Citation Nr: 19108038 Decision Date: 02/04/19 Archive Date: 02/01/19 DOCKET NO. 17-43 923 DATE: February 4, 2019 REMANDED Entitlement to service connection for obstructive ventilatory disease (OVD); asthma (claimed as asbestosis in the lower left lung) as a result of asbestos exposure is remanded. REASONS FOR REMAND The Veteran served on three different ships during his military service; his service personnel records identify his Navy rating as machinist's mate and his DD214 lists his related civilian occupation as marine mechanic. He asserts that he has a breathing disability, also claimed as pleural plaques, asthma, and obstructive ventilatory disease, due to exposure to asbestos while performing his military duties. The Board notes there is no specific statutory or regulatory guidance with regard to claims of service connection for asbestos-related diseases. However, VA's Adjudication Procedures Manual addresses these types of claims. See M21-1, Part IV, Subpart ii, Chap. 1, Sec. I, Para. 3 [hereinafter M21-1] (M21-1, IV.ii.1.I.3), entitled Developing Claims for Service Connection for Asbestos-Related Diseases (updated May 23, 2018) and M21-1, IV.ii.2.C.2 entitled Service Connection for Disabilities Resulting from Exposure to Asbestos (updated Nov. 2, 2016). The manual provisions acknowledge that inhalation of asbestos fibers or particles can result in fibrosis, the most commonly occurring of which is interstitial pulmonary fibrosis, or asbestosis; tumors; pleural effusions and fibrosis; pleural plaques (scars of the lining that surrounds the lungs); mesotheliomas of the pleura and peritoneum; and cancers of the lung, gastrointestinal tract, larynx, pharynx and urogenital system (except the prostate). M21-1, IV.ii.2.C.2.b. The latent period for development of disease due to asbestos exposure ranges from 10 to 45 years or more between first exposure and development of disease. M21-1, IV.ii.2.C.2.f. The clinical diagnosis of asbestosis requires a history of exposure and radiographic evidence of parenchymal lung disease. M21-1, IV.ii.2.C.2.g. Diagnostic indicators include dyspnea on exertion, end-respiratory rales over the lower lobes, compensatory emphysema, clubbing of the fingers at late stages, and pulmonary function impairment and cor pulmonale that can be demonstrated by instrumental methods. Id. A table describing the probability of asbestos exposure by Navy military occupational specialty (MOS) identifies as Boiler Technician, an MOS having probable asbestos exposure. M21-1, IV.ii.1.I.3.d. Private treatment records from Dr. M., including MRI results, revealed pleural calcified plaques in both hemithorax, and noted asbestosis exposure. In a March 2010 VA progress note, the examiner noted the Veteran reported a remote history of asbestos exposure in the Navy. He stated a tech told him he has “asbestosis” in his lungs. The Veteran underwent a VA examination in June 2016. The examiner reported diagnoses of asthma and obstructive ventilator disease. Following physical examination and review of the evidence, the examiner stated it is less likely as not that any claimed asbestosis is due to active duty service. The examiner noted the Veteran has pleural plaques per imaging and obstructive ventilatory disease (OVD), not a restrictive ventilatory disease consistent with asbestosis condition. Unfortunately, the examiner did not explain why the Veteran's current asthma disability was less likely related to in-service asbestos exposure and did not address other chest x-ray and MRI studies of record that have documented pleural plaques attributed to asbestos exposure. Based on these facts, the Board requires additional medical opinion evidence to decide whether any current breathing disability, manifested by either a restrictive pulmonary defect or an obstructive pulmonary defect, is related to the Veteran's military service, including his probable exposure to asbestos while performing his duties as a boiler technician. The matter is REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed respiratory disorder, to include pleural plaques, asthma, and OVD. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including asbestos exposure. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Diane M. Donahue Boushehri, Counsel