Citation Nr: 18157111 Decision Date: 12/11/18 Archive Date: 12/11/18 DOCKET NO. 16-06 773 DATE: December 11, 2018 ORDER Entitlement to service connection for pulmonary fibrosis, to include as due to asbestos exposure, is granted. Entitlement to service connection for bilateral hearing loss, is denied. Entitlement to service connection for tinnitus, is denied. Entitlement to service connection for asbestosis, is granted. Entitlement to service connection for the Veteran’s cause of death, is granted. REMANDED Entitlement to service connection of chronic obstructive pulmonary disease, is remanded. FINDINGS OF FACT 1. The Veteran died on October [redacted], 2012; the death certificate lists the immediate cause of death as pulmonary fibrosis – 4 years. 2. The Appellant, the Veteran’s surviving wife, submitted a claim for substitution within one year subsequent to the Veteran’s death. 3. The Veteran is not presumed to have been exposed to herbicides in service. 4. The Veteran is not presumed to have been exposed to radiation in service. 5. The probative evidence of record is in equipoise as to whether the Veteran’s pulmonary fibrosis resulted from active service to include exposure to asbestos. 6. The probative evidence of record is against a finding that the Veteran’s claimed bilateral hearing loss resulted from active service. 7. The probative evidence of record is against a finding that the Veteran’s tinnitus resulted from active service. 8. Resolving reasonable doubt in the Appellant’s favor, it is more likely than not that the Veteran’s asbestosis was incurred in service. 9. The probative evidence of record is against a finding that the Veteran’s cardiomyopathy resulted from active service. 10. The Veteran’s pulmonary fibrosis materially contributed the immediate cause of his death. CONCLUSIONS OF LAW 1. The criteria for a grant of service connection for pulmonary fibrosis have been met. 38 U.S.C. §§ 1110, 1112, 1113, 5103A, 5121 (West 2014); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.311 (2017). 2. The criteria for a grant of service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5103A, 5121 (West 2014); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.311 (2017). 3. The criteria for a grant of service connection for tinnitus have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5103A, 5121 (West 2014); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.31 (2017). 4. The criteria for a grant of service connection for cardiomyopathy have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 5103A, 5121 (West 2014); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.311 (2017). 5. The criteria for service connection for the Veteran’s death have been met. 38 U.S.C. §§ 1110, 1131, 1310, 1318 (West 2014); 38 C.F.R. §§ 3.1, 3.151, 3.152, 3.153, 3.155, 3.400 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The record indicates that the Veteran died in October 2012. In October, the Veteran’s spouse filed an Application for Dependency and Indemnity Compensation, Death Pension and Accrued Benefit. Persons eligible for substitution under 38 C.F.R. § 3.1010 include “a living person who would be eligible to receive accrued benefits due to the claimant under section 5121(a) of this title....” 38 U.S.C. § 5121A (West 2014); 38 C.F.R. § 3.1010 (a). Under 38 C.F.R. § 3.1010 (c)(2), a request for dependency and indemnity compensation by an eligible person, such as the Veteran’s surviving spouse, is deemed to include such a request to substitute if, at the time of the Veteran’s death, a claim seeking periodic monetary payments from VA was pending before the Agency of Original Jurisdiction (AOJ) or the Board. In this case, the Veteran’s surviving spouse filed a request for dependency and indemnity compensation in October 2012, in which she indicated that the Veteran’s death was related to service. In a May 2013 VCAA correspondence the RO failed to inform the Appellant of the requirements for substitution. Although the RO has treated the Appellant’s claim as one for accrued benefits, because the RO failed to inform the Appellant of the requirements for substitution and she and her representative proceeded with a claim for substitution. Therefore, the Board will consider the Appellant to have been substituted for the Veteran. Service Connection Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may also be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303. To substantiate a claim of service connection there must be evidence of: (1) a present disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The Veteran asserted that his claimed pulmonary fibrosis, COPD, asbestosis and cardiomyopathy were due to exposure to herbicides, radiation and asbestos in service. Certain diseases may be presumed to be service-connected if manifested in a Veteran who was exposed to herbicide agents in service, such as Veterans who served in Vietnam during the Vietnam era. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307 (a)(6), 3.309(e). A Veteran who, during active service, served between April 1, 1968, and August 31, 1971, in a unit that, as determined by the Department of Defense, operated in or near the Korean DMZ in an area in which herbicides are known to have been applied during that period, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. The term “herbicide agent” means a chemical in an herbicide, including Agent Orange, used in support of the United States and allied military operations in the Republic of Vietnam during the Vietnam era. 38 C.F.R. § 3.307 (a)(6)(iv). If a Veteran was exposed to an herbicide agent during active service, ischemic heart disease (including old myocardial infarction) shall be service-connected if the requirements of 38 C.F.R. § 3.307 (a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307 (d) are also satisfied. 38 C.F.R. § 3.309 (e). Where the evidence does not warrant presumptive service connection, an appellant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In each case where service connection for any disability is being sought, due consideration shall be given to the places, types, and circumstances of such Veteran’s service as shown by such Veteran’s service record, the official history of each organization in which such Veteran served, such Veteran’s medical records, and all pertinent medical and lay evidence. 38 U.S.C. § 1154 (a). The available service personnel records do not reveal that the Veteran served in Vietnam, at the DMZ in Korea or anywhere exposure to herbicides is presumed. Prior to his death, the Veteran did not specifically allege an activity which would have exposed him to herbicides. Although he did note that he used a flame thrower and was exposed to tear gas in basic training. However, such activities do not qualify for the herbicide presumption. 38 C.F.R. § 3.307 (a)(6)(iv) Based on the foregoing, the Board finds that the most competent and credible evidence does not support the conclusion that the Veteran physically entered Vietnam, the DMZ or was otherwise exposed to herbicides during service. As such, the Veteran is not entitled to a presumption of exposure to herbicides. Additionally, VA regulations provide that diseases specific to radiation-exposed veterans shall be presumed to have been incurred in service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. A “radiation-exposed veteran” is defined by 38 C.F.R. § 3.309 (d)(3) as a veteran who, while serving on active duty or on active duty for training or inactive duty training, participated in a radiation-risk activity. “Radiation-risk activity” is defined to mean onsite participation in a test involving the atmospheric detonation of a nuclear device; the occupation of Hiroshima, Japan or Nagasaki, Japan by United States forces during the period beginning on August 6, 1945, and ending on July 1, 1946; or internment as a prisoner of war (or service on active duty in Japan immediately following such internment) during World War II which resulted in an opportunity for exposure to ionizing radiation comparable to that of the United States occupational forces in Hiroshima or Nagasaki during the period from August 6, 1945 through July 1, 1946. See 38 C.F.R. § 3.309 (b)(i), (ii). Diseases presumptively service connected for radiation-exposed veterans under the provisions of 38 U.S.C. § 1112 (c) and 38 C.F.R. § 3.309 (d)(2) are: leukemia (other than chronic lymphocytic leukemia), cancer of the thyroid, cancer of the breast, cancer of the pharynx, cancer of the esophagus, cancer of the stomach, cancer of the small intestine, cancer of the pancreas, multiple myeloma, lymphomas (except Hodgkin’s disease), cancer of the bile ducts, cancer of the gall bladder, primary liver cancer (except if cirrhosis or hepatitis B is indicated), cancer of the salivary glands, cancer of the urinary tract; bronchiolo-alveolar carcinoma; cancer of the bone; cancer of the brain; cancer of the colon; cancer of the lung; and cancer of the ovary. See 38 U.S.C. § 1112 (c)(2); 38 C.F.R. § 3.309 (d). If a claimant does not qualify as a “radiation-exposed veteran” under 38 C.F.R. § 3.309 (d)(3) and/or does not suffer from one of the presumptive conditions listed in 38 C.F.R. § 3.309 (d)(2), the veteran may still benefit from the special development procedures provided in 38 C.F.R. § 3.311 if the veteran suffers from a radiogenic disease and claims exposure to ionizing radiation in service. Under 38 C.F.R. § 3.311, “radiogenic disease” means a disease that may be induced by ionizing radiation and shall include the following: (i) All forms of leukemia except chronic lymphatic (lymphocytic) leukemia; (ii) Thyroid cancer; (iii) Breast cancer; (iv) Lung cancer; (v) Bone cancer; (vi) Liver cancer; (vii) Skin cancer; (viii) Esophageal cancer; (ix) Stomach cancer; (x) Colon cancer; (xi) Pancreatic cancer; (xii) Kidney cancer; (xiii) Urinary bladder cancer; (xiv) Salivary gland cancer; (xv) Multiple myeloma; (xvi) Posterior subcapsular cataracts; (xvii) Non-malignant thyroid nodular disease; (xviii) Ovarian cancer; (xix) Parathyroid adenoma; (xx) Tumors of the brain and central nervous system; (xxi) Cancer of the rectum; (xxii) Lymphomas other than Hodgkin’s disease; (xxiii) Prostate cancer; and (xxiv) Any other cancer. 38 C.F.R. § 3.311 (b)(2). Under the special development procedures in § 3.311(a), dose data will be requested from the Department of Defense in claims based upon participation in atmospheric nuclear testing, and claims based upon participation in the American occupation of Hiroshima or Nagasaki, Japan, prior to July 1, 1946. See 38 C.F.R. § 3.311 (a)(2). In all other claims, 38 C.F.R. § 3.311 (a) requires that a request be made for any available records concerning the veteran’s exposure to radiation. These records normally include but may not be limited to the veteran’s Record of Occupational Exposure to Ionizing Radiation (DD Form 1141), if maintained, service medical records, and other records which may contain information pertaining to the veteran’s radiation dose in service. All such records will be forwarded to the Under Secretary for Health, who will be responsible for preparation of a dose estimate, to the extent feasible, based on available methodologies. See 38 C.F.R. § 3.311 (a)(2)(iii). In this case, the Board notes at the outset that the Veteran did not serve during the presumptive periods or locations in 38 C.F.R. § 3.309 (b)(i), (ii). Furthermore, the records available prior to the Veteran’s death do not show that he was diagnosed with one of the presumptive conditions listed in 38 C.F.R. § 3.309 (d)(2), and therefore presumptive service connection due to radiation exposure would not be warranted in this case. See 38 C.F.R. § 3.309 (d). The appellant also contends that the Veteran’s claimed disabilities were caused by exposure to asbestos in service. VA must determine whether military records demonstrate evidence of asbestos exposure during service; whether there was pre-service, post-service, occupational, or other asbestos exposure; and whether there is a relationship between asbestos exposure and the claimed disease. A review of the Veteran’s service personnel records show that he was a motor vehicle mechanic in the U.S. Navy. The Board acknowledges that during time the Veteran was in active service, asbestos was known to exist on brake pads, and it is therefore conceded that the Veteran had some degree of asbestos exposure while on active service.   1. Entitlement to service connection for pulmonary fibrosis At the time of the Veteran’s death on October [redacted], 2012, the record reflected that he had been diagnosed with pulmonary fibrosis. Such diagnosis satisfies the first element of 38 C.F.R. § 3.303. However, the Veteran’s service treatment records (STR) are silent for any complaints, symptoms or treatment relating to pulmonary fibrosis. Specifically, the Veteran indicated during his July 1967 separation exam that his lungs and chest were normal. He also denied asthma, shortness of breath and chronic cough in May 1967. Due to the Veteran’s MOS as a motor vehicle mechanic, it is presumed that the Veteran was exposed to asbestos in service. Following the Veteran’s death, the VA obtained a VA medical opinion which found that the Veteran’s pulmonary fibrosis was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. The VA physician reasoned that he saw no evidence of any asbestosis or pleural lung disease as being clinically relevant condition for him at any time. The review of the medical literature showed that both COPD and pulmonary fibrosis were independent idiopathic conditions (COPD is certainly smoking related in a vast majority of cases) and none of these were related to history of asbestos exposure (which causes pleural lung disease such as pleural effusion of mesothelioma which he was never diagnosed with). The Appellant has submitted a March 2016 posthumous private medical opinion which states that the Veteran’s cause of death was determined to be pulmonary fibrosis. He also had a diagnosis of COPD and bullous emphysema. He did not have a family history of lung disease and he was a smoker until the early 1980’s. The examiner noted that medical research has shown a relationship between asbestos exposure and pulmonary fibrosis. Pulmonary fibrosis refers to scarring of the lung tissue and is also known as asbestosis. According to a 2007 study, it generally progresses slowly. According to this study the presence of pleural plaques indicates significant asbestos exposure. A July 2004 medical record shows that the Veteran has pleural plaque scarring on both lungs. Pleural plaques typically become visible 21 or more years after inhalation of asbestos fibers. The physician concluded that there was no doubt that the Veteran’s exposure to asbestos while in service combined with other factors caused his death. He continued, the most accurate way to describe the situation is to state that his asbestos exposure substantially and materially contributed to his death. Weighing the evidence, the Board finds that the preponderance of the evidence is in favor of the claim for service connection for pulmonary fibrosis. Therefore, the pulmonary fibrosis claim is granted. 2. Entitlement to service connection for bilateral hearing loss disability For VA compensation purposes, impaired hearing will be considered to be a disability when the auditory threshold level in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Veteran filed his claim seeking service connection for bilateral hearing loss in July 2012. The evidence of record at the time of the Veteran’s death did not show current hearing loss for VA compensation purposes. 38 C.F.R. § 3.385. While the Veteran himself believed that he suffered from bilateral hearing loss, the extent of hearing loss and the etiology thereof require medical testing and expertise to determine. Accordingly, his claim for service connection for hearing loss is not competent medical evidence of hearing loss disability at the time of his death. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). Furthermore, the Veteran denied loss of hearing in his July 1967 separation examination. Although the Veteran reported muffled right ear hearing in February 2002, he denied hearing loss as recently as a December 2002 medical report. In the absence of medical evidence that a hearing loss disability pursuant to 38 C.F.R. § 3.385 existed, the criteria for establishing service connection for bilateral hearing has not been established, and service connection for bilateral hearing loss is not warranted. 38 C.F.R. § 3.303; Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, the preponderance of the evidence is against the appellant’s claim for entitlement to service connection for bilateral hearing loss. As such, there is no doubt to be resolved, and the claim for service connection for bilateral hearing loss is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to service connection for tinnitus The Veteran filed his claim seeking service connection for tinnitus in July 2012. During the Veteran’s July 1967 separation examination, he reported his ears and ear drums as normal. Also, during a May 1967 separation examination he denied any ear trouble. The Veteran also denied tinnitus during a December 2002 medical report. In fact, the first report of tinnitus is the Veteran’s July 2012 claim for service connection. The Veteran was competent to provide lay evidence of tinnitus as this condition was observable by his own senses. See Charles v. Principi, 16 Vet. App. 370, 374 (2002). The question then becomes whether this evidence is credible. As to some of the factors that go into making credibility determinations both the Court of Appeals for Veterans Claims (Veterans Court) and the Court of Appeals for the Federal Circuit (Federal Circuit) have provided guidance. See Buchanan v. Nicholson, 451 F3.d 1331, 1336-37 (Fed. Cir. 2006) (stating that “the Board, as fact finder, is obligated to, and fully justified in, determining whether lay evidence is credible in and of itself, i.e., because of possible bias, conflicting statements, etc.”); see also Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (stating that “[t]he credibility of a witness can be impeached by a showing of interest, bias, inconsistent statements, or, to a certain extent, bad character.”). Here, these statements conflict with his other statements. Although the Veteran reported tinnitus in July 2012, he denied experiencing ear trouble at service discharge and he never asserted that he experienced tinnitus continuously since service. Thus, service connection for tinnitus cannot be established based on continuing symptoms. Accordingly, the preponderance of the evidence is against the Appellant’s claim for entitlement to service connection for tinnitus. As such, there is no doubt to be resolved, and the claim for service connection for tinnitus for accrued benefits purposes is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 4. Entitlement to service connection for asbestosis VA has conceded that the Veteran was exposed to asbestos during service. Prior to his death he was diagnosed with pulmonary fibrosis and COPD. The Veteran is not shown to have a specific diagnosis of asbestosis. He did, however, have COPD and pulmonary fibrosis, which was first shown nearly 40 years following his discharge from service. In August 2013 a VA medical opinion was rendered. The VA physician determined that it was less likely than not (less than 50 percent probability) that asbestosis was incurred in or caused by the claimed in-service injury, event, or illness. The VA physician reasoned that based upon a review of the Veteran’s claims file, it is apparent that the Veteran suffered from severe “parenchymal” lung disease (which started as bullous emphysema or chronic obstructive pulmonary disease (COPD), then progress to interstitial lung disease which later progressed to pulmonary fibrosis. However, the physician saw no evidence of any asbestosis or pleural lung disease as being clinically relevant condition for him at any time. However, the March 2016 private physician referenced above defined asbestosis, according to the American Lung Association, as “a chronic lung condition that is caused by prolonged exposure to high concentrations of asbestos fibers in the air. Most people with asbestosis had their exposure before the late 1970s, and contracting it at a new job is unlikely.” He also defined asbestosis as pulmonary fibrosis and interstitial pneumonitis. Based upon the Veteran’s exposure to asbestos, and his prolonged history of progressive lung diseases such as severe “parenchymal” lung disease, bullous emphysema, COPD and pulmonary fibrosis, as well as a July 2004 medical record noting pleural scarring in both lung bases, the Board finds that the Veteran had a diagnosis of asbestosis. He also noted that such scarring is indicative of asbestos exposure and typically become visible twenty or more years after inhalation of asbestos fibers. After a review of the evidence of record, the Board finds that the evidence for and against service connection for asbestosis in equipoise; that is, the evidence demonstrating that the Veteran had asbestosis that was related to in-service exposure to asbestos is equally weighted against the evidence demonstrating other etiology. Therefore, resolving reasonable doubt in the veteran’s favor, the Board finds that it is at least as likely as not that the Veteran had asbestosis due to in-service asbestos exposure. The Veteran is therefore entitled to the benefit of the doubt. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Accordingly, it is the judgment of the Board that service connection is warranted for asbestosis. 5. Entitlement to service connection for cardiomyopathy Although the Veteran has alleged that he was exposed to herbicides and radiation, his claim for service connection for cardiomyopathy does not qualify for presumptive service connection. The Veteran did not serve during the presumptive periods or locations in 38 C.F.R. § 3.309 (b)(i), (ii). Furthermore, the records do not show that he was diagnosed with one of the presumptive conditions listed in 38 C.F.R. § 3.309 (d)(2), and therefore presumptive service connection due to radiation exposure would not be warranted in this case. See 38 C.F.R. § 3.309 (d). The available service personnel records do not reveal that the Veteran served in Vietnam, at the DMZ in Korea or anywhere exposure to herbicides is presumed. Prior to his death, the Veteran did not specifically allege an activity which would have exposed him to herbicides. Although he did note that he used a flame thrower and was exposed to tear gas in basic training. However, such activities do not qualify for the herbicide presumption. 38 C.F.R. § 3.307 (a)(6)(iv) Based on the foregoing, the Board finds that the most competent and credible evidence does not support the conclusion that the Veteran physically entered Vietnam, the DMZ or was otherwise exposed to herbicides during service. As such, the Veteran is not entitled to a presumption of exposure to herbicides. Based upon a review of the Veteran’s STRs, there are no complaints, symptoms or diagnoses related to cardiomyopathy in service. Furthermore, during his May 1967 separation examination, there was no history of palpitation or pounding heart or high or low blood pressure, and his heart was noted as normal. The record also shows that he was a cigarette smoker for 15 years. Furthermore, the only evidence of record linking his nonischemic cardiomyopathy and his active duty service is the Veteran’s lay assertions. It should also be noted that in March 2006 that a private physician stated that the etiology of the Veteran’s nonischemic cardiomyopathy was unclear. The Board has considered all of the Veteran’s submitted statements. These reflect the Veteran’s belief that his nonischemic cardiomyopathy was caused by his exposure to asbestos and his active duty service. Cardiomyopathy is not susceptible to lay observation, and the etiology is complex. As such, the Board finds that the Veteran was not competent to provide a medical opinion on this matter. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011); see also Jandreau v. Nicholson, 492 F.3d. 1372 (2007); Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir. 2010). Accordingly, the Veteran’s lay statements in this regard are not competent or probative evidence supporting his claim. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Weighing the evidence, the Board finds that the preponderance of the evidence is against the claim for service connection for cardiomyopathy, because the record does not support that the Veteran incurred or aggravated his cardiomyopathy in service; or a causal relationship between the disability and the disease or injury incurred or aggravated during service. Therefore, the cardiomyopathy claim is denied. As the evidence is not roughly in equipoise, there is no doubt to resolve. 38 U.S.C. § 5107; Gilbert, 1 Vet. App at 53. 6. Entitlement to service connection for the Veteran’s cause of death To warrant service connection for the cause of the Veteran’s death, the evidence must show that a service-connected or compensable disability was either a principal or a contributory cause of death. 38 U.S.C. § 1310; 38 C.F.R. § 3.312. A disability will be considered the principal (primary) cause of death when such disability, singly or jointly with some other condition, was the immediate or underlying cause of death or was etiologically related thereto. 38 C.F.R. § 3.312 (b). A disability will be considered a contributory cause of death when it contributed substantially or materially to death, combined to cause death, or aided or lent assistance to the production of death. 38 C.F.R. § 3.312 (c)(1). The Veteran died October [redacted], 2012 and the cause of death was listed as pulmonary fibrosis. At the time of his death the Veteran was not service connected for pulmonary fibrosis. In May 2012, the Veteran filed a service connection claim for pulmonary fibrosis. At the time of the Veteran’s death in October 2012, he had a diagnosis of pulmonary fibrosis. As noted above, the Veteran is also presumed to have been exposed to asbestos in service. Following the Veteran’s death, the VA obtained a VA medical opinion which found that the Veteran’s pulmonary fibrosis was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. The VA physician reasoned that he saw no evidence of any asbestosis or pleural lung disease as being clinically relevant condition for him at any time. The review of the medical literature showed that both COPD and pulmonary fibrosis were independent idiopathic conditions (COPD is certainly smoking related in a vast majority of cases) and none of these were related to history of asbestos exposure (which causes pleural lung disease such as pleural effusion of mesothelioma which he was never diagnosed with). However, the Appellant submitted a March 2016 private medical opinion which found that medical research has shown a relationship between asbestos exposure and pulmonary fibrosis. Pulmonary fibrosis has many causes and refers to scarring of the lung tissue. According to a 2007 study asbestosis generally progresses slowly. A medical record dated in July 2004 shows the Veteran had pleural scarring in both lung bases. They are indicative of asbestos exposure. The private physician also noted that the Veteran had several other factors which could have contributed to his lung disease such as a positive smoking history and working as a mechanic. However, the most accurate way to describe the situation is to state his asbestos exposure substantially and materially contributed to his cause of death. The only way to be more precise is if a detailed autopsy was performed. As the evidence indicates that pulmonary fibrosis was a contributory cause of death, after resolving any reasonable doubt in favor of the Appellant, the Board finds that service connection for the Veteran’s cause of death is warranted. REASONS FOR REMAND 1. Entitlement to service connection for chronic obstructive pulmonary disease (COPD), to include as exposure to asbestos The Veteran seeks service connection for COPD, to include as due to asbestos exposure. As noted above, the Board has presumed that the Veteran was exposed to asbestos in service due to the Veteran’s MOS as a motor vehicle mechanic. In March 2016 a private physician noted that the Veteran’s COPD, emphysema and pulmonary fibrosis were all related disease and you cannot separate the effects of each. It is unclear from this opinion whether the Veteran’s service connection pulmonary fibrosis caused or aggravated his COPD. Therefore, a remand is necessary for a medical opinion which determines if the Veteran’s COPD was caused or aggravated by his service connected pulmonary fibrosis. The matters are REMANDED for the following action: 1. After any additional records are associated with the claims file, send the entire claim’s file to an appropriate medical professional in order to render an opinion regarding the etiology and/or aggravation of his diagnosed COPD. The claims file, including a copy of this remand, should be made available to the medical profession, who must review it in its entirety and should note that review in the report. The opinion should specifically opine as to: Whether it is at least as likely as not (i.e. probability of 50 percent or greater) that the disability was either (i) caused by, or (ii) aggravated by, the Veteran’s service connected pulmonary fibrosis and/or asbestosis. A full rationale must be provided for any opinion offered. If an opinion cannot be offered without resort to mere speculation, the examiner must indicate why this is the case and indicate what additional evidence, if any, would allow for a more definitive opinion. 2. After completing the above development, the AOJ should consider all of the evidence of record and readjudicate the service connection issue for COPD. If the benefit sought is not granted, the AOJ should issue a Supplemental Statement of the Case (SSOC) and allow the Veteran and any representative an opportunity to respond. The Veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). These claims must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans’ Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112 (West 2014). DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Nelson, Associate Counsel