Citation Nr: 21022858 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 19-09 018A DATE: April 19, 2021 REMANDED Entitlement to service connection for asbestosis is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1958 to January 1962. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a June 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2020, the Board remanded the Veteran’s claim for additional development. The case is once again before the Board. As discussed below, the Board finds that there has not been substantial compliance with the prior remand instructions and this matter must be remanded once more. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for asbestosis is remanded. The Veteran contends that he was exposed to asbestos during service. In a July 2014 statement, he reported that he served as a boiler operator and maintenance personnel for three years and made daily repairs to steam lines which were covered with asbestos materials. The record includes a June 2013 CT scan of the Veteran’s chest. The radiologist reviewing the images noted the presence of “minimal atelectasis or scaring in the medial right middle lobe and lingula” as well as calcified pleural plaque in the left lung. The impression was “essentially [a] negative CT of the chest except for minimal atelectasis or scarring in both lungs.” In a June 2013 treatment record, the Veteran’s private physician, S.V., M.D., diagnosed him with “other dyspnea and respiratory abnormalities,” bronchitis, extrinsic asthma, and asbestosis. Dr. S.V. noted that the CT scan of the chest reveled asbestos exposure. Subsequent treatment records from Dr. S.V. note that a September 2014 chest x-ray study revealed “no acute findings.” A pulmonary function test patient questionnaire completed by the Veteran noted that he was an electrician and had “job site asbestos” exposure. The Veteran was afforded a VA examination in May 2015 to determine the nature and etiology of his claimed asbestos exposure during which the examiner opined there is insufficient evidence to support a diagnosis of the claimed condition at this time. In the report, the examiner checked “no” to “does the Veteran now have or has he ever been diagnosed with a respiratory condition.” He stated that a CT of the chest from June 2013 was essentially negative except for minimal atelectasis or scarring in both lungs. He noted these findings are “age related” and there is no sign of asbestosis or mesothelioma. In July 2015, Dr. S.V. again noted a diagnosis of asbestosis exposure. He noted that the was undergoing evaluation at VA for asbestos exposure. The Veteran was afforded a subsequent VA examination in June 2018 during which VA examiner noted a diagnosis of asbestos exposure, acute bronchitis, and asbestosis in June 2013. The VA examiner noted a June 2018 chest x-ray revealed no evidence of acute airspace consolidation, no evidence of pulmonary edema and no pleural effusion. He listed the Veteran’s previous diagnoses from private medical providers but provided no medical opinion or further rationale. In May 2020, the Board remanded the matter to obtain an addendum medical opinion for further clarification. In doing so, the Board directed the VA examiner to clarify whether a current diagnosis of a respiratory condition, including asbestosis, exists. The Board determined that a remand is necessary to clarify whether a current diagnosis of a respiratory condition, including asbestosis exists. It was noted that neither the May 2015 examiner or the June 2018 examiner discussed the evidence of plural plaques and neither examiner provided an adequate explanation for invalidating the June 2013 diagnosis of asbestosis. In the remand instructions, the Board requested that an examiner provide an opinion on whether any respiratory condition, including asbestosis is related to the Veteran’s active duty service. Pursuant to the Board’s remand an addendum VA medical opinion was obtained in September 2020. The VA examiner stated that “no chronic diagnosis is made for asbestosis.” It was explained that pleural plaques are a common sign of asbestosis exposure but are not asbestosis. The examiner stated that unlike other asbestos-related diseases like mesothelioma or asbestos lung cancer, pleural plaques are always non-cancerous or benign and have no disease potential. “They are not part of the lung parenchyma and do not affect respiratory function.” While the examiner addressed the evidence of plural plaques and stated that this has no functional impact on the Veteran’s respiratory system, the report does not address whether any of the Veteran’s other respiratory disabilities are related to service, to include his asbestos exposure. As noted above, the Veteran has been diagnosed with “dyspnea and respiratory abnormalities,” bronchitis, and extrinsic asthma.” As such, the Board finds that there has not been substantial compliance with its remand directives regarding consideration of specific evidence, and another remand is required to fix that error. Stegall v. West, 11 Vet. App. 268, 271 (1998) (where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance). The matters are REMANDED for the following action: 1. Arrange for an appropriate health care provider to review the Veteran’s claims file and provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any respiratory disorder had its clinical onset during service or is due to an event or incident of the Veteran’s period of active service, to include his asbestos exposure. The examiner should comment on the diagnoses of dyspnea, bronchitis, and asthma contained in the record. If the reviewing health care provider finds that physical examination or telehealth interview of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Aston, 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.