019 letter suggests that the Veteran’s disability developed in service and is likely related to service, the conclusion lacks rationale, and is not assigned probative value. The Veteran’s pulmonary disability is not otherwise causally related to service. While the Veteran sincerely believes that his pulmonary fibrosis and pulmonary hypertension are related to service, he is not competent to provide a medical nexus opinion in this case.  This requires medical expertise and falls outside the realm of common knowledge of a lay person.  See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011).  In this regard, any actual diagnosis and finding of causation between service and disability, require objective testing and medical expertise to diagnose.  See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).  To the extent that the Veteran believes that his disabilities are related to service, as a lay person, he is not shown to possess any specialized training in the medical field. Accordingly, the Veteran’s opinion as to the nexus in this case is not competent evidence. Id.    In sum, the evidence does not establish a link, or a nexus between the Veteran’s current pulmonary fibrosis or pulmonary hypertension and service. The Veteran did not appear for the scheduled VA examination and thus an opinion could not be completed. The Board is not permitted to make independent medical assessments. Colvin v. Derwinski, 1 Vet. App, 171, 175 (191). Finding that the Veteran’s current pulmonary fibrosis or pulmonary hypertension are related to service would do just that. In this case, the evidence does not allow for a grant of service connection for pulmonary fibrosis or pulmonary hypertension. In reaching the above conclusions, the applicability of the benefit of the doubt doctrine was considered. However, as the preponderance of the evidence is against the Veteran’s claims, that doctrine is not for application, and the claims are denied. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). T. Berry Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kuksova, Kseniya 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.