Citation Nr: 21068200 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 11-14 624 DATE: November 9, 2021 REMANDED Entitlement to service connection for a lung disorder, to include chronic obstructive pulmonary disease (COPD), is remanded. Entitlement to service connection for a liver condition, to include hepatitis C, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1973 to August 1976. This matter comes before the Board of Veterans' Appeals (Board) from a decision by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Veteran and his spouse testified before the undersigned in a July 2013. A transcript of the hearing is of record. The Board previously remanded this matter in March 2014 and August 2015. 1. Lung Condition The Veteran contends that his lung disorder is related to his service, specifically, due to exposure to a herbicide and fire suppressant chemicals. In August 2015, the Board remanded this matter in order to determine whether the Veteran was exposed to an herbicide agent and the fire suppressant chemical of carbon tetrachloride. The Board further directed the AOJ to obtain an addendum medical opinion. The examiner was to address the Veteran's exposure to any confirmed herbicide and carbon tetrachloride exposure and the Veteran's service treatment records that indicate the Veteran had an upper respiratory disorder in service. Notably, the Veteran had an upper respiratory infection in February 1975 and an upper respiratory infection with chest pain in March 1976. In July 2020, VA obtained medical opinion. The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner reasoned that the Veteran was diagnosed with COPD in a 2014 VA examination and that he had never been formally evaluated for his condition in a treatment-oriented medical setting. The Veteran endorsed a more than 40-year history of smoking two packs of cigarettes per day and the Veteran quit smoking in approximately 2009. The examiner explained the Veteran's extensive history of tobacco use is a strongly compelling risk factor for his development of COPD. There is no evidence to suggest the Veteran developed COPD during military service. Specifically, exposure to herbicides and tetrachloride during military service was less likely as not responsible for the Veteran's development of COPD because these exposures are not recognized as precursors to the development of COPD. Unfortunately, the Board finds that a remand is required. The July 2020 examiner failed to address the Veteran's service treatment records that indicate the Veteran had upper respiratory infections in service. The July 2020 examiner specifically noted there was no evidence to suggest that COPD developed during service without addressing the service treatment records that indicate several upper respiratory infections with chest pain. As such, an addendum medical opinion is required for an examiner to discuss the significance, if any, of the Veteran's in-service diagnoses of upper respiratory infections. 2. Liver Condition The Veteran contends that his liver disorder is related to his service, specifically, due to exposure to a herbicide and fire suppressant chemicals. In August 2015, the Board remanded this matter in order to determine whether the Veteran was exposed to a herbicide and the fire suppressant chemical of carbon tetrachloride. The Board directed the AOJ to obtain an addendum medical opinion. The examiner was to address the Veteran's exposure to any confirmed herbicide and carbon tetrachloride exposure and the Veteran's service treatment records that could suggest the Veteran liver disorder is related to his service. Notably, the Veteran's service treatment records indicate that the Veteran was treated for venereal disease in February 1974. Further, the service treatment records note that the Veteran was tested for venereal disease in April 1975. In July 2020, VA obtained an addendum medical opinion. The examiner opined the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that the Veteran's military service treatment records are silent for a diagnosis of or symptoms of viral hepatitis. The examiner noted the Veteran had recalled having diagnosed with viral hepatitis in 2008 and noted the following risk factors of intravenous drug use or intranasal cocaine use and high-risk sexual activity. The examiner stated that it is at least as likely as not the veteran contracted hepatitis A, B, and C while engaging in these high-risk activities. The examiner stated that there is no evidence to suggest the Veteran contracted viral hepatitis during military service, specifically exposure to herbicides and tetrachloride during military service did not increase the Veteran's risk factor for viral hepatitis as these occupational exposures do not cause viral hepatitis. Unfortunately, the Board finds that a remand is required. The July 2020 examiner failed to address the Veteran's service treatment records that indicate the Veteran was treated for venereal disease in service. The July 2020 examiner specifically noted there was no evidence of a diagnosis or symptoms of viral hepatitis without addressing the service treatment records that indicate the Veteran's treatment for venereal disease. As such, an addendum medical opinion is required for an examiner to discuss the significance, if any, of the Veteran's in-service treatment for venereal disease. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from an appropriate clinician to determine the etiology of the Veteran's COPD. The examiner must provide the following opinion: (a.) Whether the Veteran's COPD is at least as likely as not related to service or had its onset in service. i. The examiner must address the Veteran's service treatment records that note several upper respiratory infections, notably the March 1976 upper respiratory infection with chest pain. (b.) A complete medical rationale must be provided for all opinions. 2. Obtain an addendum medical opinion from an appropriate clinician to determine the etiology of the Veteran's liver condition. The examiner must provide the following opinion: (a.) Whether the Veteran's hepatitis is at least as likely as not related to service or had its onset in service. i. The examiner must address the Veteran's service treatment records that note treatment for venereal disease, notably in February 1974 and the service treatment note for venereal disease test in April 1975. (b.) A complete medical rationale must be provided for all opinions. S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Robert Batten 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.