Citation Nr: 21010525 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 13-18 460 DATE: February 25, 2021 REMANDED Entitlement to service connection for asthma is remanded. Entitlement to service connection for hypertension, to include as secondary to asthma is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1988 to June 1995. In April 2017, the Veteran testified at a video-conference hearing before the undersigned Veterans Law Judge (VLJ) of the Department of Veterans Affairs (VA) Board of Veterans’ Appeals (Board). A transcript of that hearing has been associated with the claims file. Most recently, in August 2020, the Board remanded these matters for further development; the claims file has been returned to the Board for adjudication. 1. Entitlement to service connection for asthma is remanded. As discussed by the Board in its August 2020 remand, the Veteran underwent a September 2019 VA examination to determine the etiology of her asthma. The examiner was specifically directed to consider and address the Veteran’s repeated exposure to sandstorms and toxic gases from burning human waste with mo-gas and diesel. The September 2019 examiner opined it was less likely than not that the Veteran’s asthma was related to her active service, rationalizing there was no definite medically documented written evidence that the Veteran’s asthma had its clinical onset during service, or is related to any in-service diseases. The examiner also found asthma to be a diagnosable chronic multi-symptom illness with a partially explained etiology, which was less likely than not related to a specific exposure event in Southwest Asia. The examiner rationalized that the Institute of Medicine (IOM) found inadequate/insufficient evidence to determine whether an association exists between deployment to the Gulf War and a respiratory condition. The examiner also stated asthma triggers include, in pertinent part, respiratory infections; air pollutants and irritants, such as smoke; and strong emotions and stress. The Board found that the September 2019 VA opinion was inadequate. While the examiner was asked to consider and address the Veteran’s competent and credible statements regarding her in-service exposure to sandstorms and toxic gases on numerous occasions, the opinion relied on the absence of medical documentation specifically linking the Veteran’s asthma to her active duty service, and did not appear to give any weight to the Veteran’s reports of repeated in-service exposure events. Additionally, the examiner listed several asthma triggers, including respiratory infections and air pollutants, but did not opine whether the Veteran’s in-service respiratory infections and exposures to air pollutants and irritants caused her asthma. In a September 2020 opinion, resultant to the Board’s August 2020 remand, the examiner opined that the Veteran’s asthma was less likely than not related to service, specifically, to her in-service exposure to sandstorms and toxic gases from burning waste and diesel in Southwest Asia in 1991. The examiner discussed that it was less likely that exposure in 1991 caused asthma diagnosed in 2003, as her service treatment records, including those demonstrating treatment for upper respiratory infections (URIs), were silent for asthma dyspnea-type complaints and her VA treatment records dated in August 2004 indicate that she reported that she worked in the post office with a lot of dust since 1998 and in April 2010, she reported that the postal warehouse where she worked was very dusty and many coworkers smoked. The examiner did not discuss the September 2019 examiner’s comment that air pollutants and irritants are known asthma triggers. In his discussion of whether the Veteran’s asthma was secondary to PTSD, he noted that the Veteran had allergic-type asthma and VA treatment records dated in December 2004 noted allergies to nuts, cats, and cockroaches, VA treatment records dated in February 2011 noted triggers of “strong odors,” VA treatment records dated in August 2012 noted rainy weather as a trigger, and VA treatment records dated in June 2019 noted mold exposure with allergy serum test positive for cats, dust mites, roaches, and possible mild aspergillus. The September 2020 opinion is inadequate. Despite being directed to consider the Veteran’s respiratory symptomatology, both during and after service. In her November 2010 Notice of Disagreement (NOD), the Veteran reported that she was diagnosed with bronchitis and URIs during service, continued VA treatment after service, and was eventually diagnosed with bronchitis asthma. She asserted that the symptoms for bronchitis and asthma are the same. In an undated statement, received by VA in May 2013, one of the Veteran’s children reported that prior to her diagnosis with asthma, the Veteran was a frequent patient in the hospital, being seen for what they thought was a common cold or flu, usually with breathing problems, and they assumed such were symptoms of allergies or a brief illness. In a June 2013 statement, the Veteran asserted that after her in-service environmental exposures, she had a strange metallic taste in her mouth; she believed that prolonged exposure to such severely negatively impacted her health, causing her lungs to slowly weaken over time and eventually develop asthma. During her April 2017 Board hearing, she asserted that he had experienced breathing symptoms since 1995. In her October 2017 Disability Benefits Questionnaire (DBQ), the Veteran reported that during service, she always had a chest cold that never went away, and after service, she had a constant chest cold, cough, tight chest, shortness of breath, and wheezing, and was later diagnosed with asthma. Unfortunately, another remand is required in order to obtain an adequate etiological opinion as to the Veteran’s asthma. Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers on a Veteran, as a matter of law, a right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand). The Veteran’s most recent VA treatment records available for Board review are dated in October 2020; on remand, the VA Regional Office (RO) should obtain and associate with the claims file the Veteran’s updated VA treatment records. 2. Entitlement to service connection for hypertension, to include as secondary to asthma is remanded. The issue of entitlement to service connection for hypertension, to include as secondary to asthma is not ripe for adjudication; the issue of entitlement to service connection for asthma remains on appeal and is subject to the development directed herein. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); Ephraim v. Brown, 82 F.3d 399 (Fed. Cir. 1996). The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from October 2020 to the present. 2. Forward the Veteran’s claims file to the VA examiner who submitted the September 2020 opinion as to the Veteran’s asthma or a suitable substitute. If any examiner determines that additional physical examination of the Veteran is required in order to respond fully to the Board’s inquiry, so schedule the Veteran. Resultant to review of the claims file, the examiner should provide an opinion, with complete rationale, as to the following: Is it at least as likely as not (50 percent probability or greater) that the Veteran’s asthma had its clinical onset during service, or is related to any in-service disease, event, or injury, specifically, her repeated exposures to sandstorms and toxic gases from burning human waste with mo-gas and diesel and her in-service treatment for and symptoms of bronchitis and URIs. In this regard, the examiner must consider and discuss: (1) September 2019 examiner’s comment that air pollutants and irritants are known asthma triggers; (2) the VA treatment records dated in December 2004, February 2011, August 2012, and June 2019 indicating, respectively, allergies to nuts, cats, and cockroaches, triggers of “strong odors,” rainy weather as a trigger, and mold exposure with allergy serum test positive for cats, dust mites, roaches, and possible mild aspergillus; (3) the undated statement of the Veteran’s daughter, received by VA in May 2013, that prior to her diagnosis with asthma, the Veteran was a frequent patient in the hospital, being seen for what they thought was a common cold or flu, usually with breathing problems, and they assumed such were symptoms of allergies or a brief illness; (4) the Veteran’s lay statements of always having a chest cold that never went away during service, and after service, having a constant chest cold, cough, tight chest, shortness of breath, and wheezing, and that she had experienced breathing symptoms since 1995; and (5) the Veteran’s general assertion that her in-service symptoms diagnosed as bronchitis and URIs were the same as those later diagnosed as asthma and that her prolonged in-service environmental exposures severely negatively impacted her health, causing her lungs to slowly weaken over time and eventually develop asthma. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.