Citation Nr: 21075074 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 16-06 070 DATE: December 17, 2021 REMANDED Entitlement to service connection for a pulmonary disorder is remanded. REASONS FOR REMAND The Veteran had honorable active duty service in the United States Navy from March 1983 to March 2013. The issue was remanded by the Board of Veterans' Appeals (Board) in August 2019 for additional development and has been returned to the Board for appellate review. Entitlement to service connection for a pulmonary disorder is remanded. The Board notes that the Veteran's service treatment records (STRs) show frequent treatment for upper respiratory symptoms including cough, bronchitis, pneumonia, sinusitis, viral infections, congestion, and difficulty breathing during active service. He was prescribed a variety of medications including antibiotics and inhalers for treatment of these symptoms during service. According to military personnel records, the Veteran's tenure of service included a period of service at Camp Lejeune. A medical surveillance questionnaire referenced exposure to shipyard chemicals, paint, and asbestos. In April 2014, the Veteran was afforded a VA examination. The examiner acknowledged a current diagnosis of acute bronchitis. Following the clinical evaluation, the examiner opined that the Veteran did not suffer from chronic bronchitis. The examiner stated that although several bouts with acute bronchitis were noted during active service, no chronic respiratory pathology was indicated. On the date of examination, the Veteran was described as asymptomatic. Pursuant to the August 2019 Board remand, the Veteran was afforded a new VA examination in January 2020. The examiner stated that the Veteran has no current respiratory diagnosis, including no diagnosis of asbestosis. He stated that the Veteran did have several bouts of acute bronchitis during service, which resolved with no residuals. He stated that the Veteran still gets occasional bouts of bronchitis treated with antibiotics and a chronic cough, the etiology for which is unknown, possibly secondary to post-nasal drip or GERD. Therefore, the examiner provided no etiology opinions. Subsequent to the January 2020 VA examination, numerous post-service private treatment records were added to the record indicating continued treatment for respiratory symptoms including chronic cough, chronic bronchitis, and upper respiratory infections. Of significance, a March 2015 private treatment note indicates that pulmonary function testing revealed mild obstructive lung disease. The addition of these pertinent post-service records indicates that the January 2020 examiner had an incomplete record to review. Further, the examiner did not address the Veteran's contentions or extensive medical history to explain why past symptoms and findings did not indicate a chronic condition. Accordingly, a new opinion is necessary after review of the complete record to address whether the Veteran's symptom history indicates a chronic condition and, if so, whether it was caused by or incurred in service. The matter is REMANDED for the following action: 1. Obtain an addendum medical opinion regarding the nature and etiology of any pulmonary or respiratory disorders. The entire claims file and a copy of this remand should be made available to the reporting clinician for review, and such review should be noted in the examination report. If the reporting clinician determines an additional physical examination would be beneficial, one is to be arranged and all necessary tests and studies should be conducted, to include a pulmonary function test. The clinician should identify any and all pulmonary or respiratory condition(s) attributable to the Veteran throughout the appellate period. If the Veteran is found to have a chronic pulmonary or respiratory disorder, the reporting clinician should then render an opinion as to whether it is at least as likely as not (i.e., there is a 50 percent or greater probability) that the condition had onset in or is otherwise related to service. The reporting clinician must specifically address the pertinent evidence of record, to include the symptomatology noted in the Veteran's STRs, the March 2015 diagnosis of obstructive lung disease, and post-service treatment records noting diagnoses of chronic cough and chronic bronchitis. Additional consideration much be given to the Veteran's exposure to toxins during active service, to include shipyard chemicals, asbestos, and contaminated drinking water at Camp Lejeune in North Carolina. As a part of the examination and/or opinion, the reporting clinician must consider all prior opinions in the record and explain or distinguish any variations in findings and conclusions. Any opinion offered must be accompanied by a complete rationale, which should reflect consideration of the STRs, medical evidence of record, and lay statements. If any requested opinion cannot be offered without resorting to speculation, the reporting clinician should indicate such in the examination report and explain why a non-speculative opinion cannot be offered. They should also identify what, if any, additional information or evidence would allow for a more definitive opinion. 2. Once the above development has been achieved, as well as any other development deemed necessary thereafter, readjudicate the appeal. If any benefits sought remain denied, issue a supplemental statement of the case and return the case to the Board. M. C. WILSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Sneeringer, 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.