Citation Nr: 21001927 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 17-01 661 DATE: January 12, 2021 REMANDED Entitlement to service connection chronic bronchitis, to include as due Agent Orange exposure is remanded. Entitlement to service connection for chronic obstructive pulmonary disease (COPD), to include Agent Orange exposure is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1971 to April 1972, with service in Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in September 2019.   The appeal was previously before the Board in December 2019 and has since been returned for further appellate review. In a January 2020 rating decision, the RO granted service connection for bilateral lower extremity sciatic peripheral neuropathy and bilateral lower extremity femoral peripheral neuropathy. Thus, these issues are no longer on appeal. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). 1. Entitlement to service connection chronic bronchitis, to include as due Agent Orange exposure is remanded. Remand is required for substantial compliance with the prior December 2019 Board remand directives and for an adequate opinion. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Additionally, a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The December 2019 remand directed the RO to obtain an adequate VA examination. The Board instructed the examiner to provide an opinion regarding whether it is at least likely as not the chronic bronchitis was related to service, to include as due to Agent Orange exposure. A VA examination was conducted in February 2020. After diagnosing chronic bronchitis, the examiner noted the Veteran’s chronic bronchitis has a multifactorial etiology consisting of exposure to Agent Orange, his 50 years of cigarette smoking nearly a pack a week, and exposure to toxins from working in a coal mine. The examiner acknowledged that the Veteran’s STRs noted he was treated during service for chronic bronchitis but there was no further documentation until 1994. The examiner also acknowledged the Veteran’s lay statements and the September 2019 hearing testimony regarding onset and continuity of symptoms, as well a VA treatment record. The Board finds this opinion is inadequate. The rationale provided by the examiner is unclear because the examiner stated that Agent Orange exposure contributed to his chronic bronchitis, and yet opined it is less likely than not related to active service. Further, the examiner failed to provide a reasoned explanation for the negative nexus opinion, instead focusing the explanation primarily on COPD. Accordingly, a remand is required. 2. Entitlement to service connection for COPD, to include Agent Orange exposure, is remanded. Remand is required for an addendum opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Veteran received a VA examination in February 2020. The examiner provided a negative nexus opinion, explaining although the Veteran has asserted that COPD began in service and has existed since that time, he was not diagnosed with COPD until 1994. The examiner stated that even though Veteran exposed to Agent Orange, the COPD did not arise until 1994, after many years of smoking and working in a coal mine. The Board finds that the examiner did not provide a reasoned medical explanation regarding if the Veteran’s COPD could be related to the Veteran’s in-service Agent Orange exposure. Thus, remand is required. The matters are REMANDED for the following action: 1. Obtain an opinion to determine the etiology of the claimed chronic bronchitis. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed warranted, one must be provided. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the chronic bronchitis had onset in, or is otherwise related to, active military service, to include as due to Agent Orange exposure. (a.) The examiner must address the following: 1) the February 2020 VA examination; 2) the March 1972 STR noting bronchitis; 3) VA \ treatment records documenting a diagnosis of chronic bronchitis; 4) the Veteran’s assertion that his chronic bronchitis began in service and has existed since that time; and 5) the Veteran’s September 2019 hearing testimony. 2. Obtain an addendum opinion to determine the etiology of the claimed COPD. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, one must be provided. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the COPD had onset in, or is otherwise related to, active service, to include as due to Agent Orange exposure.   (a.) The examiner must address the following: 1) the February 2020 VA examination; 2) VA treatment records documenting a diagnosis of COPD; 3) the Veteran’s assertion that COPD began in service and has existed since that time; and 4) the Veteran’s September 2019 hearing testimony. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Braxton, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.