Citation Nr: 21027676 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 16-49 996A DATE: May 6, 2021 REMANDED Entitlement to service connection for asbestosis because of asbestos exposure is remanded. Entitlement to service connection for pulmonary arterial hypertension is remanded. Entitlement to service connection for pulmonary fibrosis is remanded. Entitlement to a total disability evaluation based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1994 to January 1999. This case comes before the Board of Veterans' Appeals (Board) on appeal of August 2015 and December 2015 rating decisions. These matters were previously before the Board in October 2020, when they were remanded for a VA examination to determine whether the Veteran is diagnosed with any respiratory conditions, to include asbestosis, pulmonary arterial hypertension, and pulmonary fibrosis disorders, and to obtain an opinion as to whether such diagnosed condition is related to service. In addition, if the examiner opined that the Veteran's asbestosis was etiologically related to active service, the remand directives also required the examiner to opine if the Veteran's pulmonary arterial hypertension and pulmonary fibrosis disorders were caused or aggravated by any service-connected respiratory disabilities. The October 2020 Board remand acknowledged an October 2016 respiratory conditions (other than tuberculosis and sleep apnea) Disability Benefits Questionnaire (DBQ) provided by the Veteran's private treatment provider. The DBQ noted confirmed diagnoses of asthma, chronic obstructive pulmonary disease, asbestosis, pulmonary vascular disease, and pulmonary hypertension. The Board also notes a March 2016 private cardiac catheterization report that noted a postoperative diagnosis of pulmonary hypertension. Also of note is a March 2015 private treatment record wherein the provider noted the Veteran has slight asbestosis but no significant impairment yet. After the Board's October 2020 remand, the Veteran was afforded a VA respiratory conditions (other than tuberculosis and sleep apnea) examination. The examiner noted a review of medical records that included an October 2020 pulmonology record that discussed multiple respiratory diagnoses including asbestosis, pulmonary hypertension, chronic obstructive pulmonary disease, and asthma. However, the examiner remarked that there is insufficient evidence to warrant or confirm a diagnosis of an acute or chronic asbestosis, pulmonary fibrosis or pulmonary hypertension or its residuals. No medical opinion could be rendered as no condition was diagnosed. The examiner subsequently opined in a March 2021 VA medical opinion that there is insufficient evidence to warrant or confirm a diagnosis of an acute or chronic pulmonary condition, asbestosis, pulmonary fibrosis or pulmonary hypertension or its residuals. No medical opinion can be rendered as no condition is diagnosed. As a rationale, the examiner noted that a CT scan, pulmonary function test, and echocardiogram were all inconsistent with the claimed conditions as was stated in December 2020 examination report. The examiner concluded by noting the Veteran's symptoms are of uncertain etiology and are as likely multifactorial. The Board finds this opinion is inadequate, as it does not provide a rationale to support the finding that addresses conflicting medical evidence in the record, cited above, showing that the Veteran has been diagnosed with multiple respiratory conditions. Therefore, on remand, the claims file must be returned to the December 2020 and March 2021 examiner, or another equally qualified examiner, for the purpose of securing an addendum opinion which serves to reconcile the conflicting medical evidence of record. See Stegall v. West, 11 Vet. App. 268 (1998). The claim for TDIU remains inextricably intertwined with the claims for service connection for a respiratory condition as remanded above. A remand is thus necessary pending a resolution of the above noted service connection claims. The matters are REMANDED for the following action: After completing any needed development, return the claims file to the December 2020/March 2021 VA examiner (or, if unavailable, to another VA medical professional who has reviewed the file). A further examination may be conducted if deemed necessary. The examiner is requested to review the record, address the conflicting diagnoses noted above, and offer an opinion as to whether or not the Veteran has a diagnosis of any respiratory condition to include asbestosis, pulmonary arterial hypertension, and pulmonary fibrosis disorder. If the Veteran is indeed diagnosed with a respiratory condition at any point during the appeal (since April 2015), the examiner is requested to opine if it is at least as likely as not (i.e., a probability of approximately 50 percent or greater) that the diagnosed respiratory condition had its onset in service or is related to service. If, and only if, the examiner confirms a diagnosis of and opines that the Veteran's asbestosis is etiologically related to active service, the examiner is requested to opine whether it is at least as likely as not (50 percent or greater probability) that his pulmonary arterial hypertension and pulmonary fibrosis disorders, if diagnosed at any time during the appeal, were caused or aggravated by any respiratory disabilities of service origin. If no current diagnoses are rendered, the examiner must discuss this in the context of an October 2016 DBQ provided by the Veteran's private treatment provider (confirming diagnoses of asthma, chronic obstructive pulmonary disease, asbestosis, pulmonary vascular disease, and pulmonary hypertension). The examiner must also consider a March 2016 private cardiac catheterization report that noted a postoperative diagnosis of pulmonary hypertension. Also, the examiner should consider a March 2015 private treatment record wherein the provider noted the Veteran has slight asbestosis but no significant impairment yet. An explanation must be provided if the examiner's findings differ. It is essential the examiner discusses the underlying rationale of all opinions expressed, preferably citing to relevant evidence in the file supporting conclusions and/or medical literature or authority. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Banks, 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.