Citation Nr: 21013545 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 16-19 477 DATE: March 9, 2021 ORDER Service connection for a respiratory disorder is denied. FINDINGS OF FACT 1. The Veteran had active service from October 1964 to October 1966. 2. A current respiratory disorder, diagnosed as chronic obstructive pulmonary disorder (COPD), was not shown in-service and is not causally or etiologically related to service; residuals of tuberculosis (TB) have not been shown. CONCLUSION OF LAW A respiratory disorder was not incurred in service. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). The Veteran contends that he was diagnosed with TB during service which has caused permanent lung damage and resulted in a respiratory disorder. Turning to the medical evidence, the Veteran has been diagnosed with COPD since 2013. As such, a current respiratory disorder has been shown and the first element of service connection has been met. As to in-service incurrence, the Veteran contends that he was exposed to TB aboard the U.S.S. Grand Canyon during service. The service treatment records (STRs) reflect that he was exposed to TB in 1966. An April 1966 purified protein derivative (PPD) skin test showed positive results, but all subsequent PPD skin tests and chest X-rays taken during service reflected negative results for a TB infection. Further, the September 1966 separation examination indicated a normal clinical evaluation of the lungs and did not reflect a diagnosis of TB or any other respiratory disorder. In addition, during an April 1968 examination during active duty for training in the Reserve, the Veteran specifically indicated that he had never had TB. Accordingly, the medical evidence does not reflect the in-service incurrence of a chronic respiratory disorder. To the extent that the Veteran contends that a single PPD skin test in service resulted in COPD, the medical evidence does not support a nexus between a current respiratory disorder and service. An October 2013 VA examiner opined that a respiratory disorder was less likely than not caused by service. He noted that while the Veteran had positive skin reaction tests in 1966 and 1997, subsequent X-rays were negative, and the Veteran never had symptoms or signs of TB disease. The examiner explained that false positive TB skin tests were secondary to skin reactions or allergic responses. He also explained that two/thirds of patients exposed to TB and who have positive skin tests never develop any disease or symptoms associated with TB. Next, a July 2019 VA examiner concluded that COPD was less likely than not incurred in or caused by service. The examiner stated that the Veteran had no active TB during service. Rather, he just had a positive skin test which may have been due to an allergic reaction. The examiner also noted that the Veteran was exposed to Agent Orange which could have caused the respiratory problems. A February 2020 VA examiner explained that COPD and TB were separate conditions that were not related, and that TB did not cause COPD. Further, he noted that there was never evidence of an acute infection or diagnosis of TB. He concluded that the Veteran’s history of smoking more likely than not caused COPD. Further, the examiner stated that COPD was not due to a positive skin TB test without infection or diagnosis. He explained that the treatment the Veteran received during service was prophylactic. In addition, the treatment received in the 1990s was prophylactic as well since the Veteran reported previous TB. He also noted that the right lung scarring shown in the 2014 CT scan could have been from a multitude of causes, not necessarily TB. The examiner concluded that COPD was not present in service and there was no active TB infection. Accordingly, he reasoned that due to lack of diagnosis, COPD was not aggravated by TB and was more likely than not due to the Veteran’s smoking history rather than a positive skin test in-service or exposure to herbicides during service. As to the issue of exposure to Agent Orange as a potential cause of COPD, neither COPD nor TB are on the presumptive list related to herbicide exposure. Moreover, other than a speculative comment from the July 2019 VA examiner without a rationale or supporting evidence, the medical evidence does not support service connection on a direct causation basis. Rather, the most recent examiner reflected that COPD was more likely than not due to the Veteran’s history of smoking. In sum, the medical evidence weighs against a nexus between a current respiratory disorder and service. Therefore, the medical evidence does not support the grant of service connection. The Board has considered the Veteran’s lay statements that COPD was caused by service. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current disorder due to the medical complexity of the matters involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Kokolas, 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.