TUBERCULOSIS PULMONARY CHRONIC

Summary

The Veteran, a Marine Corps Veteran who served from October 1975 to March 1983, appeals the denial of service connection for a left lower lobe lung mass, claimed as a respiratory condition due to chemical exposures related to his MOS as an aviation supply clerk. The Board found that the Veteran has a current diagnosis of a left lower lobe lung mass, which is binding. The Veteran asserts exposure to various chemicals, including pesticides, motor oil, and paint thinner, due to his MOS, and his attorney further alleged exposure to herbicides and contaminated water at Camp Lejeune. While the Board found no evidence the Veteran was stationed at Camp Lejeune, it accepted the Veteran's statements regarding exposure to chemicals consistent with his MOS, such as motor oil, weed killers, pesticides, and paint thinner, as credible. The Board found the Veteran's private medical opinion from Dr. R.P. persuasive, as it thoroughly linked the lung mass to these occupational and environmental exposures, citing scientific literature on the synergistic effects of chemical mixtures and their potential for delayed-onset respiratory disease. The Board found the August 2021 VA examination opinion inadequate because it was conclusory, failed to explain the significance of the post-service diagnosis, and did not address the Veteran's specific chemical exposure claims. Given that the evidence was in approximate equipoise, the Board resolved doubt in the Veteran's favor, granting service connection for the left lower lobe lung mass.

Rationale

Favorable finding of current diagnosis is binding; Credible statements regarding chemical exposure consistent with MOS; Persuasive private medical opinion linking condition to exposures; Inadequate VA medical opinion; Evidence in approximate equipoise, resolved in Veteran's favor

Full Decision Text

Citation Nr: A26039893
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 211022-193534
DATE: April 29, 2026

ORDER

Entitlement to service connection for left lower lobe lung mass (claimed as respiratory condition) is granted.

FINDING OF FACT

Resolving reasonable doubt in the Veteran's favor, his left lower lobe lung mass is at least as likely as not related to service, to include chemical exposures due to his military occupational specialty (MOS) of aviation supply clerk. 

CONCLUSION OF LAW 

The criteria for service connection for left lower lobe lung mass are 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 in the United States Marine Corps from October 1975 to March 1983. 

This appeal comes to the Board of Veterans' Appeals (the Board) following an August 2021 rating decision. This decision found that new and relevant evidence had been received with respect to the previously denied claim for entitlement to service connection for a respiratory condition. The finding that new and relevant evidence has been received is a favorable finding that is binding on the Board. 38 C.F.R. § 3.104(c). The Agency of Original Jurisdiction (AOJ) proceeded to deny the claim on the merits. 

In the October 22, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A hearing was scheduled for May 20, 2025. On May 19, 2025, the Veteran, through his attorney, withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the August 2021 AOJ decision on appeal, as well as any evidence submitted by the Veteran or his attorney within 90 days following receipt of the withdrawal of the hearing request (i.e., Augus 17, 2025). 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal (i.e., after August 17, 2025), the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801. 

Evidence of record specifically identified by the Veteran or his attorney within 90 days of receipt of the withdrawal of the hearing request is likewise considered "submitted" during the evidence submission window. See Cash v. Collins, 166 F.4th 1046 (Fed. Cir. 2026).

If the Veteran would like the Department of Veterans Affairs (VA) to consider any evidence that was submitted that the Board could not consider, he 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. 38 C.F.R. § 3.2501. Specific instructions for filing a Supplemental Claim are included with this decision. 

?

Entitlement to Service Connection for a Respiratory Condition

The Veteran seeks service connection for a respiratory condition, to include left lower lobe lung mass, related to exposures to chemicals due to his MOS as an aviation supply clerk. 

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge when the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d).

VA is responsible for determining whether the evidence persuasively favors one side or another. 38 C.F.R. § 4.3. When there is an approximate or nearly
 (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge when the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d).

VA is responsible for determining whether the evidence persuasively favors one side or another. 38 C.F.R. § 4.3. When there is an approximate or nearly equal balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the Veteran and the claim will be granted on the merits. 38 U.S.C. § 5107(b). When the evidence persuasively favors against the claims of the Veteran, the benefit of the doubt doctrine is inapplicable, and the claim will be denied on its merits. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

The August 2021 rating decision on appeal favorably found that the Veteran has a current diagnosis of left lower lobe lung mass. This favorable finding is binding on the Board, and the first element of service connection-a current diagnosis-is met. 38 C.F.R. §§ 3.104(c), 3.303; Shedden, 381 F.3d at 1166-67.

As for the second element of service connection-an in-service injury, event, or disease-the Veteran asserts that he was exposed to chemicals during service due to his MOS as an aviation supply clerk. Military personnel records document a MOS of aviation supply clerk. He reports that, while working in the aviation supply shed, he was exposed to several different chemicals that created a "thick cloud." The Veteran's attorney adds that the Veteran was "constantly breathing fumes from containers including pesticides, motor and transmission oils; varnish; paint remover; acids; and calking and that herbicide spraying of the area was a regular occurrence for his inhaling the elements around him during his military duties in aviation supply." She adds that these exposures occurred while the Veteran was stationed at Camp Lejeune. Likewise, the August 2025 VA medical opinion from Dr. R.P., D.O. states, 

During his four years on base, he worked in an un-air-conditioned storeroom for chemicals, where he was routinely exposed to concentrated fumes from substances such as motor oil, weed killers, pesticides, and paint thinner as part of his duties issuing chemicals to other personnel. He recalls first noticing breathing difficulties during this period, which have progressively worsened since service. Additionally, he believes that his prolonged exposure to the contaminated water at Camp Lejeune may have been a significant contributing factor to the development and progression of his lung condition. 

It is unclear how the Veteran's attorney and Dr. R.P. have reached the conclusion that the Veteran was stationed at Camp Lejeune. The Veteran's military personnel records are largely illegible, and those that are legible do not contain any evidence suggesting the Veteran was ever stationed at Camp Lejeune. The evidence persuasively weighs against finding that the Veteran had service at Camp Lejeune and therefore against finding that he is presumed to have been exposed to contaminants in the water supply during such service. 38 C.F.R. § 3.307(a). 

However, as noted above, the record does establish that the Veteran's MOS was aviation supply clerk. Exposure to chemicals such as motor oil, weed killers, pesticides, and paint thinner are consistent with the duties and circumstances of the Veteran's service. 38 U.S.C. § 1154(a), (b). Accordingly, the Board finds no basis to question the credibility of the Veteran's statements regarding chemical exposure to motor oil, weed killers, pesticides, and paint thinner during service, and the second element of service connection is met. 38 C.F.R. § 3.303; Shedden, 381 F.3d at 1166-67. 

The remaining question for the Board is therefore whether the Veteran's current left lower lobe lung mass is etiologically related to his active service. On this question, there are opinions in favor of and against the claim. 

In support of his claim, the Veteran submitted an August 2025 private medical opinion from Dr. R.P., D.O
1154(a), (b). Accordingly, the Board finds no basis to question the credibility of the Veteran's statements regarding chemical exposure to motor oil, weed killers, pesticides, and paint thinner during service, and the second element of service connection is met. 38 C.F.R. § 3.303; Shedden, 381 F.3d at 1166-67. 

The remaining question for the Board is therefore whether the Veteran's current left lower lobe lung mass is etiologically related to his active service. On this question, there are opinions in favor of and against the claim. 

In support of his claim, the Veteran submitted an August 2025 private medical opinion from Dr. R.P., D.O. She opined that, 

...[W]hen considered individually, each of [the Veteran's] in-service exposures-prolonged inhalation of volatile organic solvents and hydrocarbons in an unventilated storeroom, repeated contact with aerosolized pesticides and herbicides, and sustained ingestion and inhalation of trichloroethylene (TCE) and perchloroethylene (PCE)-contaminated water at Camp Lejeune-has been scientifically linked to chronic respiratory injury and increased risk of pulmonary pathology. However, the true extent of his risk cannot be understood by examining these exposures in isolation. In real-world occupational and environmental health science, concurrent exposures often act synergistically, with combined toxicological effects exceeding the sum of individual risks. [The Veteran's] daily contact with multiple respiratory toxicants through ingestion, inhalation, and dermal absorption created a continuous, multi-route exposure profile over several years, directly during active service. Mechanistic and epidemiologic evidence demonstrates that such cumulative exposures can produce delayed-onset respiratory disease, even decades after initial contact, particularly where persistent, stable compounds such as TCE and PCE are involved. While the benign left lower lobe (LLL) pulmonary mass was first detected in 2004, the latency period is consistent with documented patterns of chemically induced lung pathology, where subclinical changes may progress slowly before becoming radiographically apparent. Given the established plausibility of each exposure pathway, the additive and potentially synergistic interaction of all service -related exposures, and the biologically reasonable latency, it is at least as likely as not that [the Veteran's] current lung condition is causally related to his in-service environmental and occupational exposures.

Dr. R.P. provided a lengthy medical analysis supporting her positive nexus opinion. She explained that chronic occupational exposure to organic solvents and hydrocarbons, like those found in motor oil, weed killers, pesticides, and paint thinner, has been recognized as a significant risk factor for adverse respiratory health outcomes based on numerous scientific studies. She indicated that the Veteran's "work in the unventilated chemical storeroom at Camp Lejeune placed him in daily contact with concentrated fumes from multiple solvent-containing substances, creating a high potential for inhalational exposure." Further, she explained that the Veteran's "storeroom duties exposed him to not only individual chemicals but also complex mixtures, which may act synergistically to amplify respiratory toxicity" and that his "prolonged exposure to combined chemical vapors and contaminated base water serves as a critical real-world example of how chronic contact with chemical mixtures can lead to long-term adverse respiratory outcomes." Dr. R.P. found that the Veteran's pulmonary function tests (PFTs) showed measurable respiratory limitations, including reduced Forced Expiratory Volume in 1 Second (FEV-1) values, that are consistent with documented effects of solvent exposure. Additionally, she explained, 

The potential mechanisms by which the chemicals [the Veteran] encountered induce respiratory dysfunction include both immediate irritative effects on the airway mucosa and chronic inflammatory processes. Inhalation of these vapors causes acute symptoms such as cough and throat irritation. Overtime, repeated exposure fosters persistent airway inflammation, structural remodeling, and a predisposition to obstructive lung diseases. Cellular processes involving oxidative stress and inflammatory cytokine release contribute further to tissue damage and fibrosis. These mechanistic insights not only align with [the Veteran's] reported history of in-service symptom onset and gradual progression but also provide a biologically sound rationale for linking his present respiratory condition to prolonged occupational solvent and hydrocarbon exposure. (Citations omitted).

Dr. R.P. further explained that the Veteran's daily work in a chemical storeroom during service frequently brought him into close contact with pesticide and herbicide containers, as well as aerosolized residues from substances like weed killers. She added that the Veteran's role in issuing such chemicals to other servicemembers "likely involved repeated encounters with volatile residues during routine operations. Research has shown that workers in similar roles experience subtle alterations in lung function from continuous low-dose exposure, often in the absence of acute symptoms." She further indicated that fine particulate matter and vapors from
-service symptom onset and gradual progression but also provide a biologically sound rationale for linking his present respiratory condition to prolonged occupational solvent and hydrocarbon exposure. (Citations omitted).

Dr. R.P. further explained that the Veteran's daily work in a chemical storeroom during service frequently brought him into close contact with pesticide and herbicide containers, as well as aerosolized residues from substances like weed killers. She added that the Veteran's role in issuing such chemicals to other servicemembers "likely involved repeated encounters with volatile residues during routine operations. Research has shown that workers in similar roles experience subtle alterations in lung function from continuous low-dose exposure, often in the absence of acute symptoms." She further indicated that fine particulate matter and vapors from stored pesticides and herbicides would have been easily inhaled and deposited deep into the alveolar spaces, especially when containers were opened, moved, or cleaned. Such particle deposition has been linked to structural damage at the alveolar-capillary membrane, thus impairing gas exchange efficiency, and even low-level occupational pesticide exposure can impair pulmonary function. Moreover, she explained, 

Chemical storage environments, like the storeroom in which [the Veteran] worked, often lack the engineering controls and ventilation needed to minimize aerosol exposure. In such enclosed spaces, the risk is compounded not only by direct inhalation during handling but also by secondary exposures from chemical residues and resuspended particulates during equipment movement or cleaning. Without adequate ventilation or PPE, repeated exposures accumulate over time, increasing the likelihood of both acute irritative episodes and chronic inflammatory changes in lung tissue. These conditions mirror the risk profiles documented in occupational studies, emphasizing the need for comprehensive exposure recognition and control measures in similar environments. (Citations omitted). 

Dr. R.P.'s opinion also linked the Veteran's left lower lobe lung mass to exposure to TCE and PCE in the water supply at Camp Lejeune. The record again contains no evidence that the Veteran was stationed at Camp Lejeune. For that reason, the portion of her opinion linking the Veteran's left lower lobe lung mass to contaminated water at Camp Lejeune is not persuasive. 

Nevertheless, the portion of Dr. R.P.'s opinion linking his left lower lobe lung mass to exposures to other chemicals, like motor oil, weed killers, pesticides, paint thinner, and herbicides, is persuasive. Her opinion is thorough with numerous citations to supporting medical literature. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008); see also Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). 

The record also contains an August 2021 VA examination and nexus opinion. This examination showed a diagnosis of left lower lobe lung mass. The examiner opined that it is less likely than not that the Veteran's left lower lobe lung mass was incurred in or caused by his active service. The examiner stated that the Veteran was assessed with a benign left lower lobe pulmonary mass since 2004, approximately 21 years after his separation from service. Such served as the basis for the opinion that there is no nexus between the Veteran's left lower lobe lung mass and his military service. 

The August 2021 VA medical opinion is inadequate. The opinion is conclusory, as it states that there is no nexus between the Veteran's left lower lobe lung mass and his active service without explaining why. The opinion provides no persuasive findings as to why the 21-year period between diagnosis and service was significant. The examiner also failed to address the Veteran's assertion that his respiratory condition was caused by his exposure to chemicals due to his MOS as an aviation supply clerk. This omission also renders the medical opinion inadequate. See Miller v. Wilkie, 32 Vet. App. 249, 257 (2020) (holding an examiner's failure to consider a veteran's lay statement when offering a medical opinion renders that opinion inadequate). 

The evidence is at least in approximate equipoise as to whether the Veteran's left lower lobe lung mass is related to his active service. Thus, after resolving all doubt in favor of the Veteran, the Board finds that entitlement to service connection for left lower lobe lung mass is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 

 

 

MICHAEL A. HERMAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R.M. Sachs, 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. 


 doubt in favor of the Veteran, the Board finds that entitlement to service connection for left lower lobe lung mass is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 

 

 

MICHAEL A. HERMAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R.M. Sachs, 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.