Citation Nr: 21042748 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 15-24 269 DATE: July 13, 2021 ORDER Service connection for a respiratory disorder is denied. FINDING OF FACT A respiratory disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service. CONCLUSION OF LAW The criteria for service connection for a respiratory disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1988 to August 1991 with additional service in the Reserve. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in April 2015 by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In April 2019, the Board remanded the case for additional development and it now returns for further appellate review. Entitlement to service connection for a respiratory disorder. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). The Veteran alleges that she has a current respiratory disorder that first manifested in service as a result of exposure to hazardous materials and fuel. In this regard, the Veteran's service personnel records reflect that she served as a petroleum supply specialist, and her service treatment records (STRs) reflect treatment for an upper respiratory infection in January 1989 and November 1989. Specifically, on January 25, 1989, the Veteran complained of chest pain and headaches for two days. She had a persistent dry cough and pain in the chest with coughing. STRs dated January 25, 1989 and January 27, 1989, reflect treatment for an acute upper respiratory infection. Additionally, a November 1989 STR reflects that the Veteran complained of running nose, chest pain, substernal discomfort, watery eyes, headache, and lower back pain for two weeks. Her head and neck were supple with adenopathy, and her nose had part obstruction. The examiner noted that the Veteran had possible hay fever, but diagnosed an upper respiratory infection. However, a November 1991 examination reflects that the Veteran's nose, sinuses, mouth and throat, and lungs and chest were normal upon clinical evaluation. Furthermore, while a February 1996 Reserve record reflects a notation that the Veteran had possible strep pharyngitis with a fever and vomiting, she denied currently or previously experiencing ear, nose, or through trouble, chronic or frequent colds, sinusitis, hay fever, asthma, shortness of breath, pain or pressure in chest, and chronic cough in August 1996. Post-service VA treatment records reflect, in August 2003, the Veteran complained of a hoarse voice, cough, and sore chest. She reported that she had experienced a sore throat on and off about every two weeks for the last few months. The Veteran denied experiencing any similar symptoms in the past. Her treatment provider noted suspected upper respiratory infection that will resolved spontaneously, chronic sore throat, and chronic hoarseness. At a November 2012 VA examination, the examiner found that the Veteran did not have a current respiratory disorder. In this regard, while he noted the Veteran's report of having upper respiratory infections with cough of productive sputum while in service, such resolved with antibiotic treatment. Similarly, while Veteran reported having a few episodes of chest cold that required antibiotic therapy in the past 10 to 15 years, contemporaneous examination, to include a chest X-ray, was normal. Consequently, the VA examiner opined that the Veteran's claimed respiratory disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In further support of such opinion, he noted that, while the Veteran had episodes of acute respiratory infection that were treated while in active service, such resolved without residual symptoms or functional limitation. In this regard, the examiner explained that these infectious were caused by either virus or bacteria, and they resolved as expected. Finally, he noted that the Veteran did not have an acute respiratory infection at the present time or residuals from previous infections. However, a July 2015 VA treatment record reflects the Veteran's complaints of cough, malaise, body aches, rhinorrhea, sore throat, ear pressure and pain, fever, myalgias, congestion, chills, runny nose, muscle aches, and cramps, and had vomited twice. She was diagnosed with bronchitis and upper respiratory infection. Furthermore, at the November 2018 Board hearing, the Veteran reported experiencing bronchitis in service, and had worked as a fuel handler, which resulted in exposure to hazardous materials and fuels. Furthermore, she and her mother recurrent bouts of bronchitis since service. Thus, in light of the Veteran's treatment for bronchitis and an upper respiratory infection in July 2015, and her and her mother's hearing testimony, the Board remanded the claim in April 2019 in order to afford her another VA examination so as to determine the nature and etiology of her claimed respiratory disorder. In December 2019, the Veteran underwent a VA examination, at which time the examiner diagnosed acute upper respiratory illness and acute bronchitis, which had resolved. He further noted the Veteran's report that such claimed disorders had their onset in 1989, at which time she described experiencing symptoms of "burning in the lungs," difficulty breathing, persistent cough, and fatigue. The examiner observed that she was treated with antibiotics for such upper respiratory infections and given limited duty; however, he noted her report that her symptoms would recur and persisted after separation from service, which required visits to the doctor two to three times a year. In this regard, while he found the Veteran to be a poor historian, he that she had recurrent episodes of upper respiratory illness and acute bronchitis that were treated with antibiotics. However, on examination, he found that the Veteran was not currently symptomatic or on antibiotics or treatment, and her lungs were clear to auscultation bilaterally, and a January 2019 X-ray was normal. Thus, he found that the Veteran's claimed disorders were currently resolved as she does not have signs or symptoms of acute respiratory illness or acute bronchitis. In the related medical opinion, the December 2019 VA examiner noted that the Veteran was found to have a history of recurring acute respiratory conditions, diagnosed as acute upper respiratory illness and acute bronchitis, which had resolved. He further observed that her STRs, as previously noted, showed evidence of acute upper respiratory infection and acute bronchitis that were treated during service. The examiner also noted that treatment records after separation from service, to include those in July 2015, reported the same. Specifically, he observed that, at such time, the Veteran was diagnosed with upper respiratory infection and bronchitis and treated with antibiotics. Thus, the VA examiner acknowledged that the record suggested diagnoses of upper respiratory infection and acute bronchitis both during service and after separation from service; however, he found that such conditions are acute in nature and typically self-limiting with expected full resolution. In this regard, he explained that upper respiratory infections and acute bronchitis are very common recurring infections caused by micro-organisms that infect the lower and/or upper respiratory tract, do not typically cause chronic debilitating respiratory conditions, and are acute in nature and typically self-limiting with expected full resolution and typically without residuals. In further support of his opinion, the VA examiner observed that the Veteran did not have a current chronic and active respiratory diagnosis, and her medical records and past chest x-rays did not indicate a diagnosis of chronic respiratory disease. Thus, he found that there no current active diagnosis or chronic condition or residuals from those resolved conditions. Consequently, the VA examiner opined that it is less likely than not that the Veteran's in-service treatment of an upper respiratory infection in 1989 could have resulted in any chronic or ongoing respiratory conditions. Therefore, he determined that the Veteran does not currently have chronic respiratory diagnoses that is at least as likely as not due to upper respiratory infections or acute bronchitis that occurred during service. Additionally, the VA examiner determined that the Veteran does not have a chronic respiratory diagnosis that is at least as likely as not due to her in-service occupation as a petroleum supply specialist. In this regard, he stated that such exposure is expected to cause underlying soft tissue damage in her lungs that would result in more significant respiratory symptoms than compared to symptoms due to acute bronchitis or upper respiratory infections. The Board acknowledges that, in the form provided for the December 2019 VA examiner's opinion, he checked the box next to the statement that the claimed condition was "at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service injury, event, or illness." However, as clearly articulated in the preceding paragraphs, the VA examiner's rationale as a whole is against the Veteran's claim that her respiratory disorder is related to her military service. In this regard, a medical examiner's report must be "read as a whole", and as long as an examiner's medical opinion it is based on correct facts and sufficiently informs the Board of the medical expert's judgment on a medical question and the "essential rationale" for the opinion, it will be found adequate. A medical examiner is not required to provide a detailed review of medical history or comment on every piece of favorable evidence in the record, and the law does not impose any reasons-or-bases requirements on medical examiners. See Monzingo v. Shinseki, 26 Vet. App. 97, 105-7 (2012); Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012) (noting that VA examiners do not have a reasons or bases requirement). In this case, the December 2019 VA examiner's opinion and rationale clearly states that the medical evidence of record does not support a finding that the Veteran's claimed respiratory disorder was incurred in or caused by her military service, to include her in-service treatment for related complaints and/or exposure to hazardous materials and fuel coincident with her duties as a petroleum supply specialist. The Board affords great probative weight to the December 2019 VA examiner's opinion as such considered all of the pertinent evidence of record, to include the statements of the Veteran and the relevant medical history, and provided a complete rationale. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Notably, there is no medical opinion to the contrary. The Board also considered the Veteran's assertion as to the etiology of her claimed respiratory disorder; however, as a lay person, she does not have the requisite training and experience necessary to address such a complex medical matter. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the etiology of such disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Thus, the Board finds that the Veteran's assertions as to the etiology of her claimed respiratory disorder are not competent evidence and, consequently, are afforded no probative weight. Based on the foregoing, the Board finds that the Veteran's respiratory disorder has not been shown to be causally or etiologically related to any disease, injury, or incident during service. Consequently, service connection for such disorder is not warranted. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a respiratory disorder. As such, that doctrine is not applicable in the instant appeal, and her claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dawn A. Leung, 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.