Citation Nr: 21026775 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 13-17 020 DATE: May 4, 2021 REMANDED Entitlement for service connection for asthma is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from April 1963 to April 1974. This matter comes before the Board of Veterans Appeals (Board) on appeal from a rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In July 2017, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the record. The Board remanded the case for further development in November 2017, February 2019, and August 2020. The case has since been returned to the Board for appellate review. However, the Board finds that the RO did not substantially comply with the directives set forth in a previous remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The case has been advanced on the docket pursuant to 38 C.F.R. § 20.900(c). Entitlement for service connection for asthma is remanded. Although the Board regrets the additional delay, further development is required before a decision may be made on the merits of the issue on appeal. The Board remanded the claim for additional development in August 2020. Specifically, the Board directed the RO to obtain an addendum opinion regarding the nature and etiology of the Veteran's asthma, regarding exposure to asbestos while in service, including contaminated water while stationed at Camp Lejeune; and the Veteran's lay statements that these exposures led to his current asthma condition. In the August 2020 VA opinion, the examiner opined the Veteran's asthma was less likely than not caused by his conceded in-service asbestos exposure. However, the rationale provided was that a relationship between asbestos exposure and development of asthma remains hypothetical, quoting medical literature: "Asbestos exposure may cause airway obstruction by inducing bronchial asthma, even if confirmed asbestosis is absent. To clarify this hypothesis, further investigation will be needed." The Board finds this rationale to be conclusory and inadequate for purposes of adjudication. Furthermore, the examiner did not address the Veteran's lay statements regarding breathing in paint fumes with limited ventilation, sleeping under asbestos pipes, and an upper respiratory infection while in service. In the November 2020 VA opinion by a Camp Lejeune Contaminated Water (CLCW) expert, the examiner opined the Veteran's asthma was less likely than not caused by the Veteran's exposure to CLCW. The opinion was supported by multiple medical studies and literature stating there is some data, though limited, to support an association between known CLCW toxins and asthma. While the examiner provided a thorough explanation of current medical research on the subject, he did not address the specific lay statements listed in the August 2020 remand in proffering this opinion. Based on the above, the Board finds that an additional opinion is warranted. This matter is REMANDED for the following action: 1. Obtain an addendum opinion as to the nature and etiology of the Veteran's asthma. The examiner must review the claims file and provide an opinion addressing the following: (a.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran' asthma is due to or the result of his in-service exposure to asbestos. (b.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's asthma is due to or the result of the Veteran's in-service exposure to contaminated water at Camp Lejeune. For both contentions, the examiner must address the Veteran's lay statements, including: (a.) he constantly breathed in paint fumes, dust fumes, chipping paint, and sand blasting in isolated rooms with limited ventilation; (b.) he slept underneath insulated asbestos pipes while onboard the USS Shangri-La; and (c.) he had an upper respiratory infection in 1974 and self-medicated since his discharge. The Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a basis to doubt any history or report provided by the Veteran, the examiner should provide a fully reasoned explanation. The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find favor of conclusion as it is to find against it. 2. After completing the above actions and any other development as may be indicated as a consequence of the actions taken in the preceding paragraphs, the case must be readjudicated by the RO on the basis of additional evidence. If the benefit sought is not granted, the Veteran and his representative should be furnished a Supplemental Statement of the Case and be afforded a reasonable opportunity to respond 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 C. Townsend, 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.