Citation Nr: 21061940 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 17-50 645 DATE: October 5, 2021 REMANDED Entitlement to service connection for obstructive pulmonary disease (COPD), to include as secondary to adenocarcinoma of the lung, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1969 to December 1971. This matter is on appeal from a January 2017 decision of a Department of Veterans Affairs (VA) Regional Office (RO). The case was previously before the Board in October 2020 and May 2021 when it was remanded for further development. Entitlement to service connection for obstructive pulmonary disease (COPD), to include as secondary to adenocarcinoma of the lung, is remanded. The Veteran contends that he is entitled to service connection for COPD, to include as secondary to his service-connected adenocarcinoma of the lung. However, upon review of the record, the Board finds that an additional opinion must be obtained to ensure substantial compliance with prior remand directives. The May 2021 Board remand stated that the examiner "must address the April 2021 appellate brief regarding a medical article indicating 40 to 70 percent of patients that have lung cancer also have COPD even though they never smoked a cigarette and how this evidence applies to the Veteran's medical history." In August 2021, VA obtained an opinion in which the examiner opined that the Veteran's COPD was not at least as likely as not aggravated beyond its natural progression by his service-connected disability. However, the examiner did not address the medical article cited by the Veteran's nor did she discuss the significance, if any, of this evidence. A remand by the Board confers upon the Veteran, as a matter of law, the right to substantial compliance with remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Thus, this matter must be returned to the examiner to provide an addendum opinion that substantially complies with the prior remand directives. The record also reflects the Veteran receives VA treatment; thus, updated VA treatment records should be associated with the claims file. The matter is REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from July 2021 to the present. 2. After completing the development requested in item 1, return the claims file to the August 2021 VA examiner, or another appropriate clinician if that examiner is not available, for review and an addendum medical opinion. The reviewing clinician should be requested to provide an opinion (based on a review of the record) to answer the following: Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's COPD is aggravated beyond its natural progression by his adenocarcinoma of the lung? The examiner must address the medical article cited in the April 2021 appellate brief indicating 40 to 70 percent of patients that have lung cancer also have COPD even though they never smoked a cigarette and how this evidence applies to the Veteran's medical history. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. J. B. FREEMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. H. White, 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.