Citation Nr: 21022667 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 14-13 793 DATE: April 19, 2021 ORDER Service connection for lung cancer is granted. FINDING OF FACT Resolving any reasonable doubt in his favor, the Veteran’s lung cancer was etiologically related to multiple occupational exposures in service. CONCLUSION OF LAW The criteria for service connection for lung cancer have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1990 to July 1992. Upon his death in July 2012, his surviving spouse was substituted as the Appellant for this case. The case now returns to the Board of Veterans’ Appeals (Board) after a remand to the agency of original jurisdiction in April 2020. Service Connection for Lung Cancer The Veteran attributed his lung cancer to asbestos exposure aboard the U.S.S. Semmes and at Naval Station Great Lakes. At a February 2020 hearing, the Appellant testified that the Veteran was also exposed to asbestos and other chemicals while stationed at the Charleston Naval Base. After careful review, the Board finds that service connection is warranted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection generally requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (“nexus”) between the current disability and the disease or injury incurred or aggravated during service. Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013). The most probative evidence in this case is the May 2020 VA medical opinion provided by “Dr. T.M.,” an occupational medicine specialist. After reviewing the claims file, Dr. T.M. concluded that the Veteran’s lung cancer was at least as likely as not caused by in-service exposure to asbestos, chromium, and nickel. Dr. T.M. provided a detailed rationale based on military personnel records, medical records, lay statements, and scientific and occupational literature. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (an opinion is probative when it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data). The 2020 opinion discusses seven risk factors for lung cancer: tobacco use, age, sex, genetics/family history, previous chemotherapy/radiation therapy to the lungs, occupational exposures, and environmental exposures. According to Dr. T.M., the Veteran’s personal risk factors (male sex, family history, and radon exposure growing up in East Saint Louis, Illinois) were outweighed by occupational exposures to asbestos, chromium, and nickel that increased his risk for developing lung cancer. Dr. T.M. explained that as a boatswain’s mate or deck seaman in the Navy, the Veteran would have performed maintenance on steel deck plates containing chromium and nickel. Dr. T.M. found it likely that the Veteran was exposed to asbestos during his eight months aboard the U.S.S. Semmes, which was constructed in the early 1960s when asbestos was commonly used as insulation material throughout Navy warships. Dr. T.M. noted that the Veteran was enrolled in the Navy Asbestos Medical Surveillance Program due to his risk of asbestos exposure. Dr. T.M. highlighted a January 1990 service treatment record indicating the Veteran “walked through areas where they were pulling asbestos” to get to his berthing area. He explained that even though the Veteran did not check the box indicating he had significant asbestos exposure, asbestos particles were likely present in the air he was breathing. He went on to explain that all crewmembers had “bystander exposure” for the same reason, even if they did not work directly with asbestos. Thus, the Veteran was likely unaware that he was breathing asbestos fibers while performing ship maintenance work. Dr. T.M. also discussed the conflicting VA medical opinion provided by “Dr. L.S.,” a pulmonologist, in February 2014. Dr. L.S. found that the Veteran’s lung cancer was less likely than not caused by service, in part because there was no objective evidence that he inhaled asbestos in service. Dr. L.S. noted that chest x-rays and CT scans taken between 1995 and 2012 were all negative for evidence suggestive of other asbestos-related lung disease. On the other hand, Dr. T.M. found it unsurprising that these imaging studies did not detect evidence of asbestos exposure, given the lag period between exposure and the development of disease. Dr. L.S. concluded that the Veteran’s lung cancer was one of the “unfortunate minority of spontaneously-occurring lung cancers” that occur in non-smokers. On the other hand, Dr. T.M. reasoned that his cancer was more likely one of the other 90 percent related to risk factors like asbestos exposure. Overall, the Board finds the 2020 VA medical opinion more persuasive than the 2014 opinion. The 2020 opinion contains more extensive analysis and a well-reasoned explanation for the Veteran’s lung cancer. Unlike Dr. L.S., Dr. T.M. provided a detailed account of the ways in which the Veteran would have been exposed to asbestos while serving aboard the U.S.S. Semmes. Additionally, unlike Dr. T.M., Dr. L.S. did not account for exposures from other sources like chromium and nickel. Accordingly, resolving any reasonable doubt in his favor, the Board finds that the Veteran’s lung cancer was etiologically related to multiple occupational exposures in service. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The appeal is granted. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D.Z. Wall, 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.