Citation Nr: 21002167 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 16-22 113 DATE: January 12, 2021 REMANDED Entitlement to service connection for lung cancer is remanded. REASONS FOR REMAND The Veteran served in the Army from October 1970 to July 1973; from August 1979 to September 1982; and from January 1991 to June 1991. He served in Southwest Asia. The Veteran died in January 2015. The Appellant is the Veteran’s surviving spouse. In May 2015, she was substituted as the appellant in this appeal. A November 2018 Board decision also denied service connection for lung cancer. The appellant appealed that decision to the CAVC. A March 2020 CAVC Order vacated the November 2018 Board decision that denied service connection for lung cancer and remanded the matter to the Board for further adjudication. 1. Entitlement to service connection for lung cancer is remanded. Unfortunately, the claim must be remanded for additional development in line with the decision and remand by the Court. As an initial matter, the record contains some of the Veteran’s service treatment records, and the Court has mentioned that there was “no dispute” that some of the Veterans records were lost in a fire. However, given the fact that the service treatment records have been added piecemeal over the course of many years, one is no longer able to fairly understand what service treatment record are of record, which records are missing, and what efforts have been made to acquire any service treatment records that may be missing. Moreover, according to the Court’s decision, the appellant has attempted to work with VA in understanding what medical records VA had and what records are still missing, but to no avail. Therefore, the RO must make an effort to organize the service treatment records that are of record, identify which records may be missing, and create a formal finding of unavailability for such records. Next, the Board also finds that a remand is required to obtain a better medical opinion as to whether the Veteran’s lung cancer may qualify as a medically unexplained chronic multi-symptom illness (MUCMI), given the Veteran’s service during Operation Desert Storm in Saudi Arabia from January 1991 to June 1991. 38 C.F.R. § 3.317(e). Specifically, an April 2014 VA examination indicates that the Veteran’s was diagnosed as non-small cell carcinoma of the lung. In opining that the Veteran's lung cancer does not fall into the category of illnesses considered to be "an undiagnosed illness" nor is it "a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology, the examiner explained that the "underlying causation resulting in neoplastic transformation of squamous cells is incompletely understood but occurs at [a] known rate among the general population.” A such, there was no specific or known nexus between exposure to the hazards of the environment of service in Southwest Asia and subsequent development of lung cancer. However, while the examiner stated that the etiology of lung cancer was “incompletely understood,” the examiner did not discuss pathophysiology which, as the Court has defined, is the “physiology of abnormal states; spec[ifically]: the functional changes that accompany a particular syndrome or disease.” Therefore, a new opinion is required to determine whether the pathophysiology the Veteran’s lung cancer was completely understood, incompletely understood, or not understood. Accordingly, on remand, a medical opinion must be obtained to discuss these matters. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records for the Veteran. 2. In coordination with the appellant, compile all of the Veteran’s available service treatment records in a way that it can be readily identified what records may be missing. After this inquiry is complete, issue a formal finding of unavailability for all records believed to exist but are not of record, to include a discussion of all efforts that were made to acquire such records. 3. Provide an addendum opinion to the April 2014 VA examination to determine the nature and etiology of his lung cancer. The examiner must review the entire claims file, including a copy of this remand. The examiner is asked to provide responses to the following: A) Is the etiology of the Veteran’s lung cancer (1) inconclusive, (2) partially understood, or (3) fully understood? This determination must be based on the Veteran’s specific case and cannot be based on the etiology of the disease or disability population as a whole. B) Is the pathophysiology of the Veteran’s lung cancer (1) inconclusive, (2) partially understood, or (3) fully understood? This determination must be based on the Veteran’s specific case and cannot be based on the pathophysiology of the disease or disability population as a whole. C) If both the etiology and pathophysiology are partially understood or fully understood, then the examiner is asked to provide an opinion as to whether it is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s lung cancer was incurred in, or is otherwise related to, his active service? A complete rationale must be provided for all opinions expressed. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Vample, Associate Counsel