Citation Nr: 21026053 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 14-15 231A DATE: April 29, 2021 REMANDED The claim of entitlement to service connection for asthma is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1989 to December 1992, to include service in Southwest Asia from January 1991 to April 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. In November 2015, the Board remanded this case for additional development, and in March 2020, the Board denied service connection for asthma. The Veteran appealed the March 2020 Board decision to the United States Court of Appeals for Veterans Claims (Court).  In November 2020, the Court granted a Joint Motion for Remand (Joint Motion) filed by the parties to the appeal (the Veteran, through his representative, and representatives from VA General Counsel), thereby vacating the Board’s March 2020 decision and remanding the matter for readjudication.  The claim of entitlement to service connection for asthma is remanded. The Veteran asserts that his asthma is related to his military service. Specifically, the Veteran contends that, during service, he was exposed to exhaust fumes, heat, dust, lead paint, secondhand tobacco smoke, jet fuel fumes, asbestos, and other toxins, to include environmental hazards in the Southwest Asia theatre. Service treatment records are silent for any complaints or treatments of a respiratory nature with the exception of a September 1992 record noting treatment for pharyngitis. Furthermore, the Veteran’s October 1992 separation examination shows a normal chest and lungs. However, in an October 1992 report of medical history, the Veteran noted a history of “pain or pressure in the chest.” The earliest post-service evidence of respiratory complaints is dated in August 2002. Specifically, an August 2002 private record shows a history of coughing and congestion for a period of three weeks. A September 2003 private treatment record shows complaints of shortness of breath. An August 2004 medical record notes a history of chronic chest congestion with wheezing. A December 2004 VA treatment record shows “frequent episodes of bronchitis with wheezing.” At that time, the Veteran reported that he experienced these episodes about three to four months a year, used inhalers, and was given steroids as well as antibiotics. A January 2007 VA treatment record shows a diagnosis of asthma, which was stable. The Veteran submitted an initial claim for service connection for asthma in December 2009. In connection with this claim, he was afforded a VA respiratory examination in April 2013. Significantly, the examiner noted a diagnosis of asthma (with an onset in 1991) and opined that the Veteran’s asthma was at least as likely as not (50 percent or greater probability) incurred in or caused by his military service. However, the examiner then opined that it was less likely as not that the Veteran’s asthma is related to a specific exposure event experienced by the Veteran during his service in Southwest Asia as there is no evidence in the claims file that the Veteran was treated for asthma while on active duty. In November 2015, the Board remanded the claim for further development. Significantly, the Board found that an addendum opinion was necessary as the April 2013 VA examiner, in pertinent part, did not take into account the Veteran’s lay statements regarding the onset and development of symptoms. In this regard, it was noted that the Veteran has reported an onset of symptoms during service. Pursuant to the November 2015 Board remand, an addendum medical opinion was obtained in December 2015. Significantly, the December 2015 VA examiner opined that the Veteran’s asthma was less likely than not (less than 50 percent probability) incurred in or caused by his military service. As rationale for this opinion, the examiner noted that any of the listed exposures could serve as irritants to the lungs and would result in an acute response such as wheezing and shortness of breath. However, there was no documented evidence of any such occurrences. The examiner acknowledged that the Veteran had many documented visits to sick call for multiple conditions in service but none of them were respiratory in nature with the exception of pharyngitis in September 1992. The examiner further acknowledged the October 1992 report of chest pain or pressure but stated that it occurred once. The examiner noted that the Veteran reported being in good health in a June 1994 examination, did not report asthmatic symptoms until 2003, and was first diagnosed with asthma in 2006. The November 2020 Joint Motion found that the Board erred when it relied on the December 2015 VA medical opinion in denying the Veteran’s claim for service connection for asthma. Specifically, the December 2015 VA examiner’s addendum opinion that was obtained pursuant to the November 2015 remand instructions did not address the Veteran’s lay statements regarding the onset and development of symptoms. As such, the November 2020 Joint Motion found that remand was warranted for a new medical opinion that satisfies the November 2015 Board remand instructions. Such medical opinion should be obtained on remand. The matter is REMANDED for the following action: Obtain an addendum medical opinion regarding the etiology of the Veteran’s asthma. No additional examination is necessary unless the examiner deems otherwise. The examiner should opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s asthma is related to the Veteran’s military service. In answering this question, please consider and address the Veteran’s lay statements regarding the onset and development of symptoms. Specifically, during the April 2013 VA respiratory examination, the Veteran reported that he was treated for shortness of breath on several occasions in service (for which he was prescribed an Albuterol inhaler) and that these breathing problems continued after service when he was eventually diagnosed with asthma. See VBMS, document labeled VA Examination, receipt date 4/22/13, page 3. Also, in an August 2018 statement, the Veteran wrote that he experienced asthma/bronchial issues while in service which have continued to the present. See VBMS, document labeled VA 21-4138 Statement In Support of Claim, receipt date 8/28/18, page 2. (Continued on the next page)   If unable to provide a medical opinion, please provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. The examiner is asked to provide the underlying reasons for all opinions expressed, and is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. L.M. YASUI Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board April Maddox, 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.