Citation Nr: 18152619 Decision Date: 11/23/18 Archive Date: 11/23/18 DOCKET NO. 12-16 234 DATE: November 23, 2018 REMANDED Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD) and anxiety is remanded. REASONS FOR REMAND In May 2016, the Board remanded the case to the Agency of Original Jurisdiction (AOJ) for the Veteran to receive VA examinations. The Veteran received VA examinations for both disabilities in December 2016. Once VA undertakes the effort to provide an examination, it must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Board finds the opinions provided for both disabilities were inadequate and finds another VA opinion is necessary. 1. COPD The December 2016 VA examiner considered the Veteran’s exposure to asbestos and fumes. However, the examiner did not provide an adequate opinion using the “at least as likely as not” standard. The examiner opined the Veteran’s in-service exposure may have contributed to his COPD development. This opinion does not meet the required standard and the Board finds a new opinion using the at least as likely standard is necessary. 2. Psychiatric Disorder The December 2016 VA examiner provided an addendum opinion concerning the Veteran’s anxiety in April 2018. However, the examiner’s opinion did not consider the Veteran’s in-service reports of feelings of nervousness. Additionally, the examiner’s opinion did not consider the Veteran’s in-service stressors. The examiner’s opinion was solely based on the lack of in service treatment for mental health and that his exit examination was negative for mental health issues. Therefore, the Board finds a new VA opinion is necessary that considers the totality of the claims file. The matters are REMANDED for the following action: 1. Return the Veteran’s claims file to the examiner who conducted the December 2016 VA examination for his respiratory disability so a supplemental opinion may be provided. If that examiner is no longer available, provide the Veteran’s claims file to a similarly qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination is only required if deemed necessary by the examiner. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s respiratory disability began during active service or is related to service, including exposure to fumes. The Board notes the examiner should provide an opinion that uses the at least as likely as not standard. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. 2. Return the Veteran’s claims file to the examiner who conducted the December 2016 VA examination for his acquired psychiatric disabilities so a supplemental opinion may be provided. If that examiner is no longer available, provide the Veteran’s claims file to a similarly qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination is only required if deemed necessary by the examiner. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s respiratory disability began during active service or is related to service, or began within one year after discharge. Although an independent review of the claims file is required, the Board calls the examiner’s attention to the following: the April 1969 service record documenting the Veteran’s report of nervousness and the Veteran’s in service stressors. The examiner should specifically provide an opinion concerning the Veteran’s diagnosis of anxiety. (Continued on the next page)   The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. ROBERT C. SCHARNBERGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Brunot, Associate Counsel