Citation Nr: 18141273 Decision Date: 10/10/18 Archive Date: 10/10/18 DOCKET NO. 18-36 831 DATE: October 10, 2018 REMANDED Entitlement to service connection for COPD is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from July 1960 to July 1963. Entitlement to service connection for COPD is remanded. The Veteran contends that his current COPD is secondary to scar tissue from pneumonia sustained in service. The record reflects a current diagnosis for COPD, and the Veteran’s service treatment records (STRs) indicate that he had pneumonia in service. Specifically, a January 1961 STR indicates that the Veteran had a history of pneumonia. A January 1962 STR reflects a diagnosis for lobar pneumonia of the right upper lobe. In a June 2017 VA opinion, the examiner opined that the Veteran’s pulmonary status is at least as likely as not due to or caused by his previous tobacco product abuse. The examiner stated that the Veteran reports being diagnosed with COPD approximately eight years prior. The examiner reasoned that the Veteran reported that he started smoking in high school and quit in 2005. The examiner also noted that a December 1961 STR documents that the Veteran smoked a pack of cigarettes a day when diagnosed with pneumonia. However, the June 2017 VA opinion is not adequate. While the examiner essentially linked both the Veteran’s current COPD and the in-service pneumonia to smoking, this rationale does not directly address the issue at hand, which is whether the in-service pneumonia is related to the Veteran’s current pulmonary status. An explicit opinion and rationale are necessary discussing whether it is at least as likely as not that the Veteran’s current COPD was incurred in or is otherwise related to his active service, to include his in-service pneumonia. Additionally, the STRs indicate that the Veteran had right lobe pneumonia. A July 2016 treatment note from Tallahassee Pulmonary Clinic indicates that a chest CT scan revealed an opacity in the right lung base laterally, which has an appearance most likely due to plural and parenchyma scarring. The June 2017 VA examiner did not address the July 2016 report. However, as both the in-service diagnosis and the 2016 diagnosis refer to the right lung, the Board finds the 2016 report highly relevant. As such, the report should be addressed on remand. Additionally, following the June 2017 VA examination, the Veteran submitted an August 2017 letter from Dr. F.D. at Tallahassee Pulmonary Clinic stating that the Veteran had pneumonia in the 1960s, which could have caused bronchiectasis and scarring of the lungs. The letter also indicates that CT scans were not available at that time. The Board notes that “could be” does not rise to the level of “at least as likely as not.” As such, the August 2017 opinion is not sufficient to grant the claim. However, as this opinion addresses a link between the Veteran’s current pulmonary disability and residual scarring from his in-service pneumonia, this opinion must be addressed on remand as well. The matter is REMANDED for the following action: 1. Return the claims file, to include a copy of this remand, to the June 2017 VA examiner who conducted the respiratory conditions examination. If the examiner who drafted the June 2017 opinion is unavailable, the opinion should be rendered by another appropriate medical professional. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. The claims file and a copy of this remand must be made available to the reviewing examiner, and the examiner should indicate in the report that the claims file was reviewed. The examiner is also advised that the Veteran is competent to attest to observable symptoms. If there is a medical basis to support or doubt the Veteran’s reports of symptomatology, the examiner should provide a fully reasoned explanation. The opinion provided must be accompanied by a complete rationale as to why the examiner reached the conclusions provided. The examiner is asked to provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s current COPD is related to the pneumonia he incurred in service. i) Importantly, the examiner is asked to reconcile the fact that the Veteran had pneumonia of the right lobe in service with the July 2016 report from Tallahassee Pulmonary Clinic indicating right lung opacity per CT scan. ii) The examiner is also asked to address the August 2017 treatment report from Tallahassee Pulmonary Clinic indicating that the Veteran’s pneumonia from the 1960s has led to additional respiratory conditions. 2. After completing the above actions, readjudicate the claim on appeal. If the benefit sought on appeal remains denied, the Veteran should be furnished an appropriate Supplemental Statement of the Case and be provided an opportunity to respond. Thereafter, the case should be returned to the Board for further appellate consideration, as appropriate The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). N. RIPPEL Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Smith, Associate Counsel