Citation Nr: 21069370 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 16-35 438 DATE: November 18, 2021 REMANDED Entitlement to service connection for right lower extremity neurological disability, to include radiculopathy and peripheral neuropathy, is remanded. Entitlement to service connection for a respiratory disability, to include chronic obstructive pulmonary disease (COPD) is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) prior to July 19, 2016 is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from August 1972 to December 1973, with additional service in the Air Force Reserves and Air National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in October 2019 and May 2021 and remanded for additional development. The Veteran's claim of service connection for right leg neuropathy has been recharacterized to include all right leg conditions reasonably raised by the record. Additionally, his claim of service connection for COPD has been recharacterized to include all respiratory conditions reasonably raised by the record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). REASONS FOR REMAND Right leg condition, COPD and TDIU The Veteran seeks service connection for his right leg and respiratory conditions. In support, he reported that his conditions are related to service and his lead and asbestos exposure. See NOD (September 2015). Additionally, he stated that his right leg neuropathy is secondary to his service-connected toe amputations. See Form 9 (July 2016). Further, the Veteran submitted online literature indicating that the occupational hazards for plumbers include pulmonary edema and neuropathy. In the May 2021 Board's decision, the Board acknowledged that the Veteran's military occupational specialty (MOS) duties assigned to plumbing specialist suggests asbestos exposure during service and the exposure was conceded for purposes of scheduling an examination. The Board remanded these issues, to include all respiratory and right leg disabilities, for a medical examination to determine the etiology and relation of his conditions to service and service-connected disabilities. The Board instructed the examiner to provide an opinion discussing the Veteran's documented history and assertions, as well as the evidence discussed in the remand. Additionally, the opinion should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). Subsequently, a medical opinion was provided in July 2021. As to his right leg condition the examiner opined that there is no neuropathy condition present since his complaints are not consistent with a pathological neuropathy with definite etiology. Regarding his COPD, the examiner stated that numerous epidemiologic studies indicate that tobacco smoking is overwhelmingly the most important risk factor for COPD and that asbestos related-pulmonary disease presents differently than the Veteran's current condition. In both opinions, the examiner provided a negative nexus. However, the Board finds that the instructions in the May 2021 Board remand were not followed since the examiner did not offer a complete rationale supporting the statements provided regarding the nature, cause and etiology of these conditions. Additionally, a complete rationale must be provided regarding any relation to the Veteran's remanded conditions with his exposure in service and his service-connected disabilities. Thus, the Board finds these examinations inadequate since they failed to adequately consider the nature, cause and etiology of his conditions. Therefore, on remand the examiner should determine the nature, cause, and etiology of his right leg and respiratory conditions, as well, if his conditions are related caused or proximately due to his service-connected conditions. Thus, the Board must remand these matters for compliance with the instructions in this decision and the December 2018 Board's remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Further, the Veteran is reminded about the importance of attending these examinations to further adjudicate the issues on appeal. In addition, the Board finds that the Veteran's TDIU claim prior to July 19, 2016, is inextricably intertwined with the remanded issues in this decision. See Harris v. Derwinski, 1 Vet. App. 181 (1991) (two or more issues are inextricably intertwined if one claim could have significant impact on the other). Thus, this issue must be remanded. As there is no adequate examination to determine the nature, cause, and etiology of his right leg and respiratory conditions, as well, if his conditions are proximately due or aggravated by his service-connected disabilities, a remand is necessary to have the Veteran examined and for an examiner to review his claims folder and provide opinions necessary to adjudicate this appeal. The matters are REMANDED for the following action: 1. Obtain complete VA and non-VA treatment records of the Veteran's right leg and respiratory conditions. 2. Notify the Veteran that he may submit additional lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service right leg and respiratory conditions. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible). Whether an in-person examination is necessary should be determined by the examiner. The Veteran should be examined by an examiner other than that one who conducted the July 2021 VA examination. The examiner must opine as to whether it is at least as likely as not that the Veteran's right leg and respiratory conditions are related to or had their onset in service, including his asbestos and lead exposure. Moreover, the examiner must review all the credible and competent medical and lay evidence, about the Veteran's respiratory and right leg conditions onset, etiology, nature and symptoms in and after service. Additionally, the examiner must opine if his right leg and respiratory conditions are aggravated or proximately due to service or his service-connected conditions. (Continued on the next page) In offering this opinion, the examiner must acknowledge and discuss the Veteran's competent and lay statements of his condition and any lay evidence regarding the onset of his disabilities and any relation to his service-connected disabilities. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Alvarado- 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.