Citation Nr: 21026102 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 16-24 925 DATE: April 29, 2021 ORDER Service connection for a chronic respiratory disorder is denied. FINDINGS OF FACT 1. The Veteran had active duty from January to April 1991, to include service in the Southwest Asia Theater from January to March 1991; he is in receipt of a 100 percent disability based on unemployability. 2. A respiratory disorder, diagnosed as asthma, was not shown in service and is not casually or etiologically related to service; further, objective symptoms of an undiagnosed illness or a medically unexplained chronic multi-symptom illness (MUCMI) causing a respiratory disorder are not shown. CONCLUSION OF LAW A chronic respiratory disorder, to include as due to a MUCMI, was not incurred in service. 38 U.S.C. §§ 1101, 1110, 1112, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.309, 3.310, 3.317 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a presumptive basis for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability, including an undiagnosed illness or a MUCMI that is defined by a cluster of signs or symptoms, such as chronic fatigue syndrome, fibromyalgia, and other functional disorders. The disability must manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War (PGW), or to a degree of 10 percent or more not later than December 31, 2021. An undiagnosed illness is one which, by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317; 81 Fed. Reg. 71, 382-84 (Oct. 17, 2016). Turning first to direct service connection, the Veteran was diagnosed with asthma in 2005. Therefore, a current disorder is shown, and the first element of direct service connection is met. As to an in-service incurrence, the Veteran contended that he developed asthma from in-service environmental exposure; however, service treatment records (STRs) are absent of complaints, diagnoses, or treatment for a respiratory disorder. Specifically, in-service examinations showed that the lungs were normal. Further, while he answered “yes” to being diagnosed with asthma in a 2003 examination, he was not on active duty at this time. Nevertheless, personnel records reflect that he served in Saudi Arabia from January to March 1991. Therefore, he served in the Southwest Asia Theater during the PGW. Further, the Veteran is competent to report exposure to things such as smoke, dust, and haze, as that is something that may be perceived by use of his senses. Based on the above, the second element of direct service connection is met. As to nexus, in an April 2016 VA examination, the examiner opined that asthma was less likely than not incurred as a result of exposure to environmental hazards. Specifically, the examiner explained that a scientific study showed that the major causes of Gulf War Illness came from being at the front lines, use of bromide tablets, and use of pesticides. However, he noted that the Veteran did not have any specific exposures. Further, the examiner noted that it was unclear as to whether the Veteran was downwind of a munitions explosion that occurred in the Southwest Asia Theater in 1991. Therefore, he found that the evidence did not show that asthma was at least as likely as not incurred in service. This evidence weighs against the claim. In a July 2019 VA opinion, the clinician opined that a respiratory disorder was less likely than not incurred in service. He reasoned that the Veteran was an Air Force Reservist who was deployed to the Persian Gulf from January to March 1991. He noted that the Veteran was stationed at King Fahd International Airport and flew to King Khalid city a few times. However, as the Veteran was not sent to Iraq or Kuwait and was over 400 kilometers from oil well fires and smoke, he did not incur significant exposure to oil well fire, smoke, and soot. Further, the clinician noted that the Veteran had adult onset asthma and that asthma did not have a latency period of onset. In addition, he cited a scientific study that showed that there was not a strong association between oil well fire smoke and risk of asthma. This evidence weighs against the claim. In July 2020, the Board remanded the claim for an addendum opinion. In an August 2020 VA opinion, the clinician opined that it was less likely than not that a respiratory disorder was incurred in service. While the clinician noted that the etiology of a respiratory disorder could not be determined without speculation, he reflected that he based his opinion on the 12-14 year time period separating the Veteran’s lung symptoms and service exposure and the fact that the Veteran had a Body Mass Index greater than 30, which was known to be a risk factor for developing respiratory disorders. This evidence weighs against the claim. There is no medical evidence contradicting the above medical opinions. Based on the above, the medical evidence does not support that a chronic respiratory disorder was directly incurred in service. To the extent that the Veteran asserts that symptoms of a respiratory disorder are due to an undiagnosed illness or an MUCMI incurred as a result of PGW service, in an April 2016 VA examination, the examiner wrote that asthma represented a disability pattern that was a disease with a clear and specific etiology and diagnosis. The Veteran has reported objective signs of a respiratory disorder that manifested after his return from the Gulf War; however, the nonproductive nature of his diagnosed disorder supports a finding that these manifestations have not been shown to a degree of 10 percent. Further, as the April 2016 VA examiner explained, the Veteran did not have a diagnosed illness for which no etiology had been established or symptoms that may represent an undiagnosed illness or MUCMI. As there are no showings of an undiagnosed illness present to a degree of 10 percent and no established relationship between the Veteran’s respiratory disorder and in-service exposure to environmental hazards, the medical evidence weighs against the claim. In sum, the medical evidence does not support the claim that a respiratory disorder was incurred in service, to include as a result of an undiagnosed illness or an MUCMI due to Gulf War service. The Board has considered the Veteran’s assertions that a respiratory disorder began in service. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to offer an etiology of this disorder. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to   address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Ragofsky, Attorney Advisor 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.