Citation Nr: 21014037 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 20-04 218 DATE: March 11, 2021 ORDER Service connection for a lung condition is denied. THE VETERAN’S CONTENTIONS The Veteran contends that his breathing condition is due to dust and smoke inhalation during his time overseas in service. He states that he did not have problems breathing until he went to Kuwait and had to work out in dust and smoke for four days per week, which was so bad he was unable to see three feet in front of him. See December 2018 notice of disagreement (NOD); January 2020 VA Form 9. He asserts that he was stationed less than a mile from burning oil wells in 1990 and 1991 with no breathing protection provided, and that he was also treated for pneumonia while on active duty. See July 2020 Informal Hearing Presentation (IHP). The Veteran contends that deployment in Southwest Asia is associated with a wide range of respiratory disorders related to tobacco use and workplace and environmental exposures. See February 2021 Written Brief Presentation. He asserts that most military serviceman and women deployed from World War II through the Vietnam War have had enough time for respiratory disorders with both short and long latencies to manifest. He states that more recent deployments over the past 13 years to Iraq, Kuwait, Afghanistan, and other regions in southwest Asia (SWA) have been associated with a unique spectrum of respiratory disorders; and that the long-term respiratory effects of SWA deployments are unknown. Id. FINDING OF FACT The Veteran’s lung condition did not have its clinical onset during service; and is not shown to be causally or etiologically related to during service, to include exposure to dust and smoke. CONCLUSION OF LAW The criteria for service connection for a lung condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Air Force from July 1961 to November 1963 and in the Army from November 1990 to March 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This issue was remanded by the Board in July 2020. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). As the Veteran served in Southwest Asia from December 1990 to March 1991, he is a ‘Persian Gulf veteran’ as defined by regulation. See 38 C.F.R. § 3.317. Under 38 C.F.R. § 3.317, service connection may be warranted for a Persian Gulf Veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than not later than December 31, 2021. See 38 C.F.R. § 3.317 (a)(1). For purposes of 38 C.F.R. § 3.317, there are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multi symptom illness; and (3) a diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service-connection. An undiagnosed illness is defined as a condition that by history, physical examination and laboratory tests cannot be attributed to a known clinical diagnosis. In the case of claims based on undiagnosed illness under 38 U.S.C. § 1117; 38 C.F.R. § 3.117, unlike those for ‘direct service connection,’ there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. at 8-9. Further, lay persons are competent to report objective signs of illness. Id. To determine whether the undiagnosed illness is manifested to a degree of 10 percent or more the condition must be rated by analogy to a disease or injury in which the functions affected, anatomical location or symptomatology are similar. See 38 C.F.R. § 3.317 (a)(5); see Nicholson, 19 Vet. App. 470 (2006). As an initial matter, the Board finds that 38 C.F.R. § 3.317 is inapplicable in this case as the Veteran’s lung condition is attributed to a known clinical diagnosis, idiopathic pulmonary fibrosis (IPF). See October 2018 VA examination; November 2018 VA examination; October 2019 Disability Benefits Questionnaire (DBQ); August 2020 DBQ; October 2020 DBQ; Dr. I.D.. private treatment records; Dr. A.D. private treatment records. In regard to whether the Veteran’s IPF is related to his service, the service treatment records show that the Veteran had an upper respiratory infection with sinusitis and bronchitis, which was treated with amoxicillin in December 1990. His March 1991 report of medical history at separation shows reported pain or pressure in the chest; however, the March 1991 separation examination shows normal lungs and chest. On a January 1992 report of medical history, he reported that he was “just getting over a slight case of pneumonia”. See January 1992 report of medical history. The examiner noted that he had a recent episode of pneumonia two weeks ago and that he was improving. His lungs and chest were marked normal on examination. See January 1992 examination. An October 2018 VA examiner diagnosed IPF and determined that the condition was less likely than not related to the Veteran’s service. Specifically, she found that it was not caused by or a result of his history of bronchitis and pneumonia while in service. However, in her rationale, she stated that certain risk factors are associated with IPF, to include environmental pollutants. Similarly, in an October 2019 VA DBQ, a VA clinician determined that the Veteran’s IPF was not likely incurred in or caused by his sinusitis/ bronchitis during service. She stated that risk factors for IPF do not include episodic sinusitis and bronchitis, which are very common in the general population. A November 2018 examiner opined that the Veteran’s IPF is less likely as not related to his Gulf War exposure as it is a diagnosable condition. Additional VA medical opinions were obtained in August 2020 and October 2020 pursuant to the July 2020 Board remand, which directed the RO to obtain a medical opinion on whether the Veteran has a lung condition (to include a diagnosed condition) that is related to his contended exposure to dust and smoke during his service in Southwest Asia from 1990 and 1991. The August 2020 and October 2020 clinician provided negative nexus opinions. She determined that the Veteran has a diagnosis of IPF, and no other lung conditions. She stated that IPF was diagnosed in 2018, after abnormalities were identified via chest imaging studies in 2016. She opined that the Veteran’s IPF did not at least as likely as not have its clinical onset during service as the Veteran had no symptoms of IPF or findings of IPF during military service. The clinician also determined that the Veteran’s diagnosed IPF was not related to his exposure to dust and smoke during service. She accepted as valid the Veteran’s contention that he was exposed to dust and smoke during his service in Southwest Asia. She cited medical literature acknowledging that IPF lacks a known cause, and stating that exposure to stone, metal, wood, and organic dusts have been suggested as risk factors. However, she explained that cigarette smoking is the risk factor most strongly associated with IPF. She also explained that there is conflicting and insufficient research to show that long-term health problems have resulted from airborne hazards and burn pit exposure. In sum, based on the current literature identifying cigarette smoking as the IPF risk factor most strongly associated with IPF, the Veteran’s history of cigarette smoking which preceded the onset of his IPF, and the absence of evidence supporting an association between deployment to the Gulf War and exposure to dust and smoke during service in Southwest Asia and respiratory disease, she found that the Veteran’s IPF is not at least as likely as not caused by his exposure to dust and some during service. See August 2020 and October 2020 VA medical opinions. As noted above, several VA opinions were obtained to consider different theories for granting service connection, including whether the Veteran had an undiagnosable condition, whether his lung condition was related to his sinusitis/ bronchitis during service, and whether his condition was related to exposure to dust and smoke during service. All of the VA clinicians provided negative nexus opinions. The Board finds that the VA medical opinions are the most probative evidence of record. The clinicians considered the Veteran’s contentions, reviewed the medical records, and provided robust rationale for the conclusions that the Veteran had a diagnosed condition, which was not related to his service. There are no contrary medical opinions of record. The only contrary evidence of record is the Veteran’s contention that his lung condition is related to service, to include exposures during service. However, the Board finds that there is no evidence in the record indicating that the Veteran is qualified to provide a medical diagnosis or opinion. While the Veteran, as a lay person, is competent to provide evidence regarding the symptoms he observed, he is not competent to offer an opinion as to the etiology of his lung condition as this matter falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). Based on the foregoing, the Veteran’s claim of entitlement to service connection for a lung condition is denied. S.C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Samuelson, Cheryl 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.