Citation Nr: 21022804 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 15-35 248 DATE: April 19, 2021 ORDER Entitlement to service connection for an idiopathic cough, to include as due to asbestos exposure, is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran’s idiopathic cough began during service or is etiologically related to an in-service injury or disease, including claimed asbestos exposure. CONCLUSION OF LAW The criteria for service connection for an idiopathic cough are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1966 to July 1970. He also served in the Air National Guard. This case is before the Board of Veterans’ Appeals (Board) on appeal from a May 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2017, the Veteran notified the Board that he withdrew his request for a hearing before a Veterans Law Judge pursuant to 38 C.F.R. § 20.704(e). In December 2020, during the pendency of this appeal, the Veteran was granted service connection for dental treatment purposes. As this represents a full grant of the benefit sought on appeal, this issue is no longer before the Board. This matter was previously remanded for additional development in a February 2019 Board decision. The Board finds that there has been substantial compliance with those remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with its remand instructions and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand); see also D’Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only substantial rather than strict compliance with the Board’s remand directives is required under Stegall). Entitlement to service connection for a dry cough Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The Veteran contends that his dry cough developed while he was on active duty serving at Kessler Air Force Base in 1969. See November 2020 correspondence from the Veteran. When he initially filed his claim, he theorized that his dry cough was caused by exposure to asbestos in service. See June 2010 compensation claim. The Veteran has been diagnosed with an idiopathic cough; thereby establishing the current disability element of the service connection claim. See October 2019 VA examination. The Veteran has not been diagnosed with asbestosis or asbestos related lung disease. See July 2020 VA opinion. However, the Board finds that the preponderance of the evidence is against finding that the in-service incurrence element of the service connection claim has been established. The service treatment records (STRs) do not document complaints or treatment related to a chronic cough or more broadly a respiratory condition. A May 1970 medical examination conducted at separation noted a normal clinical evaluation for the Veteran’s lungs and chest and reflected a normal chest x-ray. In a May 1970 report of medical history completed by the Veteran at separation, he responded “no” to the question “have you ever had or have you now” a chronic cough. Although the Veteran is competent to report that he first developed his cough during service, as a cough can be observed by a lay person, see Layno v. Brown, 6 Vet. App. 465, 471 (1994), the Board does not find his account credible. His contention that his cough began on active duty is inconsistent with several other statements made by him regarding the onset of his dry cough. See Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (when determining the credibility of lay evidence, the Board may properly consider internal consistency and consistency with other evidence of record). Specifically, as just noted, in May 1970 at separation from service, the Veteran reported that he did not have a chronic cough. During his October 2019 VA examination, the Veteran reported that his dry cough started in 2017, stating that he first noticed it during his walks when he would have to sit down midway through a walk due to a dry cough. Finally, he stated that his cough developed in the late 1990’s after surgery to have his adenoids and uvula removed to correct a sleep disorder. See November 2020 statement. In a May 2014 statement, Sergeant W.T., a fellow servicemember, also noted that the Veteran complained of a bad cough while he was on active duty. The Board has considered this post-service statement but affords more probative weight to the contemporaneous medical records, to include the STRs which as discussed above, do not document a cough during service. Regarding exposure to asbestos during service, in August 2010, the AOJ sent the Veteran a letter requesting that he provide information regarding his exposure to asbestos. He was asked to describe when, where, and how he was exposed to asbestos. Unfortunately, the Veteran did not respond to that request for information. To date, the Veteran has not provided any evidence or information to support his contention that he was exposed to asbestos during his military service. Accordingly, the Board finds that there is not sufficient evidence to concede that the Veteran was exposed to asbestos or to require further development. Based on the above analysis, the Board finds that the preponderance of the evidence is against finding that an injury or disease was incurred in service. Further, the preponderance of the evidence is against finding a nexus between the Veteran’s idiopathic cough and service. Specifically, October 2019 and July 2020 VA examiners opined that the Veteran’s currently diagnosed idiopathic cough (dry persistent cough) was less likely than not incurred in or related to service. The July 2020 VA examiner explained that there was no evidence of a chronic cough or respiratory condition in service and noted that the May 1970 separation exam was negative for shortness of breath or cough. He reasoned that multiple periodic exams from the Veteran’s time in the Air National Guard were negative for cough and shortness of breath and noted that a November 1986 routine pulmonary function test was normal. He explained that the record was negative for any respiratory or cough condition until at least 2002. In sum, he opined that a cough or respiratory condition was not present at separation and no care or complaints were noted proximate to service. Regarding claimed asbestos exposure, the examiner noted that there was no evidence of asbestosis or asbestos-related lung disease. Therefore, he noted that in the absence of any x-ray or pulmonary function test documenting an asbestos related disease, he found that there was no evidence that the Veteran had any condition related to asbestos exposure while in service, including a dry cough. An October 2019 VA examiner also opined that the Veteran’s dry cough was less likely than not incurred in or caused by service, explaining that there was no evidence of a dry cough during service and no objective chronicity of care. Further, the examiner noted that there was no subjective or objective data to suggest a specific etiology for the Veteran’s cough and noted that he denied any aggravating factors. In this case, the Board affords the July 2020 VA examiner’s opinion significant probative weight. The examiner reviewed the claims file, thereby considering the STRs and any post service treatment for a cough. He also took into account the onset and course of the Veteran’s dry cough by reviewing the October 2019 VA examination where the Veteran reported that his cough began in 2017, noting that it would occur when he walked and he was unsure was caused it. He offered a well-reasoned rationale that contains supporting facts from the record and is consistent with other evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning; a threshold consideration is whether the person opining is sufficiently informed). In rendering his opinion, the examiner considered the over thirty year gap between service and documentation of a cough condition, in addition to the normal medical evaluations and pulmonary function test for the chest and lungs during active duty and while serving in the Air National Guard. Ultimately, the VA examiner determined that his dry cough was not related to service, including claimed in-service asbestos exposure. Further, although an October 2019 VA examiner failed to address the Veteran’s contention that his dry cough was the result of in-service asbestos exposure, the Board finds that his opinion is still entitled to some probative weight. The VA examiner conducted an in-person examination, reviewed the claims file, and considered the Veteran’s statements regarding the onset and course of his dry cough, including his report that his cough began in 2017 and occurs randomly. He also provided a rationale, explaining that there was no in-service documented complaints of a cough and no chronicity of care after service. Further bolstering the 2019 and 2020 VA examiners’ opinions that the Veteran’s dry cough is less likely than not related to active duty service, are medical records from his time in the Air National Guard which do not show evidence of a continuous cough since discharge from active duty in May 1970. Specifically, medical examinations dated in March 1975, August 1976, August 1979, November 1986, and September 1990 reflect normal clinical evaluations for the Veteran’s chest and lungs. In reports of medical history dated in March 1975, August 1979 and February 1983, the Veteran specifically reported that he did not have a chronic cough. The Board has considered the Veteran’s assertion that his current chronic cough is related to his active duty service. While the Veteran is competent to report that he frequently coughs, he is not competent to link his cough to a particular etiology, including service and/or in-service asbestos exposure. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Determining the likelihood that a chronic cough is related to service is a complex medical question, and the Veteran has not been shown to have the experience, training, or education necessary to give an etiology opinion. Consequently, the Board gives more probative weight to the medical evidence of record. In summary, the preponderance of the evidence is against a nexus between the Veteran’s currently diagnosed idiopathic cough and his active duty service. As the preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply, and the claim for service connection for an idiopathic cough must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Alison M. Mecone, 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.