Citation Nr: 21073910
Decision Date: 12/13/21	Archive Date: 12/13/21

DOCKET NO. 18-27 759
DATE: December 13, 2021

REMANDED

Entitlement to service connection for emphysema is remanded.

Entitlement to service connection for pulmonary embolism is remanded.

Entitlement to service connection for pulmonary hypertension is remanded.

REASONS FOR REMAND

The Veteran served on active duty from June 1964 and January 2004 to May 2015. This matter comes before the Board of Veterans' Appeals (Board) from a decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified a September 2021 Board hearing. A transcript of the hearing is of record. 

1. Entitlement to service connection for emphysema is remanded.

2. Entitlement to service connection for pulmonary embolism is remanded.

3. Entitlement to service connection for pulmonary hypertension is remanded.

The Veteran contends that his emphysema, pulmonary embolism, and pulmonary hypertension were caused or aggravated by exposure to environmental factors from his service in Afghanistan. 

The Veteran's service treatment indicates that in May 2004, the Veteran had a respiratory issue. The treatment records noted that the Veteran had an "environmental response." 

In August 2017, VA obtained a medical opinion based upon an Acceptable Clinical Evidence (ACE) examination. The examiner opined that the Veteran's claimed condition was less likely than not caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran had established respiratory disorders of chronic pulmonary embolism, COPD with emphysema, and chronic thrombolic pulmonary hypertension (CTEPH). The examiner stated that the Veteran had a significant history of smoking and noted that the primary cause of COPD and emphysema is smoking. The examiner stated that the Veteran's current respiratory and pulmonary conditions are all diseases and disorders with clear and specific etiologies and diagnoses. The examiner stated a review of current medical literature finds that no adequate clinical evidence has been established to support a causal relationship between exposures from military service in Southwest Asia and the Veteran's disabilities. 

The Board finds that a remand is required for a VA examination. The August 2017 failed to discuss the Veteran's in-service respiratory issue that appeared to be related to an environmental response. Upon remand, the Veteran must be provided the opportunity to undergo a VA examination to determine whether the Veteran's respiratory disorders are etiologically related to his service. 

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination to determine the etiology of his respiratory disorders of emphysema, pulmonary embolism, and pulmonary hypertension. The examiner must review the claims file. The examiner must provide the following opinions:

(a.) Is the Veteran's emphysema, pulmonary embolism, and/or pulmonary hypertension at least as likely as not related to environmental exposures from his service in Southwest Asia including any exposures to burn pits? The examiner must discuss:

i.	The Veteran's statement that his respiratory disorders began 6 months after leaving his service in Southwest Asia.  

ii.	The May 2004 service treatment record that indicates a respiratory issue related to an environmental response.

(b.) The examiner must provide a complete medical rationale for all opinions. The Board notes that a rationale that solely relies on medical literature for a negative opinion will not be considered adequate. 

 

 

 

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.