Citation Nr: 18149106 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 16-40 488 DATE: November 8, 2018 REMANDED Entitlement to service connection for a respiratory condition is remanded. REASONS FOR REMAND The Veteran had active duty service from May 1976 to May 1980. After review of the record, the Board finds that further development is necessary before the Board can properly adjudicate the Veteran’s claim. The Veteran contends his current respiratory condition was caused by service. To determine the etiology of the Veteran’s respiratory condition, the Veteran received a VA examination in June 2015. After an examination and review of his medical history, the examiner diagnosed the Veteran with chronic obstructive pulmonary disease (COPD) and noted that the Veteran’s chest x-ray showed an opacity at the right lung, to include scarring, and possible malignancy. The examiner concluded that the Veteran’s conditions were less likely than not related to service. In so finding, the examiner noted that the Veteran’s symptoms in service appear nebulous and only the diagnoses of allergic rhinitis and upper respiratory infection appears clear. The examiner found that these conditions are not known causes of COPD. The examiner further noted that although the Veteran did not identify any occupational or other toxic exposures during his intervening years since service, it is possible that he may have developed COPD based on “second hand smoke” exposure or other unremarkable events over the course of time. The examiner noted that the opacity in the Veteran’s right apical area requires further workup to fully elucidate the Veteran’s respiratory condition. The examiner concluded that given the present evidence, it is less likely the Veteran’s mild COPD was incurred in or caused by service. After reviewing the examiner’s opinion, the Board finds the examination is inadequate for adjudicating the Veteran’s claim. In doing so, the Board initially notes that it appears the examiner’s opinion was premature given that the examiner determined that further workup was needed with regard to the Veteran’s abnormal chest x-ray to fully explain the Veteran’s respiratory condition. Additionally, the examiner’s conclusions that the Veteran’s in-service symptoms appear “nebulous,” and that second-hand smoke could “possibly” be the cause of his COPD were not supported by medical rationale and appear to be based on conjecture. Further, the examiner seems to rely on the absence of a COPD diagnosis during the Veteran’s service as the examiner noted that the only clear diagnoses are allergic rhinitis and upper respiratory infection. Although COPD was not diagnosed in service, the Veteran’s STRs are significant for rhinitis, chest tightness, and upper respiratory infections. To that end, the Board notes that the absence of a diagnosed disability does not negate service connection and the totality of the Veteran’s symptoms, treatment, and any diagnoses relative to his respiratory condition should have been considered in the rendered opinion. Finally, the Board notes that since the examiner rendered his opinion, the Veteran has submitted written correspondence concerning a plausible cause and onset of his respiratory condition. In particular, the Veteran reported that in approximately September 1976, while stationed in California, he was subjected to toxic air due to smog and was told during orientation that breathing the air was the equivalent to smoking one to two packs of cigarettes a day. He further reported that prior to then, he had never suffered from upper respiratory problems; however, within two weeks of his arrival, he began experiencing chest congestion, coughing, wheezing, and upper respiratory infections. He reported that he continued to have upper respiratory infections after leaving the Air Force, and was informed by his treating physician that living in a foggy area for several years could have started his lung problems. In considering the Veteran’s lay statements, the Board finds that the Veteran is competent to report the onset and duration of his symptoms as well as his medical history. Additionally, the Board has no reason to doubt the credibility of the Veteran’s statements. Furthermore, a February 1980 service treatment record shows that the Veteran was diagnosed with allergic rhinitis with a notation showing “probable environmental…” which lends credence to the Veteran’s lay statements. In light of the above, the Board finds a new and examination and opinion is warranted to consider the totality of the evidence, to include all symptoms, treatment, diagnoses, and the Veteran’s lay statements concerning the onset and continuity of symptoms since service. Accordingly, the matter is REMANDED for the following action: 1. Schedule an appropriate VA examination with a different examiner than the examiner who performed the June 2015 examination to determine the nature and etiology of any current respiratory condition. The claims file must be made available to, and reviewed by, the examiner. Any indicated studies, to include a CT scan, should be performed. The examiner should provide an opinion as to whether it is at least as likely as not (a 50% or greater probability) that the Veteran’s respiratory condition was incurred in, caused by, or otherwise causally related to his service. The examiner must consider the June 2015 VA examiner’s notation that the Veteran may have developed COPD as a result of second-hand smoke, as well as his notation that additional testing was necessary in order to provide a diagnosis. The examiner must also consider the relevant STRs and lay statements discussed above, to include the Veteran’s contention that he developed respiratory problems after living in a foggy/polluted area. The examiner should set forth all examination findings and a complete rationale for any opinion expressed should be provided. If the examiner determines that he or she is unable to provide the requested opinion without resort to speculation, the examiner must provide a reasoned explanation for such conclusion. 2. Then, readjudicate the claim. If any benefit sought is not granted, the Veteran and his representative should be furnished a supplemental statement of the case and provided an opportunity to respond before the case is returned to the Board. REBECCA N. POULSON Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Laffitte, Associate Counsel