Citation Nr: 21027726 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 16-14 160 DATE: May 6, 2021 ORDER Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is denied. Entitlement to service connection for a skin disorder is denied. FINDINGS OF FACT 1. The currently diagnosed COPD is not etiologically related to an in-service injury, disease, or event, to include trichloroethylene exposure during service. 2. The currently diagnosed skin disorder is not etiologically related to an in-service injury, disease, or event, to include trichloroethylene exposure during service. CONCLUSIONS OF LAW 1. The criteria for service connection for COPD are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a skin disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1965 to March 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in August 2019. A transcript of that hearing has been associated with the claims file. Previously, the Board remanded the matter for further development to include obtaining VA examinations and opinions. The matter has returned for adjudication. Service Connection Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). 3. Entitlement to service connection for COPD. The Veteran contends that he is suffering from chronic obstructive pulmonary disease (COPD) as a result of his service. Specifically, the Veteran cites his exposure to trichloroethylene in the cleaning agents used in maintaining missile components as a missile fire control crewman in the Army. See August 2019 hearing transcript. In terms of present disability, the Veteran has a current diagnosis of COPD. As such, the evidence demonstrates the existence of a current disability, meeting the first requirement for the establishment of service connection. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). In considering in-service incurrence, the Board notes the Veteran's February 1968 separation exam records noted complaints of shortness of breath, frequent colds, and sinusitis. The second Shedden element, that of an in-service incurrence, has thus also been met. The question remaining for the Board is whether a nexus exists between the Veteran's currently diagnosed COPD and his respiratory complaints or exposure to trichloroethylene in service. In October 2013 a VA examiner was asked to provide an opinion and rationale as to whether the Veteran's current respiratory condition is at least as likely as not related to in-service complaints of shortness of breath in 1968. The examiner opined that there is no current or historical medical evidence found that would connect the current pulmonary condition to the in-service respiratory complaint. According to the examiner, no continuation or etiologic association was established. His pulmonary condition was first diagnosed via spirometric testing in 2008. The examiner opined a likely cause of the Veteran's restrictive pulmonary state at that time was coexisting central obesity. In a December 2013 lay statement, the Veteran's wife stated her belief after research and discussion with the Veteran's primary care physician that 90 percent of the Veteran's current medical problems, including COPD, comes from his unprotected handling of trichloroethylene. A January 2016 letter from a private physician stated it is likely that exposure to trichloroethylene in the Army was a major contributing factor in the onset of the Veteran's COPD. The physician noted the Veteran has been having shortness of breath, wheezing, and cough with expectoration since his time in the Army and on occasion has coughed up blood. The doctor noted the Veteran did not recall having those symptoms prior to service. In an August 2019 hearing before the Board, the Veteran testified that his service treatment record showing a diagnosis of upper respiratory tract infection and acute pharyngitis reflects the onset of his COPD. He stated he never had anything like that before. The Veteran testified that he was being treated with oxygen and breathing treatments. Moreover, he testified a private physician has related his COPD to military service. He stated the doctor has said exposure to chemicals is a major contributing factor in the onset of COPD. With regard to his smoking, the Veteran testified he did not smoke cigarettes when he first went into the Army or when he got out and started smoking maybe 10 years ago. The Veteran further testified he was hesitant to seek treatment for breathing problems because he did not want to risk missing work. Finally, the Veteran testified to his experience in the military washing missile parts, and the accompanying exposure to trichloroethylene. The Veteran's wife also testified at the August 2019 hearing. She recalled the onset of his breathing problems after he got out of service. She stated her belief that the Veteran's exposure to trichloroethylene was responsible for the Veteran's COPD and that she believes his doctors feel the same way. A February 2020 VA examiner's opinion stated the Veteran's claimed COPD was less likely than not related to the Veteran's service. Rather, the examiner concluded the Veteran's COPD is from 30 years of smoking. The examiner noted the Veteran was smoking up to a pack a day, continues to smoke today, and that there is no known association between trichloroethylene and COPD. Thus, the examiner concluded the Veteran's COPD is less likely than not incurred in, caused by, or otherwise etiologically related to service, to include in-service exposure to trichloroethylene. In August 2020, the VA examiner provided an addendum opinion considering private medical opinions of record as well as the Veteran's reported continuity of symptomatology since leaving service. Specifically, the examiner was requested to discuss private opinions stating that it is likely that the Veteran's exposure to trichloroethylene was a major contributing factor in the onset of COPD. The examiner stated that upon review of the relevant evidence, a change in the opinion was not warranted. The examiner maintained that the Veteran's COPD resulted from 30 plus years of smoking and there is no association with trichloroethylene and COPD. Thus, the examiner once again concluded the Veteran's claimed COPD is less likely than not incurred in, caused by, or otherwise etiologically related to service, to include in-service exposure to trichloroethylene. The Board has considered in detail the medical opinions of record, specifically the October 2013 VA examiner's opinion, and the February 2020 VA examiner's opinion as well as the subsequent August 2020 addendum that found the Veteran's COPD not to be related to service, and the January 2016 private physician's opinion that the Veteran's COPD is likely related to service. In this regard, the Board finds that the February 2020 and August VA examiners' opinions to be probative, as they are based on both review of the record and examination of the Veteran and contain fully articulated and sound reasoning for the conclusions provided. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board has considered the private medical opinion provided by the Veteran. The Board finds that the probative value of the January 2016 private opinion is limited. The probative value of a medical opinion comes from the factually accurate, fully articulated, and sound reasoning for the conclusion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). However, the January 2016 opinion is merely conclusory, without analysis or rationale. The Board thus finds that this opinion is inadequate and affords this assertion little probative weight. Stefl, 21 Vet. App. at 124. Additionally, the Board has considered the Veteran's lay assertions as well as those of his wife that his COPD is related to chemical exposure in service. While the Veteran and his wife believe his COPD is related to service, they have not shown that they have specialized training sufficient to render such an opinion. See Jandreau, 492 F.3d at 1376-77. In this regard, the diagnosis and etiology of COPD is a matter not capable of lay observation and require medical expertise to determine. Accordingly, the Veteran's opinions, and those of his wife, as to the diagnosis or etiology of this disability are not competent medical evidence. Moreover, whether the symptoms the Veteran experienced in service or following service are related to his current disability is a matter that also requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999). Thus, the Veteran's own opinion regarding the etiology of his COPD is not competent medical evidence. The Board finds the opinion of the VA examiner to be significantly more probative than the Veteran's lay assertions. Importantly, as noted above, the competent and probative evidence of record outweighs the Veteran's contentions. Based on the above, the Board finds that service connection for a COPD is not warranted. The preponderance of the evidence reflects that the Veteran's current COPD was not caused by any in-service exposure to chemicals, or any other incident of service. See 38 C.F.R. § 3.303(b). The Board affords the VA examiner's opinions great probative weight because they are based on a thorough review of the Veteran's claims file and because the examiner provided a well-explained rationale for the conclusions. 4. Entitlement to service connection for a skin disorder. The Veteran contends that he is suffering from a skin disorder as a result of his service. Specifically, the Veteran cites his exposure to trichloroethylene in the cleaning agents used in maintaining missile components as a missile fire control crewman in the Army See August 2019 hearing transcript. In terms of present disability, the Veteran's medical treatment records show has a current diagnosis of atopic dermatitis. As such, the evidence demonstrates the existence of a current skin disorder, meeting the first requirement for the establishment of service connection. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). In considering in-service incurrence, the Board notes the Veteran's service treatment records are silent regarding the claimed skin disorder, and the separation examination evaluated the Veteran's skin as normal. However, the Board acknowledges the Veteran's and his wife's contentions that the Veteran has experienced rashes and other skin disorders since within a year of his separation from service. The Board notes that the Veteran is competent to testify to observable symptomatology. The Board finds no reason to doubt the Veteran's credibility. Accordingly, the second Shedden element has been met and the Board will now turn to the question of nexus. The Veteran contends that he is suffering from a skin disorder as a result of his service. Specifically, the Veteran cites his exposure to trichloroethylene in the cleaning agents used in maintaining missile components as a missile fire control crewman in the Army. See August 2019 hearing transcript. The Veteran's wife submitted a December 2013 lay statement recounting her experience with the Veteran's claimed disorder. In her letter, she stated the Veteran would suffer from strange looking rashes on his arms, legs, hands and scalp during and following his time in service. She stated the Veteran expressed frustration at not knowing why he had the skin problem and what caused it since he did not have a problem when he joined the military. A September 2014 letter from a private dermatologist noted the Veteran had been seen because of a rash on his trunk and extremities which was clinically an allergic contact dermatitis. The dermatologist noted the Veteran had multiple episodes of allergic contact dermatitis in active service and had the same rash that was seen in the September 2014 visit on and off since that time. The dermatologist opined it could be due to a chemical exposure in service, but did not offer a definitive opinion or skin test. Rather the dermatologist deferred to the VA as the Veteran had plans to follow up there. Finally, the dermatologist noted by the Veteran's history the allergen causing the rash appears to be the same thing, but was unsure how the Veteran was continuing to come into contact with it. The dermatologist noted a "persistent reactor" situation would be unlikely, but theoretically possible. A November 2014 opinion from a private treatment provider noted the Veteran has a continued history with a rash on his trunk and lower extremities that has been ongoing since he was in service. The physician noted the Veteran had relayed that he may have been exposed to something while on active duty that initially caused this and that the Veteran has been seen by a dermatologist on several occasions for the issue. Finally, the physician noted no definitive evaluation had been done, other than referring to dermatology, and recommended the Veteran follow up with VA. A January 2016 letter from a private dermatologist again noted the Veteran was dealing with a rash of the trunk and extremities which has been consistent with allergic contact dermatitis. The dermatologist stated the etiology was unclear, but noted there was concern prolonged exposure to trichloroethylene while on active duty may have resulted in allergy to this substance and the persistent dramatic eruption for which the Veteran was being treated. In an August 2019 hearing before the Board, the Veteran testified that he began having rashes on the skin on his hands, face, and legs in 1968, not long after he got out of the service. The Veteran maintained he has been seeing various dermatologists since he left service and had been treated with creams, different types of lotion, soaps, and antihistamines. The Veteran testified those treatments eased the problem, but did not fix them. At the time of the hearing, the Veteran testified he had pimples and raw skin on the backs of his hands and groin. He stated that dermatologist or doctors would usually tell him it was acute dermatitis. The Veteran's wife also testified at the August 2019 hearing. She stated they have been married for 52 years and the issue has been going on since 1968, within a year of his separation from the military. In a February 2020 VA examination, the Veteran stated his claimed skin disorder began in the 1970s, that he gets bumps and rashes all over his body and the severity of the disorder waxes and wanes. The examiner noted the Veteran had a few bumps on his scalp at the time of the examination. The examiner gave a diagnosis of atopic dermatitis. After a review of the pertinent medical records was performed and Veteran's verbal testimony was obtained, and a physical examination as performed, the examiner concluded that there is not sufficient evidence to substantiate the Veteran's contention for service connection. The examiner stated the Veteran's skin condition is very mild, that the Veteran had a very small lesion on his scalp during the exam, that is atopic dermatitis which is idiopathic and not caused by his service or trichloroethylene. In the opinion of the examiner, if the Veteran's claimed condition were related to trichloroethylene it would be more present on his hand, but the Veteran did not report any lesion on his hand. In August 2020, the VA examiner provided an addendum opinion considering private medical opinions of record as well as the Veteran's reported continuity of symptomatology since leaving service. The examiner stated that upon review of the relevant evidence, a change in the opinion was not warranted. Upon review of the evidence, the examiner concluded that the disorder diagnosed as atopic dermatitis is less likely than not incurred in service, within one year of his separation from service, or is otherwise related to his time in service, to include in-service exposure to trichloroethylene. By way of rationale, the examiner again explained that the Veteran's atopic dermatitis is idiopathic and that if it were related to service, it would be more severe, particularly on the areas of his body, such as his hands, that were directly exposed to chemicals. The Board has considered in detail the medical opinions of record, specifically the February VA examiner's opinion as well as the subsequent August 2020 addendum that found the Veteran's skin disorder not to be related to service, and the September 2014, November 2014, and January 2016 private treatment opinions that stated the Veteran's COPD is likely related to service. In this regard, the Board finds that the VA examiner's opinions to be probative, as they are based on both review of the record and examination of the Veteran and contain fully articulated and sound reasoning for the conclusions provided. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board has considered the September 2014, November 2014, and January 2016 private opinions supplied by the Veteran and finds their probative values limited. The probative value of a medical opinion comes from the factually accurate, fully articulated, and sound reasoning for the conclusion. Nieves-Rodriguez v. Peake 22 Vet. App. 295 (2008). However, each of the opinions is speculative in nature and does not provide the degree of certainty required for persuasive nexus evidence in this case. Although the opinions consider the Veteran's military history and medical history, they state the Veteran's exposure to trichloroethylene "may" or "could" have contributed to his current claimed skin disorder. Further, these opinions do not provide any rationale for the conclusion that the Veteran's atopic dermatitis is possibly related to service. Thus, the Board assigns these opinions little probative value. Additionally, the Board has considered the Veteran's lay assertions as well as those of his wife that his skin disorder is related to chemical exposure in service. While the Veteran and his wife believe his disorder is related to service, they have not shown that they have specialized training sufficient to render such an opinion. See Jandreau, 492 F.3d at 1376-77. In this regard, the diagnosis and etiology of atopic dermatitis is a matter not capable of lay observation and require medical expertise to determine. Accordingly, the Veteran's opinions, and those of his wife, as to the diagnosis or etiology of this disability are not competent medical evidence. Moreover, whether the symptoms the Veteran experienced in service or following service are in any way related to his current disability is a matter that also requires medical expertise to determine. See Clyburn v. West, 12 Vet. App. 296, 301 (1999)). Thus, the Veteran's own opinion regarding the etiology of any skin disorder is not competent medical evidence. The Board finds the opinion of the VA examiner to be significantly more probative than the Veteran's lay assertions. Importantly, as noted above, the competent and probative evidence of record outweighs the Veteran's contentions. Based on the above, the Board finds that service connection for a skin disorder is not warranted. The preponderance of the evidence reflects that the Veteran's current skin disorder was not caused by any in-service chemical exposure, or any other incident of service. See 38 C.F.R. § 3.303(b). The Board affords the VA examiner's opinions great probative weight because they are based on a thorough review of the Veteran's claims file and because the examiner provided a well-explained rationale for the conclusions. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.N. Bush, 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.