Citation Nr: 21003241 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 17-04 274 DATE: January 21, 2021 REMANDED Service connection for a respiratory disability, asserted as due to asbestos xposure, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from August 1979 to August 1985. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony at a hearing before the undersigned in September 2019. This matter was previously remanded by the Board in a January 2020 decision for additional development. The Veteran seeks service connection for a respiratory disorder, which he contends is related to exposure to asbestos while in the Navy. The Board found credible the Veteran’s report of in-service asbestosis exposure. During his September 2019 Board hearing, the Veteran gave a history of recurrent migraines, allergic reactions, breathing problems, and upper respiratory infections since service. Following the hearing, the Veteran’s aunt and childhood friend, both of whom have known the Veteran since he was a child, corroborated the Veteran’s account of respiratory symptoms, namely sensitivities to certain smells and chemicals, since service. The Board remanded the claim for a VA examination to address the nature and etiology of the Veteran’s reported symptoms and corroborate the account of in-service asbestos exposure. Service connection for a respiratory disability, asserted as due to asbestos exposure, is remanded. The Veteran was afforded a VA Examination for respiratory conditions in March 2020. The Veteran was diagnosed with restrictive lung disease of unknown cause. The VA examiner opined that the diagnosed respiratory condition is less likely than not incurred in or caused by service, as Veteran does not have a respiratory diagnosis that can be attributable to his in-service asbestos exposure. Veteran’s PFT and Chest CT are not consistent with an asbestosis related exposure or any other event in service. See March 2020 VA Medical Opinion. In a subsequent medical opinion in August 2020, the VA examiner addresses lay statements provided by the Veteran in support of his claim. See June 2020 Correspondence Letter. The VA examiner states that Veteran has claimed that sleep apnea is a respiratory disability, but Veteran’s condition is an upper airway obstructive process and not a pulmonary process; furthermore, asbestos exposure does not cause sleep apnea. Veteran also argues that an echocardiogram should have been obtained upon examination; the VA examiner states that obtaining an echocardiogram would be appropriate in the case of cardiopulmonary complications, which are obvious upon observation during the exam couples with existing medical records and examinations. The examiner notes that here the Veteran is a layperson and not an expert in determining this matter; to further substantiate the point, the examiner points to the Veteran’s echocardiogram completed in May 2020 which was negative for all possible cardiopulmonary complications. As the only respiratory finding for the Veteran is the PFT, dated 5/21/2020, which is read by the pulmonologist as “minimal restriction, weight related,” the condition is not indicative of asbestos exposure. See August 2020 VA Medical Opinion. Since the March 2020 VA examination, and the subsequent August 2020 VA medical opinion, the Veteran submitted an additional letter in support of his service connection claim. See September 2020 Correspondence Letter. The Veteran challenges the opinion provided by the VA examiner, asserting that his persistent recurrent chronic symptoms and airborne sensitivities started while being exposed to asbestos and excessive radiation at the Naval Reactor Facility in Idaho Falls in 1981. Veteran states that his CT Chest scan also shows a diagnosis of dyspnea, which is relevant to his condition and was not acknowledged by the VA examiner, who also did not address the chest X-rays which show scarring, which may be a sign of asbestos exposure. Further, the Veteran states he provided a sinus X-ray which shows a diagnosis of chronic sinusitis that was not reviewed by the VA. He also asserts that the VA examiner only reviewed and answered questions as to asbestos and failed to discuss all asbestos related exposure evidence. The Veteran claims that his in-service asbestos exposure may cause respiratory illnesses other than asbestosis, which can subsequently cause severe sleep apnea; he also claims exposure to airborne lead paint and toxic airborne welding gases at the Philadelphia Shipyard with no breathing protection provided by the military. The Veteran moves to amend his claim for service connection to include “due to asbestos exposure, radiation exposure, dust and fumes,” He also alleges the extent of his respiratory problems include restrictive lung disease, chronic dyspnea, chronic bronchitis, chronic sinusitis, scarring of the lungs, and severe sleep apnea with CPAP as a secondary condition. See Id. Further, the Veteran submitted a buddy letter from his aunt, who clarified her statement provided in September 2019 in support by stating she noticed Veteran’s airborne sensitivities in 1981 and they continued afterwards, making it difficult for Veteran to breath. See September 20, 2020 Supplemental Letter Email. Another buddy letter was submitted by a former Staff Instructor at NRF Idaho Falls, who worked there the entire time Veteran was on active duty at the site. The buddy asserts that he received special training on insulation removal, much of the insulation in the power plant was originally asbestos (requiring special training and precautions), and a refueling outage took place during the time Veteran was stationed there. See September 2020 Buddy Letter Email. The Board finds in light of the lay statements, buddy statements, and medical treatment records including medical diagnoses of chronic sinus conditions and severe OSA that have not been addressed etiologically through a VA medical opinion, submitted after Veteran’s last VA examination, as well as his in-service asbestos exposure, a remand is again necessary in connection with this claim. In order to make a fully informed decision in adjudicating this claim, a new VA examination by a specialist is warranted to address the new evidence of record. The matters are REMANDED for the following action: 1. Identify and obtain all outstanding treatment records regarding the Veteran’s claims. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service respiratory problems. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible by an appropriate clinician, preferably by a pulmonologist, to determine the nature and etiology of any current respiratory disorder, to include bronchitis, dyspnea, and sinus conditions. The examiner must review the entire claims file, and consider all lay statements, military personnel records, and medical treatment records provided. The examiner should assume that the Veteran was exposed to asbestos during service. The examiner must opine whether any diagnosed respiratory disorder found to be present is at least as likely as not related to an in-service injury, event, or disease, to include the Veteran’s in-service exposure to asbestos. In responding to the above inquiry, the examiner must acknowledge and discuss the September 2020 buddy letter discussing the presence of asbestos at NRF Idaho Falls, and also the Veteran’s contention that his severe OSA is secondarily related to his respiratory problems, which are directly related to in-service asbestos exposure. The examiner must provide reasons for all opinions, addressing the relevant evidence. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Zarar Ahmed, Attorney Advisor 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.