Citation Nr: 21010263 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 18-00 084 DATE: February 24, 2021 REMANDED Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for idiopathic pulmonary fibrosis is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1965 to January 1969. This case comes to the Board of Veteran’s Appeals (Board) on appeal from an October 2016 rating decision by the Department of Veteran’s Affairs (VA) Regional Office in Cleveland, Ohio. The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in February 2020. In a December 2020 rating decision, service connection for erectile dysfunction and special monthly compensation based on loss of use of a creative organ was granted. This represents a full grant of the benefits sought, and these issues are no longer in appellate status. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). 1. Entitlement to service connection for bilateral hearing loss is remanded. Though the Board regrets additional delay, remand is required for an adequate VA opinion. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. In the April 2020 Board decision, the examiner was specifically directed to address the Veteran’s competent lay statements of record regarding bilateral hearing loss, especially the December 2017 statement in support of the claim and the statements from the February 2020 hearing transcript. The Veteran was provided a VA examination in November 2020. The examiner determined that the Veteran’s bilateral hearing loss was less likely than not related to his active duty service as there were no significant threshold shifts from the entrance examination to the separation examination and both examinations showed normal hearing. The Board finds this opinion to be inadequate as the examiner did not address the Veteran’s lay statements regarding in-service noise exposure. The examiner did not reference or address any of these statements when providing is opinion. As such, remand is required to comply with prior Board remand directives. 2. Entitlement to service connection for idiopathic pulmonary fibrosis is remanded. Remand is required for compliance with the prior Board remand. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. The Veteran was provided with a VA examination to evaluate his idiopathic pulmonary fibrosis in July 2020. The examiner determined that the Veteran’s pulmonary fibrosis was less likely than not related to his active duty service to include exposure to Agent Orange. The examiner noted that the term “idiopathic” meant that the cause of the pulmonary fibrosis was unknown and could therefore, not be related to Agent Orange exposure. The examiner also stated that review of “Up to Date Online,” a resource for medical professionals, did not identify any connections between idiopathic pulmonary fibrosis and Agent Orange exposure. The examiner also noted that while there was no known cause of idiopathic pulmonary fibrosis, smoking was strongly associated with the condition. The Board finds this opinion to be inadequate as the examiner did not properly address the October 2017 private physician letter as directed by the previous Board remand. The examiner simply stated that he was not in agreement with the October 2017 letter, but did not address the letter itself. The October 2017 letter stated that although the Veteran had a history of cigarette smoking, it was remote as the Veteran had not smoked in 30 years. The physician noted that there was no family history for idiopathic pulmonary fibrosis, nor did the Veteran’s work environment include exposure to toxic chemicals. The examiner stated that it was well known that pulmonary fibrosis could be caused by exposure to toxic fumes, gases, and vapors. The private physician noted that the Veteran had exposure to chemicals in Vietnam and that if investigated, Dioxin exposure may be linked to idiopathic pulmonary fibrosis. The examiner in the July 2020 examination did not properly address this opinion or provide an explanation for the discrepancies in his finding and the findings of the private physician. As such, remand is required for an adequate VA examination that addresses these inconsistencies. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate medical practitioner regarding the nature and etiology of his bilateral hearing loss. If the examiner determines an examination is necessary, one should be provided. The entire claims file must be made available to and be reviewed by the examiner. An explanation for all opinions expressed must be provided. The examiner must opine whether it is as least as likely as not (50 percent probability or more) that the Veteran’s claimed bilateral hearing loss: (i) had its onset during service; (ii) manifested to a compensable degree within one year after his separation from service; or (iii) is etiologically related to an in-service injury, event, or disease, including conceded exposure to excessive noise while deployed in the field with combat units in Vietnam. The examiner must address all the Veteran’s competent lay statements of record regarding his bilateral hearing loss, especially the Veteran’s December 2017 statement in support of the claim and the February 2020 hearing transcript. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 2. Obtain an addendum opinion regarding the etiology of the idiopathic pulmonary fibrosis from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. The examiner must opine whether it is as least as likely as not (50 percent probability or more) that the Veteran’s claimed idiopathic pulmonary fibrosis: (i) had its onset during service; (ii) manifested to a compensable degree within one year after his separation from service; or (iii) is etiologically related to an in-service injury, event, or disease, including conceded exposure to Agent Orange or other herbicides. The examiner must address the October 2017 private physician letter. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Ashley Ki 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.