Citation Nr: 21023163 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 17-38 028 DATE: April 20, 2021 REMANDED Entitlement to service connection for a lung condition, to include interstitial lung disease, chronic obstructive pulmonary disease, shortness of breath, and use of an inhaler is remanded. Entitlement to compensation under 38 U.S.C. § 1151 for a lung condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from June 1962 to December 1965. This matter comes before the Board of Veterans Appeals (Board) on appeal from a November 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in October 2020 when it was remanded to the Agency of Original Jurisdiction (AOJ) for VA opinions. 1. Entitlement to service connection for a lung condition, to include interstitial lung disease, chronic obstructive pulmonary disease, shortness of breath, and use of an inhaler is remanded. Pursuant to the October 2020 Board remand, the Veteran received a VA examination in January 2021. The examiner provided a negative opinion. The Veteran contends his lung condition is due to asbestos exposure while stationed in Pakistan. He reported asbestos used in pipes and insulation on military bases there. See Correspondence, received February 2021. The Veteran’s personnel records reflect service in Pakistan between 1963 and 1964. The Veteran’s examinations did not address potential asbestos exposure. Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). Accordingly, remand is required. 2. Entitlement to compensation under 38 U.S.C. § 1151 for a lung condition is remanded. Pursuant to the October 2020 Board remand, the Veteran received a VA examination in January 2021. The examiner provided a negative opinion. However, in the rationale provided, the examiner noted the Veteran was prescribed Simvastatin in July 2017 and that the interstitial changes predated his Simvastatin use by a month. The Veteran’s medical records reflect Simvastatin use for years before the July 2017 prescription. A medical opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Accordingly, the issue must be remanded. The matters are REMANDED for the following action: 1. Appropriate efforts should be made to obtain and associate with this case file any outstanding records to confirm asbestos exposure, with all necessary assistance from the Veteran. 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. Obtain an addendum opinion to determine the nature and etiology of the Veteran’s lung condition, to include interstitial lung disease, chronic obstructive pulmonary disease, shortness of breath, and use of an inhaler. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including a copy of this remand, the Veteran’s service treatment records, post-service medical records, and statements. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. After examining the Veteran, if deemed necessary by the examiner, and considering his pertinent medical history and lay statements regarding his reported symptoms, and articles submitted by the Veteran, the examiner should opine as to: Whether it is at least as likely as not (a 50 percent probability or greater) that his lung condition, to include interstitial lung disease, chronic obstructive pulmonary disease, shortness of breath, and use of an inhaler was incurred in, aggravated by, or etiologically related to his military service, to include exposure asbestos exposure. 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. 3. Schedule a VA examination and opinion from an appropriate examiner to determine the nature and etiology of any residuals associated with the Veteran’s Simvastatin use. The claims folder (including a copy of this and previous remands) must be provided to and reviewed by the examiner as part of the examination. All indicated tests should be accomplished and all clinical findings reported in detail. The examiner must provide a diagnosis for any residuals associated with Simvastatin use. In rendering a diagnosis, the examiner must specifically consider and discuss the Veteran’s complaints of Simvastatin side-effects and his Simvastatin use, to include prior to July 2017. The examiner is asked to opine as to whether it is at least as likely as not (50 percent probability or greater) that any diagnosed residuals associated with the Veteran’s Simvastatin or other VA prescribed medication constitutes an additional disability caused or aggravated by VA medical treatment. If so, the examiner should also opine as to whether the proximate cause of such disorder was: (1) carelessness, negligence, lack of proper skill, error in judgment, or a similar instance of fault on the part of VA; or (2) an event not reasonably foreseeable. The event need not be completely unforeseeable or unimaginable but must be one that a reasonable health care provider would not have considered to be an ordinary risk of the treatment provided. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A clear rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 4. If the benefit sought on appeal remains denied, the Veteran and his representative should be provided a Supplemental State of the Case. An appropriate period of time should then be allowed for a response, before the record is returned to the Board for further review. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Javed, 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.