Citation Nr: 21022539 Decision Date: 04/16/21 Archive Date: 04/16/21 DOCKET NO. 17-50 632 DATE: April 16, 2021 REMANDED Entitlement to service connection for a respiratory condition, to include as due to asbestos exposure, is remanded. Entitlement to service connection for a lump condition is remanded. Entitlement to service connection for a skin condition is remanded. Entitlement to service connection for a migraine condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from November 1976 to May 1979. In November 2018, the Board of Veterans’ Appeals (Board) remanded the issues of entitlement to service connection for chronic obstructive pulmonary disease (COPD), a skin condition, lump condition, migraine condition, and alcohol dependence for further development. Specifically, the Board instructed the Regional Office (RO) to schedule the Veteran for VA examinations pertaining to his claims. The Board notes that the RO granted the Veteran’s claim of service connection for alcohol dependence in an August 2020 rating decision, and as such, the issue is no longer before the Board. Furthermore, the RO also granted service connection for the Veteran’s left wrist ganglion cyst in the same rating decision, but as the Veteran contends a lump condition in multiple locations on his body, and a right axillary lipoma was found by a September 2019 VA examiner, the lump condition claim remains before the Board. As an initial matter, the COPD issue has been recharacterized given the nature of the Veteran’s claim. See DeLisio v. Shinseki, 25 Vet. App. 45, 53 (2011); Brokowski v. Shinseki, 23 Vet. App. 79, 86-87 (2009). Upon review of the record, the Board finds that the claims must be remanded. The Board sincerely regrets the additional delay caused by this remand but wishes to assure the Veteran that it is necessary for a full and fair adjudication of his claims. 1. Respiratory Condition The Veteran contends that his respiratory condition is related to asbestos exposure onboard the U.S.S. Sea Devil and U.S.S. Blue Fish during his service. See October 2015 VA 21-526EZ, Fully Developed Claim; March 2016 VA 21-4138 Statement in Support of Claim. First, to date, the RO has not addressed the Veteran’s contentions pertaining to asbestos exposure, to include conducting development necessary to verify the asbestos exposure. As such, the RO must obtain all pertinent ship logs for the U.S.S. Sea Devil and attempt to verify, through all official sources, whether the Veteran was exposed to any asbestos during service. Second, the Board finds that a new VA examination and etiological opinion are warranted for the Veteran’s claim. Though the Veteran underwent VA examinations in September 2019 and January 2021, and an addendum opinion was associated with the Veteran’s claims file in October 2020, none of the opinions addressed the Veteran’s asbestos exposure assertion. Accordingly, remand is warranted. 2. Lump condition 3. Skin condition The Board finds that a new examination and etiological opinion are warranted for the Veteran’s claims pertaining to his skin. The Veteran contends that he has a skin condition on his scalp, hands and feet, as well as a lump condition in his wrist, thigh, and arm pits, that is related to service. In September 2019, the Veteran appeared for a skin diseases VA examination, in which the examiner noted a diagnosis of multiple seborrheic keratoses from November 2018 and diagnosed the Veteran with right axillary lipoma. The examiner opined that it was less likely than not that the Veteran’s seborrheic keratoses was related because of the lack of evidence and an inability to establish chronicity. He provided the same opinion and rationale for the Veteran’s lipoma. The Veteran was afforded another skin diseases VA examination in January 2021. The examiner noted a diagnosis of lipoma from August 2010 and seborrheic keratoses from November 2018. She opined that the Veteran’s lipoma was less likely than not related to service because he was not diagnosed with an axillary lipoma until 30 years after separation from service. She also opined that that the Veteran’s seborrheic keratosis was less likely than not related to service as there was no evidence of a diagnosis in the Veteran’s service treatment records (STRs) and the Veteran’s was not diagnosed with a skin condition until over 35 years after service. The Board finds that all opinions from the September 2019 and January 2021 VA examinations are inadequate as the rationales were conclusory. A medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record. Stefl v. Nicholson, 21 Vet. App. 102, 124 (2007). In addition to clear conclusions with supporting data, a medical opinion must contain a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 201 (2008). Moreover, neither of the examiners provided an actual etiology for the Veteran’s lipoma and seborrheic keratosis. Accordingly, remand for a new examination and etiology opinion is warranted. 4. Migraine condition The Board finds that a new examination and etiological opinion is warranted for the Veteran’s claim. He contends that his headaches are related to service. The Veteran underwent a VA examination in September 2019, in which the examiner diagnosed him with headaches, not otherwise specified. He also noted that the Veteran experienced pain on both sides of his head. He opined that the Veteran’s headaches were less likely than not related to service due to the lack of evidence of headaches in service and post-service, as well as an inability to establish chronicity. In January 2021, the Veteran was afforded another VA examination. The January 2021 examiner noted that the Veteran did not have, nor has he ever been diagnosed, with a headache condition. She noted that he experienced constant head pain on both sides of the head. She concluded that it was less likely than not the Veteran’s migraine condition was related to service because objective examination was normal and symptoms were subjective only, with no chronic diagnosis made for a migraine condition. The September 2019 examiner diagnosed the Veteran with headaches while the January 2021 examiner found that the Veteran did not have a migraine condition. The Board is unable adequately decide the claim due to these contradictory findings. Additionally, the Board notes that a Veteran may be service connected for pain when it reaches the level of functional impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (2018). Both examiner provided that the Veteran experienced pain on both sides of his head. As such, remand for a new examination is warranted. The matters are REMANDED for the following action: 1. Assist the Veteran in associating with the claims file updated treatment records. 2. Complete any development necessary to determine whether the Veteran had exposure to asbestos during service aboard the U.S.S. Sea Devil and U.S.S. Blue Fish. If additional details regarding exposure are needed to develop the claim, request such details from the Veteran. 3. Only after verification of asbestos exposure has been conducted, schedule the Veteran for a VA examination to determine the nature and likely etiology of his respiratory condition. The Veteran’s electronic claims file must be accessible for review by the VA examiner in conjunction with the examination and this review should be acknowledged in the report. Based upon a review of the relevant evidence of record, the VA examiner should respond to the following: (a.) Obtain a detailed history of any and all diagnosed respiratory condition(s) and identify any currently diagnosable condition associated with the Veteran’s respiratory condition. (b.) Determine whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran’s respiratory condition had its onset in or is related to service, to include exposure to asbestos. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his report must be taken into account in formulating the requested opinion. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic and requests flexibility and understanding in affording the Veteran an opportunity for an examination. If an in-person examination cannot be provided, consider other appropriate alternatives, such as a telehealth examination. The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. 4. Schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of his lump and skin conditions. The claims file should be made available to the examiner for review in connection with the examination. Based on review of the record and examination of the Veteran, the examiner should respond to the following: (a.) Identify and any currently diagnosable condition associated with the Veteran’s skin condition, to include lipoma and seborrheic keratosis. (b.) For each diagnosed condition, determine whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran’s lump and skin conditions had their onset in or are related to service? The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinions. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic and requests flexibility and understanding in affording the Veteran an opportunity for an examination. If an in-person examination cannot be provided, consider other appropriate alternatives, such as a telehealth examination. The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. 5. Schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of his migraine condition. The claims file should be made available to the examiner for review in connection with the examination. Based on review of the record and examination of the Veteran, the examiner should respond to the following: (a.) Identify any currently diagnosable disability associated with the Veteran’s migraine condition. If the Veteran does not have a diagnosable migraine disability, but has pain only, determine whether that pain causes functional loss of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). (b.) For each diagnosed condition, or for pain that causes functional loss, determine whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran’s migraine condition had its onset in or is related to service? The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinions. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic and requests flexibility and understanding in affording the Veteran an opportunity for an examination. If an in-person examination cannot be provided, consider other appropriate alternatives, such as a telehealth examination. (Continued on the next page)   The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. J. NICHOLS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. L. Park, 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.