Citation Nr: 21076338
Decision Date: 12/23/21	Archive Date: 12/23/21

DOCKET NO. 17-53 070
DATE: December 23, 2021

REMANDED

Entitlement to service connection for asthma is remanded.

REASONS FOR REMAND

The Veteran had active service from February 1988 to May 1992.  

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

The Board previously remanded this issue in April 2019, in relevant part, for a VA examination.  The Veteran was afforded a VA examination in December 2019, and the examiner stated that the Veteran's asthma was a diagnosable disease with a clear and specific etiology.  A supporting statement indicated fairly extensive literature described results of cohort studies to examine mortality in workers in the petroleum industry.  The studies generally did not include an exposure assessment, however, so the examiner stated it was difficult to reach a conclusion as to a relationship between respiratory disease outcomes and exposure to fuels.  In an addendum opinion, the examiner concluded that the Veteran's exposure to fossil fuel smoke and bronchospasm during active service was less likely related to his current asthma disability.

As noted in Stewart v. Wilkie, 30 Vet. App. 383 (2018), the etiology and the pathophysiology, partial or conclusive of the conditions warrants discussion in determining whether there is a medically unexplained chronic multi-symptom illness (MUCMI), and a clear rationale is warranted supporting the opinion.

Although there is evidence of a clearly defined diagnosis, the examiner did provide an explanation as to the pathophysiology and etiology of the Veteran's asthma.  Accordingly, a remand is required to offer a more complete explanation of the Veteran's disability pattern and furnish a thorough rationale that supports the findings.  

The matters are REMANDED for the following action:

Obtain an addendum opinion from an appropriate clinician regarding the Veteran's asthma.  The examiner must determine whether the etiology and pathophysiology of the Veteran's asthma is (1) inconclusive, (2) partially understood, or (3) fully understood.  This determination must be based on the Veteran's specific case and cannot be based on the pathophysiology of the disease or disability population as a whole.

If both the etiology and pathophysiology are partially understood or fully understood, then is it at least as likely as not (a 50 percent or greater probability) that the Veteran's asthma was incurred in, or is otherwise related to, his active service?

Please discuss the Veteran's assertions that he had no asthma symptoms prior to his service, and that his respiratory symptoms only began after his deployment in Operation Desert Storm.

A complete explanation should accompany each finding.  If the requested opinions cannot be provided without resorting to speculation, the examiner should provide an explanation as to why speculation is required.

 

 

Mary E. Rude

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Lauritzen, 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.