Citation Nr: 21023536 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 17-08 116 DATE: April 20, 2021 ORDER Entitlement to service connection for emphysema is granted. Entitlement to service connection for chronic obstructive pulmonary disorder (COPD) is granted. Entitlement to service connection for hepatitis C is granted. FINDINGS OF FACT 1. The evidence is in at least relative equipoise as to whether the Veteran’s emphysema was aggravated by his service connected posttraumatic stress disorder (PTSD). 2. The evidence is in at least relative equipoise as to whether the Veteran’s COPD was aggravated by his service-connected PTSD. 3. The evidence is in at least relative equipoise as to whether the Veteran’s hepatitis C was proximately due to or the result of his service-connected PTSD. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for emphysema have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310(b). 2. The criteria for entitlement to service connection for COPD have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310(b). 3. The criteria for entitlement to service connection for hepatitis C have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1966 to June 1970. This appeal to the Board of Veterans’ Appeals (Board) arose from a May 2012 rating decision issued by the Department of Veterans Affairs (VA). See August 2013 Notice of Disagreement (NOD); December 2016 Statement of the Case (SOC); January 2017 Substantive Appeal (VA Form 9). The Veteran, unfortunately, died during the pendency of the appeal. His spouse, the Appellant, is the substitute claimant. In May 2016, the Appellant testified before a Decision Review Officer. May 2016 Hearing testimony. The Appellant also testified before the undersigned Veterans Law Judge in a March 2021 hearing. See March 2021 Hearing transcript. Service Connection Service connection may be established on a secondary basis for: (1) a disability which is proximately due to or the result of a service-connected disease or injury; or, (2) any increase in severity of a nonservice-connected disease or injury which is proximately due to or the result of a service-connected disease or injury, and not due to the natural progression of the nonservice-connected disease or injury. 38 C.F.R. § 3.310 (a)-(b); see also 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a); Allen v, Brown, 7 Vet. App. 439 (1996) (en banc); Ward v. Wilkie, 31 Vet. App. 233 (2019). Generally, to prevail on theory of secondary service connection, there must be evidence of (1) a current disability, (2) a service-connected disability, and (3) a nexus, or link, between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 1. Entitlement to service connection for emphysema. 2. Entitlement to service connection for COPD. The Veteran asserted entitlement to emphysema and COPD as secondary to his service connected PTSD. The Appellant testified that the Veteran’s PTSD caused panic attacks with hyperventilation and breathing problems, which aggravated his COPD and emphysema. See March 2021 Hearing transcript. As an initial matter, the Board notes that the Appellant is currently entitled to benefits based on the Veteran’s service-connected PTSD contributing to his COPD, which is listed as the immediate caused his death. See December 2015 Rating decision. The evidence shows that the Veteran had current diagnoses for COPD and emphysema, and that PTSD was a service-connected disability. See May 2013 Private treatment evidence; February 2015 VA examination; May 2012 Rating decision. The question remaining for the Board is whether the Veteran’s COPD and emphysema were aggravated (any increase in severity beyond natural progression) by his PTSD. The Board considered the Appellant’s testimony that the Veteran’s panic attacks appear to cause difficulty breathing. While the Appellant cannot opined as to whether the Veteran’s mental health symptoms caused an increase severity in his underlying COPD or emphysema disease as it is outside her realm of knowledge as a licensed clinical social worker and addiction specialist, she is competent to report observing the Veteran having breathing difficulty coinciding with an increase in his mental health symptoms. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board finds the Appellant’s statements to be probative as to when the Veteran appeared to have increased breathing difficulty. Moreover, the medical treatment evidence shows that the Veteran also reported increased shortness of breath due to his anxiety, and doing reasonably well when he is not anxious. September 2011 Private treatment evidence. The Board also considered the June 2015 opinion from private treatment provider C R, M.D. Dr. C R was the attending physician during the Veteran’s hospitalization leading to his death. June 2015 Private treatment evidence. Dr. C R opined that it was apparent the Veteran’s underlying COPD was more likely than not exacerbated by his PTSD symptoms. Id. As a medical professional and treatment provider for his COPD, Dr. C R is qualified to opine on the contributing causes to the Veteran’s COPD symptoms. The opinion is probative and supports finding the Veteran’s service-connected PTSD aggravated his COPD and emphysema. In addition, the Appellant submitted an article from the European Respiratory Journal that suggests people with PTSD have a higher incidence of COPD and other respiratory conditions. See March 2019 Correspondence. The Board recognizes that the February 2015 and December 2016 VA examiners opined it is less likely than not that the Veteran’s PTSD aggravated his COPD. February 2015 VA examination; December 2016 VA examination. However, the February 2015 VA examiner opined that the Veteran’s COPD is caused by his tobacco abuse and did not have the benefit of the Appellant’s testimony that the Veteran had not smoked in the last 32 years of his life. February 2015 VA examination; March 2021 Hearing transcript. The December 2016 VA examiner noted that there was no medical literature linking PTSD with COPD, but, as discussed above, the Appellant submitted such an article. December 2016 VA examination; March 2019 Correspondence. The VA examiners are medical professionals and their opinions do raise a reasonable doubt as to whether the Veteran’s PTSD aggravated his COPD. In resolving any reasonable doubt in favor of the Appellant, the Board finds that the Veteran’s service-connected PTSD aggravated his COPD and emphysema. Accordingly, entitlement to service connection for COPD and emphysema as aggravated by his service-connected PTSD is warranted. 3. Entitlement to service connection for hepatitis C. The Veteran asserted entitlement to service connection for hepatitis C as a disease incurred during service. August 2013 NOD. The Appellant testified at the March 2021 Board hearing that the Veteran never discussed why he believed the onset of his hepatitis was during service, but she did testify during the prior May 2016 hearing that she believes the Veteran’s hepatitis C was from his history of IV drug abuse. See May 2016 Hearing testimony; March 2021 Hearing transcript. The Appellant testified that the Veteran abused drugs as a way to cope with his PTSD symptoms. May 2016 Hearing testimony. After careful and thorough consideration of the evidence, the Board finds that the evidence is in at least relative equipoise as to whether the Veteran’s hepatitis C is proximately due to or the result of his service-connected PTSD. The Board does not dispute that the Veteran had a current disability of hepatitis C and that he was service-connected for PTSD. April 2001 Private treatment evidence; May 2012 Rating decision. The Board also finds the Appellant’s testimony that the Veteran’s IV drug abuse was to self-medicate his PTSD symptoms to be probative as she is a licensed clinical social worker and addiction worker. A review of the medical treatment evidence shows that the Veteran’s private treatment provider noted the Veteran’s history of IV drug abuse with his contraction of hepatitis C. See April 2001 Private treatment evidence. His treatment provider also indicated that the Veteran was first diagnosed with hepatitis C in 1999, but the history of elevated hemoglobin and hematocrit may suggest hepatitis C infection by 1995 or earlier. See id. The claims file does not contain a VA examination or other evidence suggesting a different cause for the Veteran’s hepatitis C. In resolving any reasonable doubt in favor of the Appellant, the Board finds the Appellant’s testimony and the medical treatment evidence supports finding the Veteran’s hepatitis C as proximately due to or the result of his service-connected PTSD. Accordingly, entitlement to service connection for hepatitis C as proximately due to or the result of the Veteran’s service-connected PTSD is warranted. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Lin 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.