Citation Nr: 21013261 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 14-11 232 DATE: March 9, 2021 REMANDED Entitlement to service connection for a respiratory disorder is remanded. Entitlement to service connection for nasal polyps is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1962 to June 1963. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In a June 2020 rating decision, service connection for low back disorder was granted. This represents a full grant of the benefits sought, and the issue is no longer in appellate status. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). 1. Entitlement to service connection for a respiratory disorder, diagnosed as COPD, sinusitis, and rhinitis, is remanded. 2. Entitlement to service connection for nasal polyps is remanded. Although the Board regrets the additional delay remand is required for an additional VA opinion. Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). 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 in February 2020 and October 2020. In the February 2020 VA examination, the examiner determined that the Veteran’s nasal polyps were not related to his active duty service as service connection could not be established through medical records. The examiner did not provide any rationale or medical evidence to support this opinion. In the October 2020 VA examination, the examiner opined that the Veteran’s nasal polyps and rhinitis were at least as likely as not due to service. The examiner explained that nasal polyps were caused by rhinitis and agreed with the positive nexus from the July 2019 VA examination. However, the July 2019 opinion was determined to be inadequate by a previous Board decision for lack of rationale. As such, the Board finds that an adequate rationale was not provided to support the positive nexus opinion in the October 2020 VA examination and remand is required for an addendum opinion to address nasal polyps and rhinitis. The examiner also found that the Veteran’s COPD and sinusitis were less likely than not related to service. The examiner found that it was not possible to determine when the sinusitis condition began as no diagnosis had been made in service. The examiner also noted that as the coal and dust exposure had occurred more than 50 years ago, it was unlikely that this exposure led to the chronic sinusitis. In regard to COPD, the examiner acknowledged the Veteran’s exposure to coal and debris in service but noted that the most recent chest scans only showed small benign pulmonary nodules and no evidence of particulate lung disease. The examiner noted that a high-resolution chest scan had not been done on the Veteran for potential verification of any particulate lung disease. The examiner stated that the Veteran’s COPD was likely due to his status as a lifelong smoker. The examiner also noted that the Veteran’s recent PFTs documented a severe decrease in FEV-1 consistent with severe obstructive airway disease and the Veteran’s value for FEF 25-75 was only 21 percent of predicted, which represented significant small airway disease. First, the Board finds the opinion for COPD and sinusitis to be inadequate as the examiner did not address the Veteran’s lay statements regarding treatment for pneumonia in service as required by the December 2019 remand. In a May 2012 correspondence, the Veteran stated that he suffered from pneumonia that led to lung scarring in service. As the examiner failed to follow Board directives, remand is required for an adequate opinion. Second, the Board finds the examiner’s opinion to be inadequate as the examiner based her negative nexus opinion for sinusitis entirely upon lack of documentation in STRs. No other evidence was provided for denying nexus for sinusitis outside of the fact that the condition was not diagnosed in service. Third, the Board finds that the examiner’s opinion for denying nexus for COPD is inadequate as the opinion rests in part upon the fact that the Veteran has not had a high-resolution chest scan to determine whether the Veteran could have particulate lung disease. As there is insufficient competent medical evidence on file to render a decision on the claim, further development is required. Finally, remand is required as the examiner determined that the Veteran may be diagnosed with two other respiratory conditions. The examiner stated that the evidence indicated that the Veteran suffered from obstructive airway disease and small airway disease. The examiner, however, did not provide a possible etiology for these potential diagnoses. As such, remand is required for an addendum opinion that addresses these conditions. The matters are REMANDED for the following action: 1. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records, to include the December 2020 breathing test that the Veteran reported in a November 2020 correspondence. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 2. Contact the appropriate VA Medical Centers and obtain and associate with the claims file all outstanding records of treatment. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified, and this should be documented for the record. Required notice must be provided to the Veteran and his or her representative. 3. After any additional records are associated with the claims file, schedule a new VA examination with an appropriately qualified health care professional to determine the current nature and etiology of any respiratory disorder found on examination. The entire claims file should be made available to, and reviewed by, the examiner. Any and all studies, tests, and evaluations deemed necessary by the examiner (to include a high-resolution CT scan of the chest if necessary) should be performed. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that COPD, sinusitis, rhinitis, obstructive airway disease, nasal polyps, and small airway disease, are otherwise related to active service, as due to the Veteran’s described exposures due to his MOS as a fireman and his diagnosed pneumonia. The examiner must presume pneumonia and the exposures occurred for purposes of this opinion only. 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.