Citation Nr: 18155666 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 14-19 243 DATE: December 4, 2018 REMANDED Entitlement to service connection for a lung disorder, to include as a result of asbestos exposure, is remanded. Entitlement to service connection for coronary artery disease is remanded. REASONS FOR REMAND 1. Entitlement to service connection for a lung disorder, to include as a result of asbestos exposure, is remanded. In April 2017, the Veteran underwent a VA contract examination addressing his claimed lung disorder, in which the examiner diagnosed the Veteran with bilateral nodules of the lungs. The contract examiner ultimately opined that the Veteran’s diagnosed lung nodules were less likely than not incurred in or caused by service, including his exposure to asbestos in service. In support of that opinion, the examiner noted that the Veteran has metastatic colorectal cancer with evidence of pulmonary involvement, and that this was at least as likely as not the cause of his reported symptoms and the diagnosed nodules, stating that there was no evidence of pulmonary asbestosis. However, the Board notes that the Veteran underwent an April 2017 pulmonary function test, in which the physician concluded that the Veteran’s spirometry and lung volumes were consistent with mild restrictive lung disease. The April 2017 contract examiner noted the pulmonary function test during his examination, but made no reference to the finding of mild restrictive lung disease. Additionally, while the contract examiner referenced several of the Veteran’s private diagnostic tests in the examination report, including an April 2017 chest x-ray and December 2016 CT scan, there are multiple other diagnostic tests of record which do not appear to have been addressed by the contract examiner, including a July 2016 CT scan and a December 2015 CT scan, both of which note linear scarring or atelectasis present in either the right or both lung bases. Additionally, a May 2017 CT scan was also performed after the April 2017 contract examination, which again noted prominent areas of scarring in the right lung base. The examiner does not appear to directly address the noted scarring in the Veteran’s lungs in discussing his claimed lung condition. In light of the foregoing, a remand is required to obtain a new VA examination to address the nature and etiology of the Veteran’s claimed lung disorder. 2. Entitlement to service connection for coronary artery disease is remanded. The Board previously remanded the Veteran’s claim for coronary artery disease in July 2018 to obtain a VA examination to address whether the Veteran’s coronary artery disease was related to the Veteran’s high cholesterol, which first developed while in service. The Veteran subsequently underwent an October 2018 VA contract examination for heart conditions, in which the examiner diagnosed the Veteran with coronary artery disease, myocardial infarction, coronary artery bypass graft, familial hypercholesteremia, and hyperlipidemia. The examiner then opined that the Veteran’s hyperlipidemia was less likely than not related to service, and further opined that it was less likely than not that the Veteran’s coronary artery disease was caused by his in-service hyperlipidemia. In support of those opinions, the examiner noted that the Veteran’s cardiologist provided a diagnosis of a strong family history of familial hypercholesteremia and noted that while the Veteran was diagnosed with and treated for hyperlipidemia in 1988 while in service, and despite the fact that the Veteran had high cholesterol at separation, there was no mention of the condition again until 2006, and no documentation to support chronicity of hyperlipidemia after the military. However, the Board has concluded that the October 2018 contract examination is inadequate. As an initial matter, the Board notes that the Veteran’s service treatment records document that the Veteran was first given a provisional diagnosis of hyperlipidemia in August 1987, not in 1988 as referenced in the October 2018 contract examination. Additionally, the examiner appears to base her negative etiology opinions at least in part on the absence of medical records indicating that the Veteran had high cholesterol in the intervening time period between separation from service until 2006, when the Veteran was hospitalized for a myocardial infarction. The Veteran’s service treatment records document that since his diagnosis of hyperlipidemia in August 1987, his cholesterol remained high in service until his September 1989 separation examination despite taking medication and changing his diet. The examiner does not explain how she concluded that the Veteran’s high cholesterol resolved after separation from service based solely on an absence of medical records showing high cholesterol for the period between separation from service and the date of his myocardial infarction (as opposed to medical records showing normal cholesterol levels during this period). Moreover, the examiner simply states that the hyperlipidemia documented in service was less likely than not related to his current CAD, with no explanation for how this conclusion was reached. In light of the above, a remand is required to obtain a new VA examination to address the nature and etiology of the Veteran’s coronary artery disease. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination by an appropriate clinician who has not previously examined the Veteran to determine the nature and etiology of his claimed lung disorder. For any such distinct lung disorder found, the examiner must opine as to whether the Veteran’s disorder is at least as likely as not (a 50 percent or greater probability) the result of disease or injury in service, to include the conceded in-service exposure to asbestos. The examiner must address the relevant medical evidence of record, to include past diagnostic tests documenting scarring and atelectasis in the lung bases and findings consistent with mild restrictive lung disease. The examination report must include a complete rationale for the opinions provided. 2. Schedule the Veteran for a VA examination by an appropriate clinician who has not previously examined the Veteran to determine the nature and etiology of his coronary artery disease. The examiner must opine as to whether the Veteran’s coronary artery disease is at least as likely as not (a 50 percent or greater probability) the result of disease or injury in service, to include hyperlipidemia noted in-service and on separation from service. The examiner must address the relevant medical evidence of record, to include service treatment records documenting diagnosis of and treatment for high cholesterol in service. (Continued on the next page)   The examination report must include a complete rationale for the opinions provided. Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Reed, Associate Counsel