NONTUBERCULOUS LUNG DISEASE

D. JOHNSON · 2026 · Case ID: A26040139

MIXED

Summary

The Veteran served from December 1967 to November 1971. He appealed the denial of service connection for pulmonary nodules in his left and right lungs and sought service connection for hypertension. The Board considered evidence submitted prior to the December 18, 2025 rating decision and evidence submitted between December 23, 2025, and March 23, 2026. The agency of original jurisdiction had favorably found a current diagnosis of pulmonary nodules and favorable findings for toxic exposure risk activities (TERA), including asbestos and ionizing radiation. However, the Board found that the evidence persuasively weighed against a service connection for the pulmonary nodules, noting the diagnosis occurred decades after service and that the Veteran's claims of exposure to Agent Orange were unsubstantiated by service records. The VA examiner's opinion, finding the nodules less likely than not related to TERAs, was deemed adequate and more probative than the Veteran's lay opinion. Service connection for pulmonary nodules was denied. The claim for hypertension was remanded because the VA examination was incomplete, failing to address ionizing radiation exposure and contradicting the favorable finding of hypertension by the AOJ. The Board noted the Veteran's exposure to minimal asbestos and low levels of radiation, as reflected in TERA memorandums and service treatment records.

Rationale

Evidence persuasively weighs against service connection; Diagnosis occurred decades after service; Veteran's claims of Agent Orange exposure unsubstantiated

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251223-608201

Full Decision Text

Citation Nr: A26040139
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 251223-608201
DATE: April 29, 2026

ORDER

Service connection for pulmonary nodules - left and right lungs (previously rated as mediastinal masses to include the lungs, heart, upper abdomen) is denied.

REMANDED

Service connection for hypertension is remanded.

FINDING OF FACT

The evidence of record persuasively weighs against finding that pulmonary nodules - left and right lungs began during active service or are otherwise related to an in-service injury or disease.

CONCLUSION OF LAW

The criteria for service connection for pulmonary nodules - left and right lungs are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from December 1967 to November 1971.

In December 2025, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of the issues of entitlement to service connection for (1) hypertension and (2) mediastinal masses to include the lungs, heart, upper abdomen most recently addressed in September 2024 and December 2024 rating decisions. In December 2025, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claims based on the evidence of record at the time of that decision. Therefore, the Board may only consider the evidence of record at the time of the decision on appeal and any evidence submitted during an applicable evidentiary window.

In the December 23, 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the December 2025 AOJ supplemental claim decision on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the supplemental claim decision on appeal and prior to receipt of the VA Form 10182, or (2) more than 90 days following receipt of the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

Specifically, the Board has considered evidence received prior to the December 18, 2025 rating decision. Evidence submitted by the Veteran or his representative from December 23, 2025 (the date of receipt of the Veteran's Notice of Disagreement) to March 23, 2026, is also eligible for review. Any evidence submitted from December 19, 2025 to December 22, 2025 is ineligible to be reviewed. Likewise, any evidence submitted after March 23, 2026 is ineligible for review. 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 claim of entitlement to service connection for hypertension, any evidence the Board could not consider will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

Service connection for pulmonary nodules - left and right lungs is denied.

The Veteran contends that his pulmonary nodules are due to exposure to herbicide agents, asbestos, and radiation.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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
Service connection for pulmonary nodules - left and right lungs is denied.

The Veteran contends that his pulmonary nodules are due to exposure to herbicide agents, asbestos, and radiation.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

In the December 2025 rating decision, the AOJ favorably found that the Veteran was diagnosed with pulmonary nodules-left and right lungs. It also favorably found that the Veteran participated in a toxic exposure risk activity (TERA). Specifically, it favorably found that the Veteran was exposed to asbestos and ionizing radiation during military service. Consequently, the first two elements of a service connection claim have been met.

The Board concludes that, while the Veteran has a current diagnosis of pulmonary nodules-left and right lungs, and evidence shows that the Veteran participated in TERAs, the evidence of record persuasively weighs against finding that the Veteran's diagnosis of pulmonary nodules-left and right lungs began during service or is otherwise related to an in-service injury, event, or disease.

TERA Memorandums dated August 2024 and October 2024 reflect the Veteran had minimal asbestos exposure and radiation exposure.

The Veteran underwent a VA examination in November 2024. The examiner diagnosed the Veteran with pulmonary nodules - left and right lungs. The Veteran reported that duration of the toxic exposures was daily, over the course of four years. The Veteran described the route of the exposure as inhalation and dermal. He reported that PPE was not used. The examiner noted that TERA Memorandums dated August 2024 and October 2024 reflect that exposure to asbestos was minimal. He also noted that the October 2024 TERA Memorandum reflected exposure to radiation (noted on pages 13 and 33). The examiner opined that the disability was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated TERAs after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERAs of the Veteran. His rationale was that exposure to ionizing radiation and asbestos and the development of pulmonary nodules - left and right is not supported by medical literature or scientific data.

In a December 2025 correspondence, the Veteran argued that the opinion is inadequate for a couple of reasons.

First, the Veteran argued that the VA examiner did not consider the Veteran's exposure to Agent Orange. Specifically, he stated that he served on board the USS Enterprise CVN 65 off the shore of Vietnam in 1971. He stated that Enterprise was off the shore of Vietnam from June 1971 - February 1972 and decks logs show he that was onboard from April 29, 1970 - November 3, 1971. The Board does not dispute that the Veteran served aboard the USS Enterprise. However, the deck logs reflect that the ship only entered the Vietnam Blue Waters on November 25, 1971 (more than three weeks after the Veteran left the ship, and almost two weeks after the Veteran was discharged from service). Therefore, the deck logs cited by the Veteran fail to reflect that he was either in Vietnam (boots on the ground) or that he was in the Vietnam Blue Waters.

An August 2024 Memorandum confirms that exposure to herbicide agents cannot be conceded, as the Veteran did not have service in a qualifying nautical location. He did not have duty or visitation in the Republic of Vietnam, or on its inland waterways, or nautical service in the offshore eligible waters as defined in the Blue Water Navy Vietnam Veterans Act of 2019.

Consequently, the VA examiner was correct in not addressing the Veteran's erroneous contention that he was exposed to Agent Orange.

The Veteran also argued that "without an ILERS report it is unclear how the September 4, 2024, Examiner opines toward the Appellant's level of radiation exposure."

The Board notes that no pulmonary examination was conducted on September 4, 2024. The pulmonary examination was conducted in November 2024. Notwithstanding this clerical error on the Veteran's part, the
did not have duty or visitation in the Republic of Vietnam, or on its inland waterways, or nautical service in the offshore eligible waters as defined in the Blue Water Navy Vietnam Veterans Act of 2019.

Consequently, the VA examiner was correct in not addressing the Veteran's erroneous contention that he was exposed to Agent Orange.

The Veteran also argued that "without an ILERS report it is unclear how the September 4, 2024, Examiner opines toward the Appellant's level of radiation exposure."

The Board notes that no pulmonary examination was conducted on September 4, 2024. The pulmonary examination was conducted in November 2024. Notwithstanding this clerical error on the Veteran's part, the Board notes that the November 2024 VA examiner cited to the record. In his opinion, he cited to pages 13 and 33 as evidence of the Veteran's exposure to radiation. These page numbers are references to the service treatment records. Page 13 of the service treatment records consists of a radiation physical examination. More importantly, page 33 consists of a Record of Occupational Exposure to Ionizing Radiation. It reflects that the Veteran's total lifetime exposure was 00.056 rem. The report reflects that permissible lifetime exposure is 20.00 rem. Consequently, even without an ILER report, the level of radiation exposure was outlined in service treatment records that were incorporated into the claims file in May 2017 and again March 2020. Although the VA examiner did not explicitly list the level of radiation exposure, he correctly cited the portion of the claims file in which the dosage information could be found. The Board finds that both the November 2024 examination report and the accompanying opinion are adequate.

Treatment records show the Veteran was not diagnosed with a pulmonary disability until decades after separation from service (see March 2013 CT scan showing a moderately large mass in the superior mediastinum). While the Veteran is competent to report having experienced symptoms either intermittently or consistently since service, he has not done so in this case.

Further, the November 2024 VA examiner opined that the Veteran's disability is not at least as likely as not related to an in-service injury, event, or disease, including participation in a TERA. The examiner's opinion is competent because he is a licensed physician and was familiar with the Veteran's history through claims file review and the in-person examination he conducted. The opinion is also probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

The Veteran believes that his pulmonary nodules - left and right lungs are related to an in-service injury, event, or disease. He is not competent to provide a nexus opinion regarding this question. The question at issue is medically complex, as it requires knowledge of internal lung pathology and the interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of this Veteran because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the medical evidence to include the November 2024 opinion that was proffered by a VA physician.

As the evidence persuasively weighs against the claim; the benefit of the doubt doctrine does not apply. Consequently, the claim must be denied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

REASONS FOR REMAND

Service connection for hypertension is remanded.

The Veteran underwent a VA examination in September 2024. The examiner rendered an negative TERA opinion; however, there is no indication that the examiner took into account the Veteran's exposure to ionizing radiation. The opinion only addressed asbestos exposure. Consequently, the opinion is incomplete.

The Veteran underwent another VA examination in November 2024. The examiner did not diagnose the Veteran with any heart disability, including hypertension. He rendered a negative TERA opinion in which he considered both the Veteran's exposure to asbestos and ionizing radiation. However, his negative opinion was based upon his belief that there was no pathology to warrant a diagnosis or condition. The opinion is inadequate because it runs contrary to the fact that the AOJ has already favorably found that the Veteran has a current diagnosis of hypertension.

The failure to obtain an adequate VA opinion constitutes a pre-decisional duty to assist error, for
took into account the Veteran's exposure to ionizing radiation. The opinion only addressed asbestos exposure. Consequently, the opinion is incomplete.

The failure to obtain an adequate VA opinion constitutes a pre-decisional duty to assist error, for which a remand is necessary.

The matter is REMANDED for the following action:

Obtain an addendum opinion regarding the Veteran's hypertension. The examiner must review the claims file and provide a response to the following:

Is the Veteran's hypertension at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) related to service?

Is the Veteran's hypertension at least as likely as not caused by the indicated TERAs, after considering the total potential exposure through all of his applicable military deployments and the synergistic, combined effect of all of his TERAs?

(Continued on the next page)

Provide a rationale to support the opinions. If the examiner must resort to speculation, the reason for such speculation must be explained.

D. JOHNSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Prem, 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.

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