Citation Nr: 21030222 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 10-19 861 DATE: May 18, 2021 ORDER Service connection for a lung condition, to include coccidioidomycosis, is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran's a lung condition, to include coccidioidomycosis, began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a lung condition, to include coccidioidomycosis, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1969 to September 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2008 rating decision, in which service connection for a lung condition was denied. In March 2012, a hearing was held before a Veterans Law Judge (VLJ) no longer with the Board, and a transcript is of record. By letter dated in June 2018, the Veteran waived his right to an additional hearing. See 38 U.S.C. § 7107(c); 38 C.F.R. § 20.604 (formerly 20.707). In November 2012, September 2013, February 2014, December 2014, August 2015, July 2018, and January 2020, the Board remanded this issue for further development, and the case has been returned for appellate consideration. The Board finds that all due process requirements have been fulfilled and that the record is sufficiently developed such that the Board is fully informed as to the nature and etiology of the Veteran's claimed disability. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A; 38 C.F.R. § 3.159. The Veteran has not contended otherwise. Service Connection 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. The three-element test for service connection requires evidence of: (1) 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 in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). For those who had active service in the Republic of Vietnam between January 9, 1962, and May 7, 1975, service connection for certain enumerated diseases may be based upon presumed exposure to an herbicide agent, such as Agent Orange. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6)(iii), 3.309(e). The Veteran seeks service connection for the loss of his left lung in 1993, contending that it is related to in-service exposure to herbicide agents. See Statement, received 5/22/2008. Medical records show that in February 1993 the Veteran was discharged from the hospital with a diagnosis of pulmonary coccidioidomycosis, also referred to as "Valley Fever," which had been treated with antifungal medication and surgery. See VA Form 21-4142, received 3/5/2013; see also CAPRI, received 8/19/2019. The Veteran underwent total decortication of the left lung and segmental resection of the posterior and lateral segments of the left lower lobe. See VA Form 21-4142, received 3/5/2013. The pathology report of examination of removed lung tissue stated there were spherules filled with endospores that stained positive with special fungal stains. Id. A March 1993 infectious disease consultation note shows that the Veteran had been a long-distance truck driver, traveling extensively in the desert Southwest. Id. He developed pneumonitis, which was eventually diagnosed from cultures from the pleural fluids as pulmonary and pleuro coccidioidomycosis. Id. It was noted that chest X-rays showed elevation of the left hemidiaphragm, surgical clips in place, "indicating evidence of lobectomy," moderate pleural scarring, no obvious acute pleural fluid, but a pleural plaque was present. Id. Treatment required long-term prescription of anti-fungal medication. A March 2013 CT of the chest revealed post-operative changes of the left lower lobe with scarring and volume loss. See CAPRI, received 8/19/2019. This medical evidence establishes that the first Shedden element is met. The Veteran served in Vietnam from approximately April to September 1970. See MPR, received 5/19/2009. Consequently, he is presumed to have been exposed to herbicide agents, and the second Shedden element is met. His service treatment records and military personnel records are silent for any lung complaints. The issue in this case comes down to nexus, meaning whether the Veteran's coccidioidomycosis began during his active duty service or is otherwise related to service, to include exposure to herbicide agents. Coccidioidomycosis is not on the enumerated list for presumptive service connection under 38 C.F.R. §§ 3.307(a)(6)(iii) and 3.309(e), and therefore, the third Shedden element cannot be met presumptively. Nevertheless, a claim for direct service connection as due to exposure to herbicide agents may be substantiated by presentation of competent evidence, scientific and medical, relating a disability to actual exposure to herbicide agents. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). After service, the Veteran became a long-haul truck driver, driving through California, New Mexico, Nevada, Arizona, Texas, and Arkansas. On a trip in late 1992, he became ill with fever, chills, and pneumonia, such that he was hospitalized. After several weeks, he was flown back to his home state where he was hospitalized. As noted above, he was found to have coccidioidomycosis and underwent thoracotomy with left lower lobectomy and decortication of empyema. He does not have any current residuals of the condition. See Hearing Testimony, received 3/15/2012; C&P Exam (Respiratory), received 1/23/2020. A VA examining clinician opined that it was less likely than not that the Veteran's coccidioidomycosis was related to service. See C&P Exam (Respiratory), received 1/23/2020. It was explained that "Valley Fever" coccidioidomycosis is only endemic or present in the southwest United States and upper Mexico. The organism must be inhaled, and, once infected, the infection cannot be passed from person-to-person. It was explained that the Veteran frequently drove in these states and that getting in and out of his truck in those locales was the "sole reason for his exposure and infection and treatment." It was stated that coccidioidomycosis "is not ever found in Asia" and "there is no relationship to Vietnam service." The Veteran has stated that no doctor has told him that his coccidioidomycosis was related to exposure to herbicide agents, but he remembered having been asked by doctors whether he had served in Vietnam. He remembered talking about dormancy related to exposure to herbicide agents. He stated that he did not have any scientific evidence connecting his lung condition to exposure to herbicide agents but he knew other people that had the same condition and had seen videos of Vietnamese "suffering through the same things that [he was] going through." See Hearing Testimony, received 3/15/2012. While the Veteran believes that his coccidioidomycosis is related to exposure to herbicide agents during his active service, he is not competent to provide a nexus opinion in this case. This issue is medically complex as it requires knowledge of infectious diseases. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). The Veteran has been accorded ample opportunity to furnish medical and other evidence in support of his claim; he has not done so. See 38 U.S.C. § 5107(a) (noting it is a claimant's responsibility to support a claim for VA benefits). Consequently, the Board gives more probative weight to the VA examining clinician's medical opinion. The Board notes the Veteran's representative's contention that the examining clinician's medical opinion did not "sufficiently take into account the [Veteran's] service in Vietnam." See Appellate Brief, received 4/17/2021. The Board finds that this contention lacks merit. The medical opinion clearly states that coccidioidomycosis occurs only in a clearly defined geographic regions in the world and that Asia is not within that defined area. In other words, the fungus that causes coccidioidomycosis is found in that region only, and the region does not include Vietnam. Consequently, the Veteran could not have become infected with this fungus during his active duty service in Vietnam. In the 1990s, on the other hand, the Veteran was regularly driving truck through the region where the fungus is commonly found, and he became infected with it. Furthermore, exposure to a chemical, such as an herbicide, bears no relationship to exposure to an organism, such as the fungus that causes coccidioidomycosis. Therefore, no further consideration of the Veteran's service in Vietnam could possibly be afforded. The Board notes that the Veteran has also been found to have asthma that the January 2020 VA examiner found directly related to his morbid "obesity only" (weight exceeding 330 pounds in November 2019). This condition is also not related to service. See C&P Exam (Respiratory), received 1/23/2020. Again, service treatment and personnel records are negative for repository complaints or treatment. (Continued on the next page) In conclusion, because the Veteran has failed to present probative evidence in support of his claim that his coccidioidomycosis was related to his active duty service in Vietnam, including as due to exposure to herbicide agents, the third Shedden element is not met. Based upon the foregoing, as the preponderance of the evidence is against the claim, the benefit of the doubt rule does not apply, and the claim must be denied. See 38 U.S.C. §§ 501, 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7; see also Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Leanne M. Innet, 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.