Citation Nr: 21012857 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 14-41 839 DATE: March 5, 2021 REMANDED Entitlement to service connection for a lung disorder, including chronic obstructive pulmonary disease (COPD), is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1968 to October 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the matter in June 2018, November 2019, and September 2020 for further development. The Veteran testified at a hearing before the undersigned Veterans Law Judge in August 2015. A transcript of the hearing is of record. Entitlement to service connection for a lung disorder, including COPD, is remanded. As discussed in the Board’s prior remand, the Veteran’s diagnosed COPD is consistently attributed to his history of cigarette smoking. The Board explained that for claims received by VA after June 9, 1998, a disability or death will not be considered service-connected on the basis that it resulted from injury or disease attributable to the veteran’s use of tobacco products during service. 38 U.S.C. § 1103(a); 38 C.F.R. § 3.300(a). However, that provision does not preclude secondary service connection for a disability related to use of tobacco products after service. VAOPGCPREC 6-03 (69 Fed. Reg. 25178 (2004). To establish secondary service connection based on tobacco use after service, it must be shown, in pertinent part, that a service-connected disability caused the veteran to use tobacco products after service. Id. The Board finds the record insufficient to make an informed decision as to whether service connection may be established for the Veteran’s COPD as secondary to service-connected posttraumatic stress disorder (PTSD) by way of tobacco use under the criteria set forth in VAOPGCPREC 6-03. He has submitted articles supporting a relationship between PTSD and tobacco use. One article, which is from VA’s website and titled “PTSD and Tobacco Use,” states that veterans with PTSD are more likely to smoke than veterans without PTSD. Another article reflects a finding that PTSD is associated with elevated rates of cigarette smoking compared with population norms, and that smokers with PTSD are significantly more likely to be “heavy” smokers and take larger puffs. “Effects of Nicotine on Emotional Reactivity in PTSD and Non-PTSD Smokers: Results of a Pilot fMRI Study” B. Froeliger et. al. (2012). Medical articles or other items of treatise evidence, standing alone, may support a claim if they discuss generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least a plausible argument for causality based upon objective facts rather than an unsubstantiated lay medical opinion. Sacks v. West, 11 Vet. App. 314, 317 (1998). The Board finds that while the articles submitted by the Veteran provide general support for a correlation between PTSD and cigarette smoking, they are not sufficient in itself to support a finding that his PTSD caused him to smoke after service. See VAOPGCPREC 6-03. In this regard, there is no evidence or information in the file as to when he began smoking, or what led him to begin. In sum, the Veteran has made general arguments regarding the associations between PTSD and tobacco use, supported by articles such as those mentioned above; however, there is no evidence in the file, including statements from the Veteran or witnesses, showing that in his case he smoked cigarettes after service due to mental health symptoms associated with PTSD. The fact that there are articles supporting a relationship between PTSD and tobacco use, and that he has PTSD and a history of smoking, is not sufficient to bridge that gap in the evidence. A VA medical opinion was obtained in November 2020, which states that there is a great body of research in the medical community finding that PTSD does not cause tobacco use; rather, tobacco use is owing to chemical dependency on the tobacco itself, and is not due to psychological issues. The examiner added that the Veteran’s file does not support a connection between his PTSD diagnosis and tobacco use. In a December 2020 addendum, the examiner stated that the Veteran’s use of tobacco products after service can only be assumed, and that the file does not contain records of longstanding mental health treatment that might show a connection between the Veteran’s PTSD and use of tobacco products. On remand, the Veteran should be given another opportunity to provide or authorize the release of any records that might document the history of his tobacco use, such as treatment records pertaining to his COPD or PTSD. As discussed in the Board’s prior remand, he received treatment at private facilities for his COPD, including at Beaver Valley Medical Clinic, but there are no records dated prior to 2006. VA sent a letter to the Veteran in September 2020 inviting him to complete and return authorized release forms for such records, or to submit them himself. He did not respond. In addition, the Veteran should be invited to provide a statement specifying when he began smoking cigarettes, and describing the circumstances that led to his cigarette smoking. He should also state whether he believes he continued to smoke due to his PTSD symptoms, and if so, explain why he believes that to be the case. If additional evidence is added to the file specific to the Veteran regarding his history of cigarette smoking which supports a potential link to PTSD, a new VA medical opinion should be obtained on the issue. The matter is REMANDED for the following action: 1. Request the Veteran to authorize the release of any private treatment records that might provide information regarding the history of his cigarette smoking, including from Beaver Valley Medical Clinic/Hospital. He should also be invited to submit the records himself. A copy of the request must be sent to his representative. 2. Request the Veteran to submit a statement specifying when he began smoking cigarettes, and describing the circumstances that led to his cigarette smoking. He should also state whether he believes he continued to smoke due to his PTSD symptoms, and if so, explain why he believes that to be the case. A copy of this request must be sent to his representative. 3. If additional evidence is added to the file specific to the Veteran regarding his history of cigarette smoking which supports a potential link to PTSD, a new VA medical opinion should be obtained on the issue. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Rutkin, 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.