EMPHYSEMA PULMONARY

Summary

The Veteran, who served in the Coast Guard from July 1971 to January 1975, appeals the denial of service connection for pulmonary emphysema and the remand of claims for left and right shoulder residual pain following rotator cuff surgery. The Veteran asserted exposure to toxins, including chlorine and firefighting foam/smoke, during service due to his roles as a fitness trainer and firefighting instructor. While service treatment records did not explicitly document these exposures or treatment for respiratory issues, the Board found the Veteran's lay testimony credible and corroborated by service personnel records indicating instructor training and assignment. The Board found the VA examiner's opinion inadequate for failing to address the plausible etiology of toxic exposure and for being generalized. A private medical provider's nexus letter, however, opined that the Veteran's emphysema was at least as likely as not related to these exposures, which the Board found probative. Applying the benefit of the doubt, service connection for pulmonary emphysema was granted. The shoulder claims were remanded because the VA examination was inadequate; the examiner failed to review surgical notes and provided a negative nexus opinion based on a lack of in-service treatment records, despite the Veteran's documented in-service shoulder injury and subsequent surgery. The Board found the examiner's rationale inadequate and remanded for a new opinion addressing the nexus to repetitive motion and the documented fall.

Rationale

Current diagnosis of emphysema confirmed; Likely exposure to toxins (chlorine, firefighting foam/smoke) during service; Private medical opinion found nexus to service; VA examiner's opinion found inadequate

Full Decision Text

Citation Nr: A26035756
Decision Date: 04/16/26	Archive Date: 04/16/26

DOCKET NO. 250825-579528
DATE: April 16, 2026

ORDER

Entitlement to service connection for pulmonary emphysema is granted.

REMANDED

Entitlement to service connection for left shoulder residual pain, rotator cuff surgery, is remanded.

Entitlement to service connection for right shoulder residual pain, rotator cuff surgery, is remanded.

FINDING OF FACT

The Veteran has a current diagnosis of pulmonary emphysema that is related to exposure to toxins during service.

CONCLUSION OF LAW

The criteria for entitlement to service connection for pulmonary emphysema have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from July 1971 to January 1975. 

In the August 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on January 12, 2026. Therefore, the Board may only consider the evidence of record at the time of the September 2024 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

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. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

However, because the Board is remanding the claims of entitlement to service connection for left and right shoulder disabilities, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

1. Entitlement to service connection for pulmonary emphysema

The Veteran contends that due to extensive exposure to toxins during active service, he developed emphysema. After a thorough review of the evidence, the Board finds that entitlement to service connection for emphysema is warranted. 

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d).

With regard to a present disability, the Veteran's medical records confirm a diagnosis of emphysema. See, e.g., June 2024 VA Examination. Accordingly, the first element of entitlement to service connection is met. 

With regard to in-service disease or injury, the Veteran's service treatment records (STRs) do not show treatment for respiratory disorders during service. The Veteran's treatment records do not remark on exposure to asbestos or other toxins. 

However, the Veteran asserted during his appeal at the 2026 Board hearing and in documents that he was exposed to toxins in the form of firefighting foam and smoke, and chlorine at the swimming pool. The Veteran recounted at the January 2026 Board hearing that he was at the swimming pool almost daily as he was a fitness trainer for the Coast Guard. Further, he was a firefighting instructor. During both of those roles, he asserted he was exposed almost daily to toxins. The Veteran's service personnel records (SPRs) show that he completed instructor training and was assigned as an instructor during his active service period
 not show treatment for respiratory disorders during service. The Veteran's treatment records do not remark on exposure to asbestos or other toxins. 

However, the Veteran asserted during his appeal at the 2026 Board hearing and in documents that he was exposed to toxins in the form of firefighting foam and smoke, and chlorine at the swimming pool. The Veteran recounted at the January 2026 Board hearing that he was at the swimming pool almost daily as he was a fitness trainer for the Coast Guard. Further, he was a firefighting instructor. During both of those roles, he asserted he was exposed almost daily to toxins. The Veteran's service personnel records (SPRs) show that he completed instructor training and was assigned as an instructor during his active service period. Based on the Veteran's lay statements and evidence in his personnel file, the Board finds it likely that he was exposed to the claimed toxins. Thus, the second element of entitlement to service connection is met.

The Veteran attended a VA examination for respiratory disorders in June 2024. The examiner confirmed a diagnosis of emphysema and a lung nodule. The examiner opined that the Veteran's emphysema was not at least as likely as not related to active service based on lack of treatment for respiratory conditions during service. The Board finds this rationale to be inadequate, as it is generalized and conclusory. The examiner did not provide an explanation about why the asserted toxic exposure was not a plausible etiology for the emphysema, nor adequately take into account the Veteran's lay statements. See Jones v. Shinseki, 23 Vet. App. 382, 387 (2010).

The Veteran submitted a medical nexus letter in March 2026 in which his medical provider opined that it was at least as likely as not that the Veteran's exposure to toxins in the form of chlorine and firefighting foam and smoke was the etiology of the development of the Veteran's emphysema. The Board finds this opinion probative, as it comes from a long-term treatment provider familiar with the Veteran's medical history and references medical research regarding the claimed condition. 

The evidence persuasively weighs in favor of entitlement to service connection for emphysema. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), has therefore been applied to the claim. Lynch v. McDonough, 21 F.4th (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). Accordingly, the service connection claim for emphysema is granted.

REASONS FOR REMAND

1. Entitlement to service connection for left shoulder residual pain, rotator cuff surgery, is remanded.

2. Entitlement to service connection for right shoulder residual pain, rotator cuff surgery, is remanded.

The Veteran contends that he injured his shoulders in service, and the pain and damage persists to the present.

The Veteran's STRs show he fell down and was treated at sick call for injury to both shoulders in June 1974.

The Veteran had rotator cuff surgery on both shoulders in the 2013/2014 timeframe.

The Veteran attended a VA examination in June 2024. The examiner noted that they did not see any surgical notes as part of the record. The examiner stated that there was no listed treatment for shoulder injury in the STRs, but the Veteran reported being injured in service. The examiner diagnosed bilateral shoulder pain and post-surgery rotator cuff. The examiner opined that the Veteran's shoulder condition was not at least as likely related to active service because there was no report of shoulder condition until over 30 years from separation from service. 

The Veteran further asserted at the January 2026 Board hearing that the repetitive motion work during service in addition to the documented fall resulted in the current condition and surgery which has bothered him since service. 

As the Board has noted above, the Veteran's STRs do in fact contain record of shoulder injury bilaterally in service. Accordingly, the Board finds this examination and opinion inadequate and not obtaining an additional adequate opinion is a pre-decisional duty to assist error. Because the record contains no other medical opinion attesting to this asserted nexus to service, the Board must remand for a new opinion. 

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination for the bilateral shoulders. The examiner must review the claims file.

If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below.

The examiner is asked to provide a response to the following:

Direct service connection - Is the bilateral shoulder disability at least as likely as not related to service, including repetitive motion injury and
 is a pre-decisional duty to assist error. Because the record contains no other medical opinion attesting to this asserted nexus to service, the Board must remand for a new opinion. 

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination for the bilateral shoulders. The examiner must review the claims file.

If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below.

The examiner is asked to provide a response to the following:

Direct service connection - Is the bilateral shoulder disability at least as likely as not related to service, including repetitive motion injury and documented fall in June 1974? The examiner must reference the Veteran's lay statements about repetitive motion and continuing symptoms. 

Provide a rationale to support the opinion(s).  

 

 

JENNIFER HWA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Miller, Erin (BVA)

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.