Citation Nr: 21012712 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 16-41 370 DATE: March 5, 2021 REMANDED Service connection for the cause of the Veteran's death is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1962 to June 1983. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran died in August 2014 and the appellant is his surviving spouse. In February 2016, the RO found the appellant to be qualified to be a substitute claimant. In February 2019, the Board denied the entitlement to service connection for the cause of the Veteran’s death. The appellant appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (Court). By way of a May 2020 Order, the Court vacated the Board’s decision, with remand for adjudication consistent with the joint motion for remand (JMR).   Service connection for the cause of the Veteran's death is remanded. The appellant contends the Veteran’s lung condition, notably pleural effusions, was related to his military service, specifically exposure to asbestos. In a March 2016 statement, the appellant asserted that had the Veteran not been exposed to asbestos he would have completely recovered from heart surgery. Pursuant to the JMR, a remand is needed for a new medical opinion. Although the Court directed the Board to obtain the Veteran’s oncology records, the appellant submitted these records in January 2021; thus, they no longer need to be obtained. Nevertheless, the appeal is being remanded for an addendum opinion. The Veteran’s service treatment records contain several entries concerning complaints of persistent coughing. They also indicate that he had pain in the left chest wall. In December 1981 and November1982 the Veteran reported that in the past year, he had been exposed to asbestos, welding, sanding and/or grinding operations, cleaning solvents, fuels, fumes and vapors, and fiberglass. The Veteran also indicated in December 1981 that he experienced symptoms of asthma, bronchitis, and excessive mucus. The Veteran underwent multiple chest x-rays which were negative. The Veteran sought treatment in January 1983 after coughing up blood; however, that chest x-ray was negative. At his March 1983 retirement examination, the Veteran’s lungs were noted to be normal. A chest X-ray was also normal. The Veteran’s file was reviewed by a VA examiner in February 2015 who opined that the Veteran's contributing cause of death, which is identified as pleural effusion was not substantially and/or materially caused by, related to, or a result of in-service asbestos exposure. The examiner explained that there is no objective evidence of asbestosis or clinical findings which would lend to a diagnosis of asbestosis; rather, the Veteran had evidence of asbestos exposure without evidence of disease due to such exposure. The pleural effusions were not a result of, aggravation of, or related to asbestos exposure. In her brief to the Court, the appellant argued that the examiner did not address “favorable 2014 medical records characterizing [the Veteran’s] pleural plaques as an asbestos-related disease.” The Board finds, however, that the examiner’s statement, “pleural plaques are a marker of previous asbestos exposure but do not constitute lung disease,” reflects acknowledgement and consideration of said favorable evidence. In January 2021, the appellant submitted a favorable nexus opinion from a private physician, Dr. P. C.; however, the Board does not find this opinion entirely persuasive. For these reasons, an addendum opinion that reflects consideration of the relevant evidence, including the recently submitted medical relevant records and the December 2020 nexus opinion from Dr. P.C., would be most helpful. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician (if possible, a pulmonologist) regarding whether the Veteran’s lung condition, characterized on his death certificate as pleural effusions, onset during service or is otherwise related to service, including as a result of asbestos exposure. The examiner must review the entire claims file, and attention is directed to the medical records recently associated with the file in January 2021 and the favorable medical opinion from Dr. P. C., dated in December 2020 found in the appellant’s January 2021 Appellate Brief. After a complete review of the file, the examiner is asked to provide a response to the following: 1) Does the evidence support a finding that the Veteran had an asbestosis-related disease? Please explain why or why not. In addressing the question please address the significance, if any, of the: a) April 11, 2014 CT scan showing "calcified and non-calcified pleural plaques are present suggesting asbestos-related pleural disease;" and b) June 22, 2014 CT scan confirming the presence of "calcified pleural plaques bilaterally, suggestive of chronic asbestos-related pleural disease;" and, c) The August 1, 2014 treatment report documenting "faint bibasilar crackles, [and] faint expiratory wheeze" on examination. 2) Is it at least as likely as not that the pleural effusions noted on the Veteran’s death certificate onset either during military service or developed as a result of service, to include as a result of asbestos exposure therein? Please explain why or why not. In addressing the question, please address opinion and findings offered from Dr. P.C., particular with respect to benign asbestos pleural effusion (BAPE) and asbestos related lung disease (ARLD). A complete rationale must be provided for all opinions. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Telamour, 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.