Citation Nr: 21021106 Decision Date: 04/09/21 Archive Date: 04/09/21 DOCKET NO. 16-55 794 DATE: April 9, 2021 REMANDED Entitlement to service connection for lung disease, to include as due to asbestos exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1972 to November 1972. The Veteran died in February 2020. The appellant is the Veteran’s widow. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2016 rating decision by a Department of Veterans Affairs Regional Office (RO). In March 2020, the appellant testified at a Board videoconference hearing before the undersigned. A copy of the transcript of that hearing has been associated with the claims file. At that time, the Board held the record open for 60 days for the appellant to submit additional relevant evidence. In August 2020, the Board remanded this case and instructed the Agency of Original Jurisdiction (AOJ) to readjudicate the issue on appeal based on the current evidence of record. This case was further remanded in December 2020. At that time, the AOJ was instructed to obtain an outside expert medical opinion. See 38 U.S.C. § 5109; 38 C.F.R. § 3.328. Lung Disease As noted above, this case was recently remanded to obtain an outside expert medical opinion. That opinion was obtained in February 2021. The examiner opined that it was “less likely than not (less than 50 percent probability)” that the Veteran had a respiratory condition that was etiologically related to service. In support of this opinion, the examiner noted that a review of the medical record and medical literature suggested that the Veteran’ s COPD and metastatic small cell lung cancer was less likely than not primarily due to service. Instead, the examiner concluded that it was more likely that the Veteran’s COPD and metastatic small cell lung cancer was primarily due to his long smoking history. The examiner conceded the Veteran’s exposure to asbestos, and noted that such exposure damaged his lungs, including the development of pleural plaques, thereby increasing his risk of developing COPD and small cell lung cancer. However, the examiner found that the Veteran’s asbestos exposure did not primarily cause those conditions. In this regard, the examiner stated that if the Veteran had not been a heavy smoker, then he would have less likely developed COPD and/or small cell lung cancer. Specifically, the examiner noted that the development of COPD and/or small cell lung cancer was extremely rare in people with asbestosis alone who never smoked. In support of this finding, the examiner cited medical literature. The Board finds that an addendum opinion is necessary to adjudicate this issue on appeal. In this regard, the examiner appears to acknowledge that the Veteran had respiratory conditions other than COPD and small cell lung cancer. Specifically, the examiner conceded asbestos exposure and stated that such exposure damaged the Veteran’s lungs, including the development of pleural plaques. The examiner also appears to suggest the Veteran suffered from asbestosis. While such lung damage was not found to result in the development of COPD and small cell lung cancer, the question remains whether the Veteran had a lung condition during the period on appeal other than COPD and small cell lung cancer that was etiologically related to service. The matter is REMANDED for the following action: Refer the Veteran’s claims file for an addendum to the February 2021 VA medical opinion. The examiner is asked to provide the Veteran’s known diagnosed respiratory conditions, including conditions other than COPD and metastatic small cell lung cancer, during the period on appeal. In this regard, the Board notes that the examiner appears to acknowledge and assert that in-service asbestos exposure damaged the Veteran’s lungs, including the development of pleural plaques and asbestosis. (1) Did the Veteran have a diagnosis of asbestosis? (2) Were the findings of pleural plaques related to conceded asbestosis exposure during service (February to November 1972)? (3) With regard to each of the Veteran’s diagnosed respiratory conditions, to include COPD and metastatic small cell lung cancer and any other respiratory condition, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that such diagnosed respiratory condition was causally or etiologically related to his service (February to November 1972), asbestos exposure (conceded), and his military occupational specialty (aircraft mechanic). The examiner is asked to consider the representative’s cited medical literature, including a Mayo Clinic research report (https://www.mayoclinic.org/diseases-conditions/asbestosis/symptoms-causes/syc-20354637) and Swedish COPD study (https://www.asbestos.com/asbestos/copd/). See March 2021 Brief. (4) Additionally, if the Veteran is found to have had a diagnosis for asbestosis, the examiner is asked to explain why the disease, on its own (i.e. absent the Veteran’s smoking history), would not have caused the development of the Veteran’s lung cancer. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Lamb, 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.