Citation Nr: 21063503 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 17-13 801 DATE: October 14, 2021 REMANDED Entitlement to service connection for the Veteran's cause of death is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Navy from April 1952 to November 1955. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran died in June 2016, and his surviving spouse has been substituted as the Appellant in this case. The Appellant testified before the undersigned Veterans Law Judge (VLJ) at a hearing in April 2019. This case was previously before the Board in March 2020 and May 2021, when it was remanded for further development. The case has been returned to the Board for further appellate review. Entitlement to service connection for the Veteran's cause of death is remanded. Unfortunately, another remand is necessary in this case. In September 2021, the RO obtained a VA medical opinion and an addendum to that opinion. These opinions are inadequate to determine whether the Veteran's death was at least as likely as not the result of in-service asbestos exposure. The examiner was asked to provide an etiology opinion for each respiratory and cardiovascular disease found to have caused or contributed to the Veteran's death, including but not limited to chronic obstructive pulmonary disease (COPD), aortic and mitral valve replacement, and coronary artery disease (CAD). The examiner was specifically asked to discuss the length and nature of the Veteran's conceded asbestos exposure; the Veteran's history of smoking and quitting at age 30; and the relationships between asbestos exposure and each disability. The examiner discussed CAD, but failed to provide a rationale for the conclusion that the CAD is more likely related to the Veteran's history of smoking and "lifestyle." For example, there was no discussion of whether quitting smoking at age 30 would decrease the risk for developing coronary artery disease around age 50, as was the Veteran's case. The examiner also discussed the difference between lung cancer and mesothelioma due to asbestos exposure. The examiner explained that mesothelioma affects the pleura and not the lung itself, implying that the Veteran's conceded asbestos exposure did not result in lung cancer. In the addendum opinion, the examiner opined that the Veteran's malignancy is not commonly found with asbestos exposure because it is not a mesothelioma. The examiner did not explain whether there are associations between asbestos exposure and diseases or conditions other than mesothelioma, or discuss any such associations in the context of the Veteran's particular circumstances. The examiner addressed COPD in the addendum, opining that it, along with CAD and lung cancer, is less likely than not due to asbestos exposure and more likely due to history of smoking and lifestyle. For a rationale, the examiner noted that the length of exposure to asbestos is unknown and smoking was presumed to be between five and ten years. The examiner did not discuss each of these three disabilities individually or explain their relationships with asbestos exposure, nor did the examiner acknowledge the Board's guidance that the Veteran served at the Naval Gun Factory for approximately one year and aboard the USNS Gen L. Eltinge for approximately seven to ten months. In summary, the examiner failed to offer sufficient rationale to support the negative etiological opinions detailed here. The opinions are therefore inadequate, and another remand is necessary to obtain an opinion that adequately addresses the Veteran's particular circumstances regarding asbestos exposure and the diseases that caused or contributed to his death. The matter is REMANDED for the following action: Forward the claims file to a pulmonologist or other appropriate clinician to provide an opinion whether the respiratory and/or cardiovascular issues that caused and/or contributed to the Veteran's death were at least as likely as not (50 percent or greater probability) the result of conceded in-service asbestos exposure. Prior to preparing the requested opinions, the examiner must review the claims file, to include lay statements made by the Appellant and the body of the May 2021 and October 2021 Board Remand Orders. The examiner is advised that the Veteran served at the Naval Gun Factory for approximately one year and aboard the USNS Gen L. Eltinge for approximately seven to ten months. This service is the basis for the concession that the Veteran was exposed to asbestos while in service. The examiner should provide the following opinions: (a) Whether it is at least as likely as not (50 percent or greater probability) that the in-service asbestos exposure caused the Veteran's COPD; (b) Whether it is at least as likely as not (50 percent or greater probability) that the in-service asbestos exposure caused cardiovascular disease requiring aortic and mitral valve replacement; (c) Whether it is at least as likely as not (50 percent or greater probability) that the in-service asbestos exposure caused coronary artery disease; and (d) Whether it is at least as likely as not (50 percent or greater probability) that the in-service asbestos exposure caused any other respiratory or cardiovascular disability that caused or contributed to the Veteran's death. In providing the requested opinions, the examiner should specifically address the length and nature of the Veteran's conceded asbestos exposure; the Veteran's history of smoking and quitting at age 30; the relationship between asbestos exposure and each disability for which an opinion is given. If the examiner finds that a relevant disability was caused in part by asbestos exposure, the examiner should discuss the likelihood that, but for the asbestos exposure, the Veteran still would have developed that disability. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Josey, 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.