Citation Nr: 0712428 Decision Date: 04/27/07 Archive Date: 05/08/07 DOCKET NO. 03-25 650 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection for a respiratory condition, to include bronchiectasis and catarrh. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL Appellant; his wife ATTORNEY FOR THE BOARD B. Buck, Associate Counsel INTRODUCTION The veteran served on active duty from April 1943 to January 1946. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2002 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, which denied entitlement to the benefit currently sought on appeal. The Board granted the appellant's motion to advance the case on the Board's docket under the provisions of 38 U.S.C.A. § 7107 (West 2002) and 38 C.F.R. § 20.900(c) (2006). FINDING OF FACT The veteran's current diagnosis of bronchiectasis with catarrhal symptoms is not related to his military service. CONCLUSION OF LAW Bronchiectasis with catarrhal symptoms was not incurred or aggravated in the veteran's active duty service. 38 U.S.C.A. §§ 1101, 1110, 5103, 5103A, 5107 (West 2002); 38 C.F.R. § 3.303 (2006). REASONS AND BASES FOR FINDING AND CONCLUSION Duties to Notify and Assist In correspondence dated in July 2002, the agency of original jurisdiction (AOJ) satisfied its duty to notify the veteran under 38 U.S.C.A. § 5103(a) (West 2002) and 38 C.F.R. § 3.159(b) (2006). Specifically, the AOJ notified the veteran of information and evidence necessary to substantiate the claim for service connection; information and evidence that VA would seek to provide; and information and evidence that the veteran was expected to provide. While the veteran was not instructed to "submit any evidence in his possession that pertains to the claim," he was advised to notify VA of any information or evidence in support of his claim that he wished VA to retrieve for him. Since the July 2002 correspondence, the veteran has continuously sent in information and evidence that he has felt relevant to his claim. Thus, the veteran has been able to participate effectively in the processing of his claim. Because service connection is denied, any question as to the appropriate disability rating or effective date is moot, and there can be no failure to notify prejudice to the veteran. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). VA has done everything reasonably possible to assist the veteran with respect to his claim for benefits in accordance with 38 U.S.C.A. § 5103A (West 2002) and 38 C.F.R. § 3.159(c) (2006). Service medical records have been associated with the claims file. All identified and available treatment records have been secured. The veteran has been medically evaluated in conjunction with his claim, and an expert medical opinion has been sought. Service Connection The veteran seeks service connection for a respiratory disorder, described by doctors as bronchiectasis and by the veteran as catarrh, which he contends initially manifested in service. In order to establish service connection, three elements must be established. There must be medical evidence of a current disability; medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See 38 C.F.R. § 3.303 (2006); see also Hickson v. West, 12 Vet. App. 247, 253 (1999). The veteran's service medical records document that in September and November 1945, he was treated for "nasopharyngitis, acute, catarrhal, mod-severe." On the first occasion, he was directed to quarters for four days, while the second occasion resulted in assignment to quarters for two days. The veteran has indicated that, thereafter, he self-medicated his symptoms, which were on and off, until his current diagnosis was established by computed tomography (CT) scan in 1997. Referable to whether a medical nexus exists, the veteran asserts that the 1945 service medical records confirm that he was chronically catarrhal, and that being so led to his current disorder. In support of his claim, he has submitted a New England Journal of Medicine article that finds that bronchiectasis "is always produced by chronic catarrh, or by some other disease attended by long, violent, and often repeated fits of coughing." N Engl J Med, Vol. 346, No. 18 (May 2, 2002). The veteran's personal assertion is afforded no probative weight in the absence of evidence that he has the expertise to render opinions about medical matters. Although he and other lay persons are competent to testify as to his in- service experiences and symptoms, where the determinative issue involves a question of medical diagnosis or causation, only individuals possessing specialized medical training and knowledge are competent to render such an opinion. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992). The evidence does not reflect that the veteran possesses medical expertise that would render his opinion as to etiology and a medical diagnosis competent. The veteran has also submitted general medical literature on the topic of catarrh and bronchiectasis. This information, however, does not apply medical principles regarding causation or etiology to the particular facts of the veteran's individual case. Nor does it discuss generic relationships with a degree of certainty such that a nexus could be established here. Therefore, this literature does not provide competent evidence to establish the nexus element. See Libertine v. Brown, 9 Vet. App. 521, 523 (1996); see also Wallin v. West, 11 Vet. App. 509, 513 (1998). In March 2005, a VA physician was asked to review the file and opine whether it was likely that the veteran's current bronchiectasis was first manifested during his military service from April 1943 to January 1946, or was otherwise etiologically related to his in-service nasopharyngitis. While the physician answered the first part of the question in the negative, he did not provide an answer as to the second part. Thus, the Board sought an expert opinion from a pulmonologist as to whether there was an etiological relationship. The pulmonologist reviewed the veteran's file, with specific attention to the service medical records and the New England Journal of Medicine article to which the veteran referred. In his March 2007 opinion, the expert explained that the passage quoted by the veteran in the medical journal article was written by the French physician Rene Laennec, who died in 1826. He further explained that in that era (the 18th century) bronchiectasis would have been present in many patients that had survived severe lung infections, e.g., tuberculosis or bacterial pneumonia, which would leave the bronchial tubes permanently damaged, dilated, and subject to recurrent infection. With respect to the article, the expert concluded that "the use of the word catarrh... in this quote more than 100 years prior to its use in describing the patient's nasopharyngitis in 1945 does not convey the same meaning, nor does it imply causality." Specific to the veteran's current disorder, the expert indicated that for it to be related to the two remote episodes in service, the initial symptoms in 1945 "would have been more prolonged and severe." The service medical records, however, show that the veteran was confined to quarters only briefly - a matter of four days. Thus, the expert concluded, it was unlikely that the bronchiectasis discovered in 1997 was the result of an infection acquired in 1945. Although the veteran has submitted lay testimony and general medical research as to a nexus, the preponderance of the competent medical evidence is against a relationship between his in-service treatment and his current respiratory disorder. Accordingly, the benefit of the doubt provision does not apply. Service connection for bronchiectasis and catarrh is not warranted. (CONTINUED ON NEXT PAGE) ORDER Entitlement to service connection for a respiratory condition, to include bronchiectasis and catarrh, is denied. ____________________________________________ J. E. Day Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs