Citation Nr: 21026386 Decision Date: 04/30/21 Archive Date: 04/30/21 DOCKET NO. 18-05 977 DATE: April 30, 2021 ORDER Entitlement to service connection for pulmonary hypertension, to include as due to asbestos exposure, is denied. FINDING OF FACT The preponderance of the competent and probative evidence of record does not show that it is as likely as not that the Veteran’s diagnosed pulmonary hypertension is related to service, to include any in-service exposure to asbestos. CONCLUSION OF LAW The criteria for service connection for pulmonary hypertension, to include as due to asbestos exposure, have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309.   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Navy from October 1960 to September 1968. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In a February 2019 decision, the Board denied the Veteran’s claim of service connection for pulmonary hypertension. The decision was appealed to the U.S. Court of Appeals for Veterans Claims (“the Court”), and in January 2020, the parties filed a Joint Motion for Remand (JMR) of the appeal to the Board. In February 2020, the Court granted the motion and vacated the Board’s decision. Entitlement to service connection for pulmonary hypertension, to include as due to asbestos exposure. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. This may be accomplished by affirmatively showing inception or aggravation during service. 38 C.F.R. § 3.303(a). Service connection may also be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred in service. 38 C.F.R. § 3.303(d). For a Veteran who served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for hypertension if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309(a). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “chronic.” Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran contends that his pulmonary hypertension is due to asbestos exposure in service. Service personnel records indicate that the Veteran served aboard the USS Constellation (CVA-64). His military specialties included Electrician’s Mate and Missile Technician, which both have a probable likelihood of asbestos exposure. In statements including in June 2016 and November 2016, the Veteran stated that he was part of the pre-commissioning crew onboard the ship at Brooklyn Naval Yard, and that conditions onboard the ship prior to commissioning were bad. He was part of the electrical crew of the shipyard and worked alongside other workers who were removing old asbestos and replacing it with new applications of asbestos throughout the ship. He only wore a hard hat and safety glasses. The Veteran’s medical records also concede a history of remote exposure to asbestos while in service. Therefore, the Board concedes that the Veteran was exposed to asbestos while in service. The Veteran’s service treatment records do not show treatment for or complaints of pulmonary hypertension or any other pulmonary illnesses or symptoms. The Veteran’s medical records reflect that he has been diagnosed with pulmonary hypertension due to pulmonary embolisms. In 2009, the Veteran went to the emergency room due to shortness of breath and was told that he had blood clots in his lungs. He was treated for deep venous thrombosis and pulmonary embolus with severe pulmonary hypertension in October 2009. The Veteran’s medical records report, by reference, that the Veteran had a history of a pulmonary hypertension in the 1970s; however, there is no documentation confirming this treatment. The Veteran’s medical history also reflects that the Veteran had a history of heavy smoking during his youth. A CT scan taken in October 2010 showed that the Veteran had residual evidence of chronic thromboembolia with marked improvement. In January 2011, the Veteran had an embolectomy of the pulmonary embolus in his pulmonary system. A thrombectomy was performed and the Veteran’s IVC filter was cleaned and replaced. The Veteran also had a right heart catherization procedure and the results were consistent with precapillary pulmonary hypertension. The Veteran’s post-operative diagnoses included chronic pulmonary hypertension; hypercoagulable state, protein deficiency; chronic pulmonary embolism; chronic deep venous thromboses; acute inferior vena cava filter thrombosis; and hypertension. The Veteran’s medical treatment records also note that he smoked one pack of cigarettes a day from the age of 16 to 32. The Veteran underwent VA examinations for heart, respiratory, and artery and vein conditions in December 2016. However, as the parties to the January 2020 JMR found the opinion regarding the etiology of the Veteran’s pulmonary hypertension to be inadequate it need not be further addressed. A CT scan dated in September 2018 shows a diagnosis of pleural plaque with presence of asbestos. A June 2019 Disability Benefits Questionnaire (DBQ) examination shows a diagnosis of pulmonary hypertension. In a July 2020 VA opinion, the examiner after reviewing the claims file opined that it was less likely than not that pulmonary hypertension was incurred in or caused by the claimed in-service injury, event, or disease, including asbestos exposure. The examiner noted that pulmonary hypertension can be asbestos related, however it is usually secondary to an asbestos related disorder. The examiner noted that in the instant case it appears to be related to pulmonary embolism, which is in turn related to cardiovascular diseases rather than an asbestos-related lung disorder. To the extent that the examiner indicated that the Veteran was diagnosed with pulmonary hypertension within the last five years, the examiner in the subsequent February 2021 opinion acknowledged that the Veteran was diagnosed with pulmonary hypertension in October 2009. In a February 2021 VA opinion, the examiner after reviewing the claims file noted that the Veteran was diagnosed with pulmonary hypertension in October 2009 and a CT scan in September 2018 shows a diagnosis of “pleural plague with presence of asbestos”. The examiner also noted that the Veteran’s medical records show a diagnosis of pulmonary embolism status post embolectomy in January 2011 and that pulmonary embolisms are known to cause pulmonary hypertension. The examiner pointed out that an operative note on October 27, 2009 documents a diagnosis of pulmonary hypertension caused by deep vein thrombosis and pulmonary embolism. The examiner opined that the pulmonary hypertension was less likely than not incurred in or caused by the claimed in-service injury, event, or illness based on the rationale that although pulmonary hypertension can be associated with asbestos exposure, medical record review did not reveal consistent clinical evidence for asbestos exposure to negatively impact and proximately cause pulmonary hypertension. The examiner explained that pulmonary hypertension condition was caused by a history of deep vein thrombosis with pulmonary embolism. Thus, the examiner concluded that the diagnosis of pulmonary hypertension is less likely than not incurred in or caused by the claimed in-service injury, event, or disease, including asbestos exposure during service. The Board finds the February 2021 VA opinion to be highly probative as the examiner after reviewing the file opined that the Veteran’s pulmonary hypertension is not related to service to include asbestos exposure. The examiner attributed the Veteran’s pulmonary hypertension to a history of deep vein thrombosis with pulmonary embolism. This opinion is uncontroverted by the other competent evidence of record. In a statement in March 2021 the Veteran appeared to contend that the July 2020 VA opinion is inadequate as the examiner determined that he did not have any other medical disorder that was caused by his asbestos exposure that could have led to hypertension. The Veteran submitted a copy of a private medical record dated in September 2019 that shows that chronic obstructive pulmonary disease (COPD) among other issues was addressed. Although the Veteran contends that the VA examiner did not consider that he was diagnosed with COPD, which he notes VA has agreed is due to service, the Veteran is not service connected for COPD nor does the evidence show that in the instant case the Veteran has COPD due to asbestos exposure in service. As a lay person, the Veteran is competent to report symptoms pertaining to the claimed disorder. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the etiology of his claimed disorder falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). The Veteran’s pulmonary hypertension is not the type of condition that is readily amenable to mere lay diagnosis or probative comment regarding its etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating such disorder. Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value. As the lay evidence is not competent the matter of whether it is credible is not reached. To the extent that the Veteran submitted medical literature in June 2020 showing that pulmonary hypertension can be induced by amosite asbestos, the United States Court of Appeals for Veterans Claims has held that a medical article or treatise “can provide important support when combined with an opinion of a medical professional” if the medical article or treatise evidence discussed generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least “plausible causality” based upon objective facts rather than on an unsubstantiated lay medical opinion. Wallin v. West, 11 Vet. App. 509 (1998). The Board places little probative value on the literature submitted by the Veteran as it was written to explain general medical principles, and not opinions regarding the specific facts in this case. Hypertension is included among the chronic diseases under 38 U.S.C. § 1101 and 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). However, the evidence does not show nor does the Veteran contend that there has been a continuity of symptomatology since service.   Accordingly, because the preponderance of the evidence is against the claim of service connection for pulmonary hypertension, to include as due to asbestos exposure. the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Thomas H. O'Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Mac, 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.