Citation Nr: 21022959 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 18-36 831 DATE: April 19, 2021 ORDER Service connection for bronchiectasis is granted. FINDING OF FACT The Veteran has a current diagnosis of bronchiectasis due to active service. CONCLUSION OF LAW The criteria for service connection for bronchiectasis have been met. 38 U.S.C. §§ 1131, 1154(a), 5107; 38 C.F.R. § 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1960 to July 1963. This matter originally came before the Board of Veterans’ Appeals (Board) from a July 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board for further development in October 2018. This matter is again before the Board and has been advanced on the docket pursuant to 38 C.F.R. § 20.902(c). Service connection for bronchiectasis is granted. Generally, service connection will be granted if the evidence demonstrates that a current disability resulted from a disease or injury incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 C.F.R. § 3.303. A current disability exists when a veteran has the disability at the time that the claim for service connection is filed or at any point during the pendency of the claim. See McClain v. Nicholson, 21 Vet. App. 319 (2007). Direct service connection requires competent evidence showing: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the veteran will receive the benefit of the doubt. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The first element for direct service connection is the existence of a current disability. Evidence in favor of a current diagnosis of bronchiectasis includes medical records from the Veteran’s pulmonologist, who has treated the Veteran since 2008 until at least 2018, which show a diagnosis of bronchiectasis. See March 2019 Medical Treatment Record; December 2017 Medical Treatment Record. Medical records from 2015 show that a recent CT scan revealed a lung scar. See May 2017 CAPRI. A 2016 CT scan showed an opacity of the right lung base, most likely due to scarring. See July 2020 C&P Exam. Finally, medical records from 2016 show an abnormal lung scar. See May 2017 CAPRI. Evidence against a diagnosis of bronchiectasis consists of a medical opinion which stated that imaging studies up to 2017 did not document the characteristic features of bronchiectasis or scarring. See May 2018 Medical Opinion. Based on the evidence of record, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran has a current diagnosis of bronchiectasis. Therefore, giving the Veteran the benefit of the doubt, the first element of direct service connection is met. The second element for direct service connection is the in-service incurrence or aggravation of a disease or injury. Service records show that the Veteran had lobar pneumonia in December 1961 while in Japan and was treated at the base hospital. He was released after about three weeks. The Veteran additionally had other respiratory problems during service, including upper respiratory infections and bronchitis. See March 2017 STR – Medical. Therefore, the second element of direct service connection is met. The third and final element for direct service connection is the causal relationship between the current disability and the disease or injury incurred or aggravated during service. Evidence in favor of a relationship includes a November 2018 medical opinion from the Veteran’s pulmonologist. The opinion stated that the Veteran was hospitalized for pneumonia during service, during which time he apparently required an oxygen tent and antibiotics for his serious illness. A 2014 CT scan showed bronchiectasis which was consistent with previous pneumonia. The Veteran’s current bronchiectasis resulted from his previous pneumonia. See March 2019 Medical Treatment Record. The Board finds the November 2018 medical opinion highly probative. Specifically, the opinion was given by a specialist of the respiratory system who has treated the Veteran for years, and the opinion is based on an adequate rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board also notes that the Veteran’s pulmonologist previous stated that the Veteran’s in-service pneumonia could have caused bronchiectasis and scarring of the lungs. See December 2017 Medical Treatment Record. Evidence against a relationship includes a July 2019 VA examination from an advanced registered nurse practitioner, which found that the objective evidence went against the in-service pneumonia resulting in bronchiectasis because there were no available medical records for review until the Veteran came to VA. The examination also found that the Veteran did not require an oxygen tent while being treated for his in-service pneumonia. See July 2020 C&P Exam. The Board finds the July 2019 VA examination inadequate, among other reasons, because it did not consider/was unable to consider all the relevant evidence of record. Specifically, among other evidence, the examination did not consider/was unable to consider the Veteran’s report that he spent three weeks in an oxygen tent while hospitalized during service. See December 2017 NOD. As such, the Board gives this examination less probative weight than the November 2018 medical opinion. Based on the evidence of record, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran’s bronchiectasis is related to service. Therefore, giving the Veteran the benefit of the doubt, the third and final element of direct service connection is met. Service connection for bronchiectasis is granted. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Dougan, 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.