Citation Nr: 21039806 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 16-58 365A DATE: July 1, 2021 ORDER Entitlement to service connection for chronic obstructive pulmonary disease (COPD), secondary to service-connected coronary artery disease (CAD) on a causation basis, is granted. FINDING OF FACT The evidence is at least evenly balanced as to whether the Veteran's COPD is a result of his service-connected CAD. CONCLUSION OF LAW The criteria for service connection for COPD, secondary to CAD, on a causation basis, have been met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. § 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1968 to November 1971. The Veteran is recipient of the Vietnam Service Medal and three Bronze Service Stars. This matter is before the Board of Veterans' Appeal (Board) on appeal of a June 2015 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). In that decision, the RO, in pertinent part, denied service connection for COPD. In December 2018 the Board remanded the matter for further evidentiary development, specifically to schedule the Veteran for a new VA examination and to obtain a medical opinion to determine the etiology of the Veteran's COPD and whether it is proximately due to, or aggravated by his service-connected CAD. As the Board is granting the Veteran's service connection claim for COPD in full, discussion of the agency of original jurisdiction's (AOJ) remand compliance is unnecessary. As a final preliminary matter, the Board notes that in January 2017 correspondence, the Veteran's previous attorney, J. Michael Woods, indicated that he no longer represents the Veteran. Thus, the Board recognizes the Veteran as now proceeding pro se in this appeal. See 38 C.F.R. § 14.631 (an appellant can revoke his representative, in order to become unrepresented, at any time). Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection is also warranted for disability proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Entitlement to Service Connection for COPD The Veteran contends he suffers from COPD which was caused by his service-connected CAD. A May 2019 VA examination reflects a current diagnosis of COPD. Therefore, the Veteran has met the current disability requirement. The Veteran is receipt of service connection for CAD. The issue is thus whether the CAD caused the COPD. There are conflicting medical opinion on this question. An April 2015 VA examiner opined that the Veteran's COPD was not incurred in service, due to or aggravated by any of the Veteran's service connected disabilities. The VA examiner indicated that the Veteran's COPD was caused by his tobacco usage. As the VA examiner did not consider other causes, the probative weight of the opinion is reduced. In December 2016, Dr. H. S., a private physician, reviewed the Veteran's claims file, interviewed the Veteran, and then rendered a medical opinion regarding the causal relationship between the Veteran's service connected CAD and his COPD. In his opinion, Dr. H. S. cited medical studies explaining why and how he based his findings regarding CAD and COPD. Dr. H. S. opined that the Veteran's serviced connected CAD has aided in the development of and permanently aggravates the Veteran's COPD. Dr. H. S. explained that CAD and COPD typically share numerous risk factors, and as such the two conditions frequently exist simultaneously. Dr. H. S. concluded that the impairment of the coronary arteries is known to be a significant contributing factor to COPD. As Dr. H.S. explained the reasons for his conclusion based on an accurate characterization of the evidence of record and citation to relevant medical literature, his opinion that the CAD is a cause of the COD is entitled to significant probative weight. See Nieves-Rodriguez, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). Additionally, the medical literature submitted in support of Dr. H. S.'s theory on the relationship between CAD and COPD is entitled to probative weight, particularly when combined with Dr. H. S.'s positive nexus opinion. Sacks v. West, 11 Vet. App. 314, 317 (1998) (medical article and treatise evidence "can provide important support when combined with an opinion of a medical professional"). A September 2017 VA examiner opined that the Veteran's COPD was not aggravated beyond its natural progression by CAD. The VA examiner indicated that it is possible for CAD to aggravate COPD. However, the VA examiner found that the Veteran's COPD does not reveal signs of permanent aggravation. There is no requirement of permanent aggravation in the secondary service connection context. Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). Thus, the opinion is of little, if any, probative weight. A May 2019 VA examiner opined that the Veteran's COPD is less likely than not proximately due to the Veteran's service connected CAD. The VA examiner acknowledged the frequent occurrence of the coexistence of COPD and CAD; however, the VA examiner found that CAD does not have a cause and effect relationship with COPD. The VA examiner disagreed with the opinion of Dr. H.S. As Dr. H.S.'s opinion is entitled to substantial probative weight and the contrary negative opinions are either of limited probative weight or probative weight equal to that of Dr. H.S.'s opinion, the evidence is at least evenly balanced as to whether the Veteran's current COPD is caused by his service connected CAD. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for COPD, secondary to service-connected CAD, on a causation basis, is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Henderson, 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.