Citation Nr: 21068442 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 17-55 719 DATE: November 10, 2021 REMANDED Entitlement to service connection for pulmonary fibrosis and residuals thereof is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from October 1975 to September 1978 and in the U.S. Navy from July 1980 to July 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In March 2021, the Board remanded the matter for a VA examination and etiology opinion. As an initial matter, the Board notes that the claim for service connection for a low back condition remanded by the Board's prior decision was granted in a July 2021 rating decision. Because the grant of service connection represented full relief for that claim, the issue is no longer before the Board. See Holland v. Gober, 10 Vet. App. 433, 436 (1997). Regarding the claim for service connection for pulmonary fibrosis and residuals thereof, the Board finds that further remand unfortunately is required. The Board's prior decision remanded for an etiology opinion that considered whether the Veteran's pulmonary fibrosis, which led to needing a lung replacement, is related to his claimed asbestos exposure working on an older Navy ship cleaning and repairing pipe insulation. The examiner was directed to consider a June 2017 letter from Dr. T.G. stating that "I believe, more likely than not, that [the Veteran's] time in the military contributed to his illness" and a September 2017 letter from Dr. A.M. stating that asbestos exposure "more likely than not may have caused his pulmonary fibrosis." Consideration was also to be given to a medical record attributing the Veteran's condition to cocaine use. A new examination and opinion was provided in June 2021. The clinician noted the Veteran's reported exposure to asbestos in service, as well as a two-pack-per-day cigarette smoking history and "a longstanding inhalation of drugs due to habit of smoking crack cocaine and heroin." She acknowledged the two letters from the private clinicians but emphasized that the letters did not make clear that they had considered the full facts of the Veteran's case, to include the history of cocaine abuse. In her estimate, "there are two etiologies (illicit drug smoking and asbestosis) which resulted in pulmonary fibrosis aka nonspecific interstitial pneumonitis [NSIP] (crack cocaine and heroin habit have clearly been documented to cause NSIP in this case) which resulted in the lung transplant." She concluded that "[i]t is just as likely as not that the pulmonary fibrosis diagnosed is due to crack cocaine abuse as it is from the asbestos exposure" but added that "[i]t is outside the scope of [her] medical practice to opine that one condition outweighs the other." In August 2021, the RO clarified to the clinician that it was seeking an opinion whether the Veteran's claimed in-service asbestos exposure was at least as likely as not the cause of the pulmonary fibrosis, rather than an opinion about whether the clinician could opine that one cause was outright more likely than the other. In response to this, the clinician stated that the pulmonary fibrosis is less likely than not caused by exposure to asbestos cleaning and repairing pipes in service. Unfortunately, given the clinician's conflicting opinion that "it is just as likely as not that the pulmonary fibrosis diagnosed is due to . . . the asbestos exposure" in June 2021 and that the pulmonary fibrosis is less likely than not due to the asbestos exposure in August 2021, the Board finds that the Veteran has not been provided with an adequately clear etiology opinion. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Remand is therefore needed in order to obtain a new opinion. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matter is REMANDED for the following action: 1. Obtain an opinion regarding the etiology of the Veteran's pulmonary fibrosis and residuals thereof. The clinician should opine whether it is at least as likely as not that the Veteran's lung condition is related to his service, to include service on an older Navy ship cleaning and repairing pipes covered with insulation and sleeping in the forward part of the ship near boiler rooms in which asbestos was present. The clinician should consider and discuss a June 2017 letter from Dr. T.G. that he "believe[s], more likely than not, that [the Veteran's] time in the military contributed to his illness"; a September 2017 letter from Dr. A.M. that asbestos exposure "more likely than not may have caused his pulmonary fibrosis"; a March 1999 assessment from an NP of "pulmonary fibrosis ... secondary to cocaine abuse"; the Veteran's history of 2-pack-per-day cigarette use and drug use including crack-cocaine; and, that the Veteran's post-service work was in sales, without any occupational exposures. (Continued on the next page) 2. After the above development and any other development deemed necessary is completed, readjudicate the Veteran's claim. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Davis, 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.