Citation Nr: 21031623 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 17-47 611 DATE: May 24, 2021 ORDER Service connection for a variously diagnosed respiratory disorder, to include histoplasmosis, bronchitis, chronic obstructive pulmonary disease (COPD) and bronchiectasis, is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that the Veteran has had at any time during the appeal a current diagnosis for histoplasmosis that is etiologically related to his active duty service. 2. The preponderance of the evidence is against a finding that the Veteran has a variously diagnosed respiratory disorder, to include bronchitis, COPD and bronchiectasis that is etiologically related to his active duty service. CONCLUSION OF LAW The criteria for service connection for a variously diagnosed respiratory disorder, to include histoplasmosis, bronchitis, COPD, and bronchiectasis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from September 1968 to May 1975. In August 2019, the Veteran testified before the undersigned Veterans Law Judge at a travel board hearing. A hearing transcript is of record. In December 2019, the Board of Veterans' Appeals (Board) issued a remand requesting further development prior to adjudicating the claim. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease initially diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). There are three requirements to establish service connection: (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 (Fed. Cir. 2004). With any claim for service connection, it is necessary for a current disability to be present. See Brammer v. Derwinski, 3 Vet. App. 223 (1992); McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). The requirement that a current disability exists is satisfied if the claimant had a disability at the time his claim for VA disability compensation was filed or during the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Without a current diagnosis, there may be no service connection for the claimed condition. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Entitlement to service connection for a variously diagnosed respiratory disorder, to include histoplasmosis, bronchitis, chronic obstructive pulmonary disease (COPD) and bronchiectasis The Veteran contends he suffers from a respiratory condition that is either directly related to his military service because he was treated for respiratory problems in service, or indirectly due to his military service in that he was exposed to mold and fungus that caused or contributed to histoplasmosis. See January 2015 Statement in Support of the Claim. At the August 2019 Board hearing, the Veteran testified that the climate was wet and hot in the Republic of Vietnam and that there were bird droppings all over the aircraft in the hangars as well as the aircraft outside. Altogether, during his service, he indicated he was treated for a respiratory issue around four times while serving in Vietnam and four to five more times afterwards. The Veteran further testified that he underwent diagnostic testing during his service and was diagnosed with histoplasmosis. He was given different medication to treat his cough. Following his separation from service, around January or February of 1976, the Veteran sought medical treatment for his respiratory conditions. He testified his physician diagnosed him with bronchiectasis and is treated with inhalers and breathing machine. He requires antibiotics when his respiratory condition worsens. See August 2019 Hearing Transcript. The Veteran's service treatment records (STRs) corroborate he was treated for respiratory infections during service. However, his records do not confirm a diagnosis of histoplasmosis during service. Moreover, his April 1975 service separation report of medical examination is silent for any signs, symptoms, or diagnoses, including cough or chronic upper respiratory tract infection (URTI). See STRs. At the outset, the Board notes the record contains several conflicting VA examinations and medical opinions. First, in April 2015, the Veteran underwent a VA examination to determine the nature and etiology of his respiratory condition. The April 2015 VA examiner diagnosed mycotic lung disease (histoplasmosis) with a date of diagnosis in 1973 and bronchitis/acute, chronic, and asthmatic. As part of the examiner's review of the record and examination of the Veteran, the examiner noted that according to three pulmonary treatment notes between November 2014 and March 2015, there was a mention of history of histoplasmosis even though there was no specific mention of a current histoplasmosis illness. The examiner then opined that the Veteran's claimed condition was at least as likely as not incurred in or caused by his service because his respiratory ailments were well-documented in his STRs dating to 1968, and had become chronic in nature, requiring pulmonology intervention. See April 2015 Medical Opinion. Due to the conflicting report of a histoplasmosis diagnosis, which was not found in the Veteran's STRs or other records, clarification of the April 2015 VA medical opinion was sought. The clarifying medical opinion noted that the Veteran was diagnosed with acute bronchitis multiple times during service and continued to have respiratory problems. However, no diagnosis of histoplasmosis was found during service. Therefore, the examiner made the finding that it appeared the Veteran's more chronic respiratory condition, including COPD and bronchiectasis, developed after service. The examiner also stated she could not "[see] a direct connection between episodic active bronchitis in service to current respiratory diagnosis of COPD, asthmatic bronchitis and bronchiectasis" and concluded it was less likely than not that the Veteran's current respiratory conditions were related to episodic active bronchitis in service. See April 2015 Medical Addendum Opinion. However, as the December 2019 Board remand explained, the VA examiner who provided the April 2015 addendum opinion failed to explain why the Veteran's in-service respiratory issues, including bronchitis, were episodic and acute in nature, and not related to his current respiratory conditions, as the first April 2015 VA examiner found. Further, the clarifying medical opinion was incomplete in that it did not address the Veteran's contention of continuity of symptomatology regarding his respiratory conditions shortly after his separation from service. In satisfaction of the December 2019 Board remand, another VA examination was performed with a medical opinion provided to clarify the conflicting medical opinions already of record. The January 2020 VA examination diagnosed the Veteran with chronic cough, with a date of diagnosis that same month. See January 2020 VA examination. Historically, the examiner recounted that during his active duty, the Veteran was diagnosed with bronchitis and had multiple upper respiratory infections during his military career. He had not had tonsillectomy as a child and had episodes of strep pharyngitis. However, the examiner also noted that the April 1975 service separation report of medical examination was silent for any signs, symptoms, or diagnoses, including cough or chronic URTI. Following the January 2020 VA medical examination, the examiner opined it was less likely than not that the Veteran's respiratory conditions were caused by or incurred during his service. In support of that opinion, the examiner highlighted the Veteran's report of having had pulmonary histoplasmosis in the past, which he indicated he was treated for about one year, but stated the records did not show that the Veteran suffered from histoplasmosis. Furthermore, the examiner noted that histoplasmosis was treated with antifungals for days to weeks, not for a year. The examiner also noted how there had been no evidence of histoplasmosis on any x-rays taken either. Instead, the examiner thought the Veteran's description of his condition sounded more like prophylaxis. Therefore, the examiner concluded the Veteran did not have a past nor a present diagnosis of histoplasmosis. Instead, the examiner noted that the Veteran had been diagnosed during active duty with bronchitis and had multiple upper respiratory infections during his military career, as previously discussed. He was first seen at VA for treatment in Spring 2001. There was no available data covering the interval between 1975 and 2001. His initial physician visit was in 2002 and in that appointment, there was no mention of respiratory issues. There were no emergency room visits in 2002-2004 and the primary care physician note did not discuss any respiratory issues. The first mention of a cough was not until December 2006 and the cough had been present for only two days. He was referred to pulmonary in October of 2014 for a cough that had begun a year ago during an episode of bronchitis. Given this medical history, the examiner concluded there was no evidence of continuity and there was no evidence that there was any nexus between the Veteran's history of bronchitis while in the military and his current pulmonary diagnoses. See January 2020 VA examination. Based on the foregoing medical opinions, particularly the most recent January 2020 VA examination and opinion which provided clarity to the previously conflicting medical opinions of record, it is not shown that the Veteran's current variously diagnosed respiratory disorder had its onset in service or was otherwise caused by his service. As highlighted and explained by the January 2020 VA examiner, although the Veteran has reported having pulmonary histoplasmosis in the past, he did not have an actual diagnosis in the past or in the present of the disability. This finding was made based on the lack of evidence of histoplasmosis in the record, including in x-ray reports, as well as the Veteran's description of a treatment plan which was not consistent with a diagnosis of histoplasmosis. Importantly, this finding is based on objective evidence contained in the Veteran's medical treatment records and not historical evidence provided by the Veteran or from historical notes in his medical records (that were made based on reports from the Veteran). Therefore, service connection for histoplasmosis is not warranted. Brammer, 3 Vet. App. at 223. As for the Veteran's additional respiratory disorder diagnoses, including bronchitis, the Veteran was seen for multiple upper respiratory infections during his military career. However, as explained by the January 2020 VA examiner, the Veteran's medical history lacks continuity of respiratory symptoms to support a finding that his present respiratory conditions have been caused by or were incurred during his service. Significantly, the Veteran did not report symptoms of a cough to his physician until December 2006 and even still it was not until October 2014 that he was referred to a pulmonary doctor for a cough post bronchitis. The Board finds the negative nexus medical opinion provided by the January 2020 VA examiner to be highly probative. The opinion was based on a thorough review of the claims file, including the STRs and current medical records, and the opinion is consistent with other evidence of record. Moreover, the examiner provided adequate rationale for the opinion. Accordingly, the VA examiner's opinion is entitled to great probative weight. See Nieves-Rodriguez, 22 Vet. App. at 304. While the Veteran is competent to report having experienced symptoms of respiratory disorders, including cough during service and consistently since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of his current respiratory disorder as the Veteran has not demonstrated the necessary medical expertise. Additionally, to the extent the Veteran believes his current respiratory disorder is related to his military service, he is not competent to provide a nexus opinion regarding this issue. The questions to be resolved in this case involve medical matters and are not capable of resolution through lay observation. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). (Continued on the next page) In conclusion, the Board finds that there is no probative evidence to warrant service connection for a variously diagnosed respiratory disorder, to include histoplasmosis, bronchitis, COPD, and bronchiectasis. The Board has considered the applicability of the benefit of the doubt doctrine; however, as the preponderance of the evidence is against the Veteran's claim, the doctrine is not applicable. Service connection for a variously diagnosed respiratory disorder, to include histoplasmosis, bronchitis, COPD, and bronchiectasis is denied. See 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. 49, 55-57 (1990). A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Churchwell, 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.