Citation Nr: 21003518 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 13-12 073 DATE: January 21, 2021 REMANDED Entitlement to service connection for a respiratory disorder, claimed as asthma, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1968 to May 1971, August 1972 to October 1980, June 2006 to November 2006, and May 2009 to October 2009. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. In February 2017, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In June 2017, April 2018, and July 2020, the Board remanded the case for additional development and it now returns for further appellate review. Entitlement to service connection for a respiratory disorder, claimed as asthma. The instant appeal stems from the Veteran’s claim seeking service connection for asthma, and as there is evidence of record suggesting that such disorder preexisted service, the Board has remanded this claim on multiple occasions to obtain an adequate medical opinion addressing whether his asthma did indeed preexist service, and if so, was aggravated therein. However, in the most recent VA opinion obtained in July 2020, the examiner essentially opined that the Veteran does not have asthma, an obstructive respiratory disease, but rather has an unspecified form of restrictive lung disease. Specifically, he essentially concluded that the Veteran’s diagnoses of asthma of record were based on his symptomatology, as opposed to pulmonary function testing (PFT) results, which provide clinical data regarding the type and severity of a respiratory impairment. In this regard, the examiner found that the PFT results of record indicate that the Veteran does not have an obstructive lung disease, such as asthma, but a restrictive lung disease. Given this conclusion, he found that the Veteran’s claimed asthma was unrelated to service, either as a preexisting disorder aggravated by service or as a disorder whose onset was in service. However, the Board finds that given the Veteran’s in-service emergent treatment for respiratory distress (which was characterized during service as an exacerbation of asthma based on his reported medical history of asthma) and the July 2020 VA examiner’s aforementioned conclusions, a medical examination is required to determine the exact nature of his restrictive respiratory disorder and whether such disorder was caused or aggravated by service. The claim is therefore REMANDED for the following action: Schedule the Veteran to for a VA respiratory examination to determine the nature and etiology of his current respiratory disorder. The Veteran should be scheduled to undergo pulmonary function tests (PFTs) to determine the nature of his current respiratory disorder. After reviewing these results, conducting an appropriate clinical examination, reviewing the claims file, and obtaining a history from the Veteran of his respiratory symptoms, the examiner is asked to offer the following opinions: (A) Identify all respiratory disorders that have been present at any time since May 2010, even if such are asymptomatic or resolved. In this regard, the examiner should indicate whether the Veteran does, in fact, has asthma. He or she should also identify any restrictive lung disease found to be present. (B) For each diagnosed respiratory disorder, the examiner should state whether there is clear and unmistakable evidence that such disorder preexisted the Veteran’s entry into active duty in May 2009. (C) If there is clear and unmistakable evidence that a respiratory disorder preexisted such period of service, the examiner is asked to opine whether there is clear and unmistakable evidence that respiratory disorder did not undergo an increase in the underlying pathology during service, i.e., was not aggravated during service. (Notably, the inquiry is not whether the Veteran’s respiratory disorder is currently worse than his pre-service respiratory disorder, the incorrect standard utilized in the prior opinions of record.) (D) If there was an increase in the severity of the Veteran’s respiratory disorder during service, the examiner should offer an opinion as to whether such increase was clearly and unmistakably due to the natural progress of the disease. (E) If there is no clear and unmistakable evidence that a respiratory disorder preexisted such period of service, then the examiner is asked to opine whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such is directly related to service, including the Veteran’s illness in July 2009. In offering the foregoing opinions, the examiner should consider the entirety of the record, to include the Veteran’s lay statements as to the effect that, prior to his deployment in 2009, he felt fine and was able to do his job; however, after such deployment, his asthma became worse, which impacted his ability to do his job and ultimately led to his retirement. Additionally, the examiner should consider the Veteran’s consistent reports that he stopped smoking in 1996. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Northcutt, 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.