Citation Nr: 21008863 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 17-12 216 DATE: February 18, 2021 REMANDED The issue of entitlement to service connection for a respiratory disability, to include chronic obstructive pulmonary disease (COPD), lung disease, asthma, and shortness of breath, to include as secondary to service-connect posttraumatic stress disorder (PTSD) with secondary major depressive disorder (MDD) or as being associated with exposure to herbicide agents is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1970 to November 1971, to include service in the Republic of Vietnam from November 1970 to November 1971. The Veteran passed away in February 2015. In April 2016, VA determined that the appellant met the basic eligibility for substitution as the spouse of the deceased Veteran and substituted her as the claimant. In November 2019, the Board remanded this matter for additional development. For the reasons outlined below, the Board finds that remand is again needed. The issue has been expanded and recharacterized pursuant to Clemons v. Shinseki, 23 Vet. App. 1 (2009). Entitlement to service connection for a respiratory disability, to include COPD, lung disease, asthma, and shortness of breath, to include as secondary to service-connect PTSD with secondary MDD or as being associated with exposure to herbicide agents. The Board finds that additional development is needed prior to final adjudication of the issue on appeal. In a January 2021 brief, the appellant’s representative submitted “an excerpt from Global Initiative for Chronic Obstructive Lung Disease (GOLD) Executive Standard highlighting aggravating factors impacting COPD.” The Board will remand to obtain an addendum opinion that considers the evidence submitted. In addition, the Board asks for clarification of the following. In the August 2020 VA addendum opinion, it states that the “Veteran’s COPD has progressed over the course of years, as expected for the disorder without permanent aggravation of progression.” (Emphasis added). The Board asks for clarification of the use of the term “permanent aggravation.” Finally, the Board asks for clarification of the Veteran’s diagnosis. Further, the Board asks that additional attempts be made to obtain any outstanding records. In the November 2019 remand, the Board identified potentially outstanding treatment records. Subsequently, the appellant was sent a letter in February 2020 with enclosed VA Forms 21-4142 and 21-4142a. However, the letter does not address the treatment records identified in the Board remand. In addition, the letter states that if a response is not received within 30 days “we will take no action on your Notice of Disagreement. However, you still have until , to file an appeal on the issue(s) associated with the decision notice dated .” The Board finds this communication confusing for several reasons. First, it appears to reference dates, but the dates are not included. Second, the Board notes that the issue remanded for further development has already been appealed to the Board. Accordingly, the Board asks that clearer more complete letter, be sent to the appellant upon remand. The matter is REMANDED for the following action: 1. After securing any necessary consent forms, obtain any outstanding treatment records, to include any VA and/or private treatment records, pertaining to the issue on appeal. In particular, the Board points to August 2011 correspondence, in which the Veteran indicated that he had received treatment at the P.M.C. Further, it appears that VA attempted to obtain records from a Dr. S. O. without success. See VA Memo, August 2011. Upon remand, the Board asks that any outstanding records be obtained, if possible. The Board notes that in the November 2019 remand, the Board identified specific potentially outstanding treatment records. Subsequently, the appellant was sent a letter in February 2020 with enclosed VA Forms 21-4142 and 21-4142a. However, the letter does not address the treatment records identified in the Board remand. In addition, the letter states that if a response is not received within 30 days “we will take no action on your Notice of Disagreement. However, you still have until , to file an appeal on the issue(s) associated with the decision notice dated.” The Board finds this communication confusing for several reasons. First, it appears to reference dates, but the dates are not included. Second, the Board notes that the issue remanded for further development has already been appealed to the Board. Accordingly, the Board asks that clearer more complete letter, be sent to the appellant upon remand. All efforts should be documented in the claim file. If any records could not be obtained, this should be noted in the claim file. 2. In addition to the above, the Board seeks confirmation of the Veteran’s name change. The appellant’s representative has indicated that the Veteran’s middle initial is “L.” not “J.” See Correspondence, October 2019. The Board has carefully reviewed the record and official forms, including the Veteran’s birth certificate, DD 214, marriage certificate, and death certificate, which use the initial “J.” Indeed, the Veteran used the initial “J.” during his lifetime, including in his signature. See, e.g., VA Form 21-22, June 1993. The Board asks that the appellant and/or her representative provide documentation to support changing the Veteran’s name. 3. Upon completion of the above, obtain a VA addendum opinion that clarifies the diagnosis of the claimed respiratory disability and to address the etiology of any diagnosed disability(ies). The Board notes that the issue on appeal is listed as service connection for a respiratory disability, to include COPD, lung disease, asthma, and shortness of breath. For each respiratory disability diagnosed, the examiner is asked to address whether it is at least as likely as not (i.e., a 50 percent or greater probability) that it was caused by the Veteran’s active duty service, to include exposure to herbicides. The Board asks that the examiner address the following: (a) the appellant’s testimony “that the veteran would have trouble breathing as a result of his PTSD symptoms” and her belief that his “PTSD exacerbated his breathing problems.” See VA Form 646, September 2017; (b) the May 2012 VA examiner’s acknowledgement that PTSD “can occasionally cause mild shortness of breath if the vet gets anxious,” although “this would be short-lived and self-resolved;” (c) any articles submitted in support of the claim. See, e.g., Article, March 2011. The examiner should also provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that any diagnosed respiratory disability is proximately due to, or the result of, or aggravated (permanently worsened) beyond normal progression by the Veteran’s service-connect PTSD with secondary MDD. The examiner is asked to address the “excerpt from Global Initiative for Chronic Obstructive Lung Disease (GOLD) Executive Standard highlighting aggravating factors impacting COPD” noted in the January 2021 brief. The Board also asks for clarification of the August 2020 VA addendum opinion, which states that the “Veteran’s COPD has progressed over the course of years, as expected for the disorder without permanent aggravation of progression.” (Emphasis added). The Board asks for clarification of the use of the term “permanent aggravation.” The Board also asks that the examiner clarify if any of the claimed respiratory disabilities, such as shortness of breath, can be considered separate disabilities, or are they symptoms of the Veteran’s service-connect PTSD with secondary MDD. The VA examiner should be given access to the claim file. The examiner should state that a review of the claim file was completed. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. A detailed rationale is requested for all opinions provided.   4. If upon completion of the above action the issue denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Foster, 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.