Citation Nr: 21008967 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 15-40 103 DATE: February 18, 2021 REMANDED A claim for service connection for a chronic obstructive pulmonary disease (COPD) is remanded. REASONS FOR REMAND The Veteran honorably served on active duty from May 1963 to May 1968. In a March 2014 rating decision, the Regional Office (RO) denied his claim for COPD. The Veteran appealed, contending that his COPD was caused by his conceded exposure to asbestos in service. In December 2020, upon finding that the medical evidence was necessary but insufficient to decide the Veteran’s claim, due the medical opinions of record being inadequate, the Board remanded the claim for a supplemental medical opinion. In December 2020, upon obtaining the requested opinion, the RO issued a supplemental statement of the case affirming the prior denial and then returned the appeal to the Board. Upon reviewing the supplemental medical opinion and noting that most probative value of any medical opinion is derived from its rationale, the Board has found that the rationale rendered in support of the December 2020 opinion is inadequate and thus has no more probative value than any past medical opinions of record. Specifically, a December 2020 addendum report reflects that “[g]iven the veteran does not have a diagnosis of asbestosis and carries a current diagnosis of COPD with significant smoking history it would be less likely than not that his COPD is secondary to asbestosis exposure.” Essentially, the examiner’s rationale is that the Veteran’s COPD is more likely related to his smoking history than to his exposure to asbestos because the Veteran does not have a diagnosis of asbestosis. However, as unequivocally outlined in the December 2020 Board’s remand order, a VA examiner specifically noted in a September 2020 VA examination report that some environmental studies show that asbestos-exposed workers may present lung function impairments, such as COPD, even in the absence of radiological evidence of asbestos-related pleural fibrosis or asbestosis. This statement implies that COPD well may be due asbestos exposure even in the absence of formal clinical diagnosis of asbestosis or any radiological evidence of such, without even suggesting that the nature of such an association may be spurious rather than causal. In December 2020, the examiner has not even acknowledged, let alone adequately addressing, this material piece of the evidence particularly favorable to the Veteran. In addition to omitting a discussion of favorable evidence, the rationale offered in support of this opinion is unclear as to why a significant history of smoking would be the most probable pathophysiological mechanism leading to the Veteran’s COPD, as opposed to his significant history of exposure to asbestos, or why his asbestosis exposure would be considered insignificant or less significant than his history of smoking. Ultimately, a medical opinion that is based on incomplete facts or on only partial information has no probative value and thus is inadequate. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Among other considerations, the Board must meaningfully understand whether or not, from a medical perspective, a pathophysiological mechanism from asbestos exposure to subsequently developed COPD exists and, if so, why or why not. As such, having not found a meaningful explanation, the Board finds that the December 2020 medical opinion is inadequate for the Board to decide the claim. Once the VA’s duty to obtain a medical opinion arises, VA must not only obtain such an opinion but also ensure its adequacy. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Given the inadequacy of the December 2020 medical opinion, the Board finds that the RO has not substantially complied with the Board’s remand instructions and thus another remand for an adequate medical opinion is necessary for the Board to make a fully informed decision. See Stegall v. West, 11 Vet. App. 268 (1998). Of note, in assigning probative weight to medical opinions, the Board generally defers to the expertise of licensed medical professionals, but also must consider such factors as the accuracy and completeness of facts relied upon, any supporting scientific data and the generally accepted cited authorities, the depth and detail of analysis, the soundness of rationale connecting data to conclusions, and the veracity and the scope of the ultimate conclusion(s). See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Hernandez-Toyens v. West, 11 Vet. App. 379 (1998). Accordingly, the matter is REMANDED for the following action: Obtain an etiological opinion as to the etiology of the Veteran’s COPD from a pulmonologist or other similarly appropriate examiner. Examination of the Veteran is left to the discretion of that examiner, as deemed appropriate. The examiner should review the entire claims file, to include all pertinent evidence and medical literature, and to specifically include the October 2018, August 2020, December 2020 Board’s remand orders and this order. After review of the claims file (and physical examination if deemed appropriate), the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s COPD was caused by or otherwise is etiologically related to his military service, to include his conceded exposure to asbestos during service. The examiner should address the Veteran’s contentions and lay statements of record, to include onset of symptomatology and any continuity of symptomatology since onset/discharge from military service. The examiner should address all pertinent evidence of record, as appropriate. The examiner must provide a complete rationale for all opinions and conclusions reached. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Alex Bardin, 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.