Citation Nr: 21026637 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 16-19 641A DATE: May 3, 2021 REMANDED Entitlement to service connection for lung cancer, non-small cell carcinoma, is remanded. REASONS FOR REMAND The Veteran served honorably on active duty from September 1945 to June 1946 and from December 1950 to October 1952. Unfortunately, the Veteran passed away in April 2016 during the pendency of this appeal. The Veteran's surviving spouse has been substituted as the Appellant by the Agency of Original Jurisdiction (AOJ) in an August 2017 decision. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). The Appellant testified at a virtual Board hearing in August 2020. A transcript of this hearing has been associated with the claims file. Entitlement to service connection for lung cancer, non-small cell carcinoma, is remanded. The Veteran asserted that his lung cancer was related to asbestos exposure that occurred during his active duty service in the Navy. The record reflects that he was diagnosed with non-small cell lung carcinoma in 2005. Further, the Veteran died in April 2016 and his immediate cause of death was listed as pulmonary asbestosis secondary to asbestos exposure. The VA medical opinion obtained in October 2012 indicates that it was less likely than not that the Veteran's exposure to asbestos during service was the cause of the Veteran's lung cancer, based almost entirely on the Veteran's history of smoking. The VA clinician indicated that the Veteran "has a 40-year history of smoking approximately one pack of cigarettes per day." However, during the Board hearing in August 2020, the Appellant testified that the Veteran had been a non-smoker for over 20 years at the time of his death. Further, private treatment records indicate the Veteran quit smoking in the late 1990s, specifically, 1997, and VA treatment records indicated that he had smoked for 35 years prior. The Appellant also submitted an article from a medical journal of the American Society for Clinical Pathology entitled 'Criteria for Attributing Lung Cancer to Asbestos Exposure', which discusses the possibility of asbestosis establishing a link between a lung cancer and exposure to asbestos, even when the patient was also a tobacco smoker. See May 2016 document labeled Correspondence. Notably, as mentioned above, the cause of death listed on the Veteran's death certificate was pulmonary asbestosis. Further, the Veteran submitted a letter from his private treatment provider dated October 2011, wherein the private treatment provider asserted that the Veteran's adenocarcinoma and bronchoalveolar carcinoma "certainly could have a correlation with his previous asbestos exposure while on Naval duty. The patient also smoked cigarettes, and with the two combined, increased his risk of development of malignancy almost six-fold." While this tends to add support service connection, it is too speculative to support a full grant. See Warren v. Brown, 6 Vet. App. 4, 6 (1993) (finding physician's statement that the Veteran's disorder "could have been" caused by active service was too speculative). In light of the above discrepancies regarding the Veteran's history of tobacco use, as well as the medical literature submitted by the Appellant, and the indication from the Veteran's private treatment provider that the Veteran's asbestos exposure could have resulted in his lung cancer, the Board finds that a remand is necessary to obtain an addendum opinion which clarifies inconsistencies and adequately addresses all of the contentions raised by the Appellant regarding the etiology of the Veteran's lung cancer, including whether the Veteran's lung cancer was a result of his asbestosis in light of the medical literature submitted. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from a qualified VA clinician. The entire claims file and a copy of this remand must be made available to the examiner for review. The examiner is asked to provide an opinion regarding whether it is at least as likely as not (50 percent probability or greater) that the Veteran's lung cancer was etiologically related to his conceded in-service exposure to asbestos. In providing this opinion, the examiner must address the specific nature of the Veteran's tobacco use that is, that while he had been a heavy smoker, the Veteran had been quit some 20 to 35 years prior to his death.. The examiner must also specifically address the medical literature submitted by the Appellant, which documents a link between asbestosis and lung cancer, even in tobacco users, in relation to the Veteran's case. See VBMS, document labeled Correspondence, receipt date 05/27/2016. 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. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. M. Lowman, 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.