Citation Nr: 21064907 Decision Date: 10/22/21 Archive Date: 10/22/21 DOCKET NO. 16-38 257 DATE: October 22, 2021 REMANDED Entitlement to service connection for a respiratory disability, claimed as a result of asbestos exposure in service, is remanded. Entitlement to service connection for atrial fibrillation, claimed as secondary to a respiratory disability resulting from asbestos exposure in service, is remanded. REASONS FOR REMAND In November 2020, the Board of Veterans' Appeals (Board) remanded the Veteran's appeal directing the Agency of Original Jurisdiction (AOJ) to "[s]chedule the Veteran for an examination with a pulmonologist to obtain an opinion regarding his service connection claim for a respiratory disability, claimed as a result of asbestos exposure in service." In its remand directives, the Board noted, "[i]f it is not possible to schedule an examination with a pulmonologist, there must be an explanation of record regarding why it is not possible to schedule an examination with a pulmonologist and an examination must be scheduled with another qualified VA examiner." The record reflects the AOJ initially scheduled the Veteran for an examination with a family medicine specialist in January 2021. It appears the AOJ subsequently recognized such examination did not constitute substantial compliance with the Board's prior remand directives and obtained a new opinion from a pulmonologist in June 2021. Although the June 2021 opinion indicates it was based on an in-person examination, the Veteran has asserted he was never examined by the author of the June 2021 opinion, a fact that is supported by the extreme distance between the Veteran's home address and the physician's office location. Further, it appears the AOJ obtained an examination report from a nurse practitioner, located near the Veteran, either in conjunction with or after the June 2021 opinion. Yet, the AOJ did not associate any documentation with the claims file explaining why it was not possible to schedule an in-person examination with a pulmonologist, as required by the Board's November 2020 remand directives. Further, the author of the June 2021 opinion failed to address "the conclusion provided by B.M., M.D., in the June 2018 Disability Benefits Questionnaire (DBQ), to include a discussion of the applicability of the medical principles noted in the February 2020 written statement from the Veteran, which purports to be an addendum to the June 2018 DBQ, although unsigned by the physician who completed the June 2018 DBQ" as also required by the Board's November 2020 remand directives. Thus, there has not been substantial compliance with the Board's prior remand directives, even if the obtainment of the June 2021 opinion from a pulmonologist with either its contemporaneous or subsequent examination by a nurse practitioner is deemed acceptable. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: Renew efforts to schedule the Veteran for an examination with a pulmonologist to obtain an opinion regarding his service connection claim for a respiratory disability, claimed as a result of asbestos exposure in service. If it is not possible to schedule an examination with a pulmonologist, there must be an explanation of record regarding why it is not possible to schedule an examination with a pulmonologist. Only then should the Veteran be scheduled for an examination with another qualified VA examiner. The opinion provided must address whether the Veteran has any current respiratory disability, to include, but not limited to, obstructive sleep apnea, chronic obstructive pulmonary disease, pulmonary hypertension, ventilatory restriction, and/or restrictive lung disease, that is at least as likely as not (50 percent probability or greater) the result of disease or injury in service, to include, but not limited to, asbestos exposure. For the purpose of the opinion, the examiner must presume the Veteran was exposed to asbestos in service. The selected examiner must be advised the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports of symptoms capable of lay observation, he or she must provide a reason for doing so. The examination report must include a complete rationale for the opinion provided that addresses the conclusion provided by B.M., M.D., in the June 2018 Disability Benefits Questionnaire (DBQ), to include a discussion of the applicability of the medical principles noted in the February 2020 written statement from the Veteran, which purports to be an addendum to the June 2018 DBQ, although unsigned by the physician who completed the June 2018 DBQ. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. S. Kyle, 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.