Back to BVA DecisionsGRANTEDService Branch ARMY Special Benefit NO SPECIAL BENEFIT Docket No. 250423-539465
RESTRICTIVE LUNG DISEASE INTERSTITIAL PULMONARY FIBROSIS
MICHAEL LANE · 2026 · Case ID: A26035134
Summary
The Veteran, who served in the Army from January 1984 to January 1987, including service in the Army Reserve and Army National Guard, appeals the denial of service connection for interstitial pulmonary fibrosis and bladder cancer. The Board reviewed the case based on evidence of record at the time of the April 2025 agency of original jurisdiction decision. For interstitial pulmonary fibrosis, the Board found a current diagnosis and evidence of in-service exposure to toxins from explosives and mortars, including PFAS. While a VA examiner opined less likely than not, the Board gave greater weight to the opinion of the Veteran's treating VA pulmonologist, who found a potential contribution from ordnances and noted that exposures are known to cause pulmonary fibrosis. The Board found persuasive evidence linking the condition to service. For bladder cancer, the Board found a current diagnosis and evidence of in-service exposure to PFAS (forever chemicals). A VA urologist opined it was more likely than not that PFAS exposure caused the bladder cancer, noting the absence of other risk factors like smoking. The Board gave this opinion great weight, finding persuasive evidence linking the condition to service. Service connection for both interstitial pulmonary fibrosis and bladder cancer, as secondary to in-service toxic exposures, was granted.
Rationale
Current diagnosis of interstitial pulmonary fibrosis; In-service exposure to ordnances (explosives, mortars, cement, mercury); Treating VA pulmonologist opinion found potential contribution from ordnances; VA examiner opined less likely than not, but Board gave greater weight to treating physician
Full Decision Text
Citation Nr: A26035134 Decision Date: 04/15/26 Archive Date: 04/15/26 DOCKET NO. 250423-539465 DATE: April 15, 2026 ORDER Entitlement to service connection for interstitial pulmonary fibrosis as secondary to in-service exposure to toxins from explosives and mortars is granted. Entitlement to service connection for bladder cancer as secondary to in-service exposure to forever chemicals is granted. FINDINGS OF FACT 1. The evidence persuasively shows that interstitial pulmonary fibrosis is related to in-service exposure to toxins from explosives and mortars. 2. The evidence persuasively shows that bladder cancer is related to in-service exposure to forever chemicals. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for interstitial pulmonary fibrosis as secondary to in-service exposure to toxins from explosives and mortars have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2026). 2. The criteria for entitlement to service connection for bladder cancer as secondary to in-service exposure to forever chemicals have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from January 1984 to January 1987 with additional service in the Army Reserve and Army National Guard. These matters come before the Board of Veterans' Appeals (Board) on appeal from an April 2025 higher-level-review rating decision of a Department of Veterans Affairs (VA) regional office (RO). In a December 2023 rating decision, the RO denied service connection for interstitial pulmonary fibrosis and cancer of the gall bladder. In July 2024, the Veteran requested a higher-level review of those two denials. In an October 2024 rating decision, the RO found duty-to-assist errors regarding the denials of service connection for interstitial pulmonary fibrosis and cancer of the gall bladder. In the April 2025 rating decision, the RO found that new and relevant evidence had been received to warrant readjudication of the claims and then denied service connection for interstitial pulmonary fibrosis and cancer of the gall bladder based on the entire evidence of record. In the April 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the April 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301 (2026). Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801 (2026). If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501 (2026). If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. While the Veteran filed a claim in November 2023 for service connection for cancer of the gall bladder, he has stated that he has bladder cancer and not cancer of the gall bladder. In any event, the April 2025 rating decision shows that the RO considered service connection for bladder cancer as part of the claim. Service Connection 1. Entitlement to service connection for interstitial pulmonary fibrosis as secondary to in-service exposure to toxins from explosives and mortars Pertinent law and regulations In general, service connection may be granted for disability or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131. Notwithstanding the above, service connection may be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred or aggravated in service. 38 C.F.R. § 3.303(a). To establish service connection for a claimed disorder, there must be (1) medical evidence of a current disability; (2 1. Entitlement to service connection for interstitial pulmonary fibrosis as secondary to in-service exposure to toxins from explosives and mortars Pertinent law and regulations In general, service connection may be granted for disability or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131. Notwithstanding the above, service connection may be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred or aggravated in service. 38 C.F.R. § 3.303(a). To establish service connection for a claimed disorder, there must be (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). Analysis As for Hickson element (1), the RO in the April 2025 rating decision made the following favorable finding: the Veteran has a current disability. More specifically, the RO noted that a November 2023 VA examination report reflects that there is a diagnosis of interstitial pulmonary fibrosis. Thus, there is a favorable finding on current disability, Hickson element (1), and this element is satisfied. As for Hickson element (2), the RO in the April 2025 rating decision made the following favorable finding: the Veteran had a qualifying event, injury, or disease. In particular, the RO found that the Veteran participated in a toxic exposure risk activity (TERA) and noted that he was exposed to perfluoroalkyl and polyfluoroalkyl substances (PFAS). An October 2024 VA memorandum shows that PFAS are also known as forever chemicals. In a September 2024 statement, a VA doctor noted that the Veteran was exposed to explosives (dynamite, picric acid, lead azide, black powder, fulminate of mercury, and blasting caps) and mortars (portland cement, hydrated lime, and sand). The Veteran's DD Form 214 reflects that he served as an indirect fire infantryman. The evidence persuasively shows that in service, the Veteran was also exposed to toxins from explosives and mortars. Hickson element (2), in-service injury or disease, is established. As for Hickson element (3), medical nexus, a VA doctor who specializes in pulmonary and critical care medicine opined that the Veteran's in-service exposure to ordnances may have contributed to his lung disease. The clinician noted several in-service exposures that are known to cause pulmonary fibrosis. The physician stated that portland cement contains various metal oxides, including aluminum, that have been linked to the development of interstitial lung disease with usual interstitial pneumonia and that inhalation of mercury vapors can cause an acute lung injury that may progress to fibrosis. The pulmonologist added that lung injury has been associated with smoke from gunpowder. The doctor indicated that the Veteran did not have any history of radiation exposure, high-risk medication use, drug use, or exposure to antigens that may explain his lung disease. In a November 2024 opinion, a November 2024 VA examiner opined that it is less likely than not (likelihood is less than approximately balanced or nearly equal) that interstitial pulmonary fibrosis was caused by the indicated toxic exposure risk activit(ies) after considering the total risk exposure through all applicable military deployments of the Veteran and the synergistic and combined effect of all toxic exposure risk activities of the Veteran. The clinician stated that a review of medical and scientific evidence does not strongly support a finding that the Veteran's known exposure to PFAS would directly lead to the development of interstitial lung disease. In a February 2025 opinion, a VA doctor noted that the exact cause of interstitial pulmonary fibrosis is unknown in most cases but that some potential risk factors include environmental exposures, for example, asbestos and silica. The Board gives great weight to the opinion of the Veteran's treating VA pulmonologist because this opinion has a thorough basis and is the only opinion addressing in-service exposure to toxins from ordnances. The evidence persuasively shows that interstitial pulmonary fibrosis is related to in-service exposure to toxins from explosives and mortars. Accordingly, Hickson element (3), medical nexus, is established. In summary, the Board is of the opinion that the Veteran has met all requirements needed to establish service connection for interstitial pulmonary fibrosis as secondary to in-service exposure to toxins from explosives and mortars. The benefit sought on appeal is accordingly allowed. 2 some potential risk factors include environmental exposures, for example, asbestos and silica. The Board gives great weight to the opinion of the Veteran's treating VA pulmonologist because this opinion has a thorough basis and is the only opinion addressing in-service exposure to toxins from ordnances. The evidence persuasively shows that interstitial pulmonary fibrosis is related to in-service exposure to toxins from explosives and mortars. Accordingly, Hickson element (3), medical nexus, is established. In summary, the Board is of the opinion that the Veteran has met all requirements needed to establish service connection for interstitial pulmonary fibrosis as secondary to in-service exposure to toxins from explosives and mortars. The benefit sought on appeal is accordingly allowed. 2. Entitlement to service connection for bladder cancer bladder cancer as secondary to in-service exposure to forever chemicals Analysis As for Hickson element (1), the RO in the April 2025 rating decision made the following favorable finding: the Veteran has a current disability. More specifically, the RO noted that an August 2023 VA examination report reflects that there is a diagnosis of bladder cancer. Accordingly, there is a favorable finding on current disability, Hickson element (1), and this element is satisfied. As for Hickson element (2), the RO in the April 2025 rating decision made the following favorable finding: the Veteran had a qualifying event, injury, or disease. In particular, the RO found that the Veteran participated in TERA and noted that he was exposed to PFAS or forever chemicals. Hickson element (2), in-service injury or disease, is established. As for Hickson element (3), medical nexus, a VA doctor who specializes in urology opined that it is more likely than not that in-service exposure to PFAS water contamination is the cause of his bladder cancer. The clinician noted that although bladder cancer is not on the VA list of malignancies believed to be caused by contact with PFAS water contamination, the data is suggestive of an increased risk of developing bladder cancer as well as an increased risk of mortality from PFAS water contamination. The physician added that the Veteran has no current or past history of smoking, which is the main cause of bladder cancer. In a November 2024 opinion, a November 2024 VA examiner opined that it is less likely than not (likelihood is less than approximately balanced or nearly equal) that cancer of the gall bladder was caused by the indicated toxic exposure risk activit(ies) after considering the total risk exposure through all applicable military deployments of the Veteran and the synergistic and combined effect of all toxic exposure risk activities of the Veteran. The clinician noted that there was no current diagnosis of cancer of the gall bladder. The Board notes that this opinion does not address bladder cancer. The Board gives great weight to the opinion of the Veteran's treating VA urologist because this opinion has a thorough basis and is the only opinion addressing bladder cancer. The evidence persuasively shows that bladder cancer is related to in-service exposure to forever chemicals. Accordingly, Hickson element (3), medical nexus, is established. In summary, the Board is of the opinion that the Veteran has met all requirements needed to establish service connection for bladder cancer as secondary to in-service exposure to forever chemicals. The benefit sought on appeal is accordingly allowed. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Cherry, David T. 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.