Citation Nr: 21028130 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 17-31 332 DATE: May 10, 2021 REMANDED Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is remanded. Entitlement to an initial rating for gastroesophageal reflux disease (GERD) in excess of 10 percent prior to February 24, 2017 and in excess of 0 percent thereafter is remanded. Entitlement to an initial rating for esophagitis in excess of 50 percent prior to February 24, 2017 and in excess of 0 percent thereafter is remanded. Entitlement to an initial rating for asthma in excess of 30 percent prior to February 24, 2017 and in excess of 10 percent thereafter is remanded. REASONS FOR REMAND The Veteran had active service in the Army from September 1982 to March 1989, March 2003 to August 2004, August 2005 to November 2006, and April to December 2008. The appeal originates from December 2015 and April 2017 decisions of a Department of Veterans Affairs (VA) Regional Office. The Veteran appeared for a hearing before the undersigned in July 2020. 1. Entitlement to service connection for COPD is remanded. The Veteran contends that he has COPD which was diagnosed in service (around 2004) and resulted from in-service exposure to burn pits, smoke, dust, and other substances. See June 2015 Statement. The record presents some ambiguity as to whether he has a confirmed diagnosis of COPD. Service treatment records do not appear to reflect such a diagnosis. VA treatment records seem to show that COPD was assessed in 2014 based on the Veteran's self-reported history, whereas pulmonary function and CT tests in 2015 did not find COPD. The July 2015 VA examination indicates a diagnosis of COPD in 2004, which appears to be supported by a December 2015 VA opinion. However, the most recent examination in February 2017 contained no diagnosis of a respiratory condition. In a March 2017 addendum opinion, the examiner was unable to opine on COPD without resort to speculation and suggested that a pulmonologist may offer clarity on the matter. Notably, a July 2020 opinion from the Veteran's physician linked his "respiratory symptoms" to in-service exposures, but the physician also expressed uncertainty about the nature of the respiratory symptoms, including whether they were actually caused by GERD. An addendum opinion from a pulmonologist or similar specialist would be of assistance in clarifying whether the Veteran has a diagnosis of COPD related to service. 2. Entitlement to an initial rating for GERD in excess of 10 percent prior to February 24, 2017 and in excess of 0 percent thereafter is remanded. 3. Entitlement to an initial rating for esophagitis in excess of 50 percent prior to February 24, 2017 and in excess of 0 percent thereafter is remanded. 4. Entitlement to an initial rating for asthma in excess of 30 percent prior to February 24, 2017 and in excess of 10 percent thereafter is remanded. At the August 2020 hearing, the Veteran testified that there had been a worsening of his disabilities since his last examinations in February 2017. He described pyrosis, nausea, and vomiting due to GERD, difficulty swallowing and near-death episodes of choking from esophagitis, and using excessive albuterol and a nebulizer. As there appears to be evidence of worsening of the Veteran's disabilities, he should be afforded new examinations. The matters are REMANDED for the following action: 1. Schedule the Veteran for a respiratory examination with a pulmonologist. The examiner is asked to address the following: a. Specify whether the Veteran has had a clinical diagnosis of COPD at any time during the appeal. If a diagnosis of COPD is not made, reconcile the finding with the evidence, including the Veteran's assertion that he was diagnosed with COPD proximate to service and the notations of COPD in the record. b. If a diagnosis of COPD is made, is it at least as likely as not that the disorder had its onset in or is otherwise etiologically related to active service? The examiner should address the in-service respiratory symptoms and the lay statements and articles submitted by the Veteran and others regarding environmental exposures such as burn pits, smoke, dust, and other substances. The examiner should also address the significance, if any, of the Veteran's history of tobacco abuse and employment at a casino where he was noted to have daily secondhand smoke exposure. c. The examiner should delineate the symptoms of any diagnosed respiratory disorder, including asthma and/or COPD. If the examiner is unable to do so without resort to speculation, provide an explanation as to why. 2. Schedule the Veteran for an examination to evaluate the current severity of his GERD. The examiner should provide a retrospective opinion on whether the Veteran has had symptoms of pain, vomiting, material weight loss, hematemesis, melena, anemia, dysphagia, pyrosis, regurgitation, or substernal or arm or shoulder pain, as well as whether his GERD symptoms have resulted in considerable or severe impairment of health. 3. Schedule the Veteran for an examination to evaluate the current severity of his esophagitis. The examiner should provide a retrospective opinion on whether the Veteran has had stricture permitting passage of only liquids with marked impairment of general health, severe stricture permitting liquids only, or moderate stricture. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Alhinnawi, Mohammad 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.