Citation Nr: 18154256 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 16-49 967 DATE: November 29, 2018 REMANDED Entitlement to service connection for a respiratory condition, to include chronic obstructive pulmonary disease (COPD) and asbestosis, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1984 to April 1989. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a December 2014 rating decision by a Department of Veterans Affairs Regional Office (RO). 1. Respiratory Condition The Veteran asserts entitlement to service connection for a respiratory condition. Specifically, the Veteran asserts that she developed a respiratory condition, claimed as COPD, as a result of exposure to welding fumes, asbestos and other environmental hazards during active duty service. The service treatment records (STRs) include a January 1984 enlistment examination noting normal lungs and a normal chest X-ray. However, the Veteran’s April 1989 separation examination noted a chest X-ray that revealed old granulomatous disease. Post service medical records include a November 2011 VA medical record showing the Veteran reported exposure to a second hand smoke due to her work as a bar tender. The Veteran was diagnosed with very severe obstructive lung function and severe restrictive lung function. A January 2012 VA medical record noted suspected congestive heart failure (CHF) due to possible severe obstructive lung disease. In August 2013, a VA physician noted COPD that was thought to be secondary to welding and smoke exposure. The Veteran was noted to have never been a smoker. The Veteran has also undergone two VA examinations. At a November 2014 VA examination, the Veteran asserted that her lung condition was etiologically related to her military occupational specialty as a welder, including related fumes. She denied any history of smoking, but did note exposure to second hand smoke. The examiner opined that the diagnosed respiratory conditions were “less likely than not (less than 50% probability)” etiologically related to service. In support of this opinion, the examiner noted she had reviewed several research projects regarding welding and the development of COPD with each project unable to support any such association. Based on a lack of supporting medical literature, the examiner concluded the current condition was less likely due to welding or welding fumes. At an August 2016 VA examination, the Veteran reported being exposed to asbestos and fumes from welding during service. The examiner opined that the diagnosed COPD was “less likely than not (less than 50% probability)” etiologically related to service. In support of this opinion, the examiner found that the COPD was more likely as not attributable to the Veteran’s debilitating non-ischemic cardiomyopathy with atrial fibrillation causing rapid ventricular response cardiac disease. The examiner also noted a 27-year post service history with no medical treatment records showing continuity of symptoms regarding COPD or other respiratory issues. While acknowledging a theoretical possibility of developing COPD as a result of welding fumes, the examiner found no medical evidence to support such a finding. The Board finds both VA examination inadequate. In this regard, the Board notes that neither VA examiner addressed the chest X-ray findings noted on the Veteran’s separation examination. As noted above, the Veteran’s enlistment examination noted a normal chest X-ray. Under the presumption of soundness, a Veteran is considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by such service. Here, old granulomatous disease was not noted on the Veteran’s entrance examination. Therefore, the presumption of soundness attaches. Additionally, the August 2016 VA examiner’s conclusion that COPD was more likely attributable to the Veteran’s heart conditions appears contradicted by prior VA medical records noting that the heart condition might be secondary to the respiratory conditions. At the very least, the examiner should have addressed the conflicting VA medical records. The Board also notes the literature referenced by the Veteran’s representative in the July 2018 IHP. Such should be considered by an examiner on remand. The matter is REMANDED for the following action: 1. With any necessary identification of sources by the Veteran, request all VA treatment records not already associated with the file from the Veteran’s VA treatment facilities, and all private treatment records not already associated with the file. 2. Then, obtain an addendum by an appropriate examiner to determine the nature and etiology of any diagnosed respiratory condition, to include COPD and asbestosis. The Veteran should be scheduled for another VA examination only if determined necessary. The examiner should address whether it is at least as likely as not (50 percent or greater probability) that the Veteran has a diagnosed respiratory condition that is etiologically related to her period of service, to include due to exposure to asbestos and welding fumes. The examiner should note that the Veteran’s military occupational specialty of hull technician has a high probability of exposure to asbestos and that exposure to welding is also considered highly probable for this occupational specialty. The examiner should review pertinent documents in the Veteran’s claims file in connection with the examination, including: STRs noting a chest x-ray finding of old granulomatous disease at separation from service, a January 2012 VA medical record noting suspected CHF due to possible severe obstructive lung disease, an August 2013 VA physician notation that COPD that was thought to be secondary to welding and smoke exposure, and the literature referenced by the Veteran’s representative in the July 2018 IHP. (Continued on the next page)   Reasons should be provided for any opinion rendered. If the examiner is unable to provide an opinion without resort to speculation, an explanation as to why this is so should be provided and any additional evidence that would be necessary before an opinion could be rendered should be identified. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Lamb, Associate Counsel