Citation Nr: 21028632 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 17-13 801 DATE: May 11, 2021 REMANDED Entitlement to service connection for the Veteran's cause of death is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Navy from April 1952 to November 1955. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran died in June 2016, and his surviving spouse is the Appellant in this case. The Appellant testified before the undersigned Veterans Law Judge (VLJ) at a hearing in April 2019. This case was previously before the Board in March 2020, when it was remanded for development. The case has been returned to the Board for further appellate review. Entitlement to service connection for the Veteran's cause of death is remanded. As part of the development directed by the Board, the RO obtained an opinion from a VA pulmonary specialist in November 2020. Unfortunately, this opinion does not adequately address the Appellant's contentions regarding the cause of death of the Veteran, and another remand is necessary to address the following deficiencies. Regarding COPD, the examiner stated that, in the absence of a diagnosis of asbestosis, COPD is not known to be caused by asbestos exposure alone. The examiner opined that the Veteran did not have a diagnosis of asbestosis because his presumed exposure was too short to result in the development of any asbestos-related lung disease, including asbestosis. However, the examiner later appears to state that asbestosis requires a greater exposure dose than any other asbestos-related lung disease. The examiner noted a study indicating no appreciable increase in risk of cancers of the lung, pleura, or gastrointestinal tract in workers employed at an asbestos cement factory for six months. The examiner also noted a relationship between development of asbestos-related lung disease and cumulative exposure over time, but did not discuss what level of risk might be expected from the Veteran's in-service asbestos exposures at the Naval Gun Factory, where he was stationed for approximately one year, and aboard the USNS Gen. L. Eltinge, where he was stationed for approximately seven to ten months. Rather, the examiner concluded that any exposure during the Veteran's three year and seven month active duty service was too short to result in asbestos-related lung disease, without explaining how this length of exposure compared to the noted study, where the length of exposure was six months. The Board notes the examiner also appeared to conclude that the asbestos the Veteran was exposed to during service was of the type that poses a much lower risk of disease, without explaining the basis for this assumption. Regarding lung cancer, the examiner concluded that this was more likely than not caused by the Veteran's history of cigarette smoking, but did not discuss the significance, if any, of the Appellant's report that the Veteran stopped smoking at age 30 and was not diagnosed with lung cancer until age 48. Finally, regarding cardiovascular disease, the examiner discussed the Veteran's coronary artery disease and valvular heart disease, which followed radiation treatment for lung cancer. The examiner opined that the radiation treatment did not cause the cardiovascular disease, and provided a sufficient rationale for this conclusion. However, the examiner did not discuss whether the cardiovascular disease was at least as likely as not caused by the in-service asbestos exposure. For these reasons, the November 2020 VA opinion is inadequate, and another remand is necessary to obtain an opinion that addresses the relationship between the Veteran's in-service asbestos exposure and the disabilities that caused or contributed to his death. The matter is REMANDED for the following action: Forward the claims file to an appropriate clinician to provide an opinion whether the respiratory and/or cardiovascular issues that caused and/or contributed to the Veteran's death were at least as likely as not (50 percent or greater probability) the result of in-service asbestos exposure at the Naval Gun Factory and aboard the USNS Gen. L. Eltinge. The examiner must review the claims file, to include lay statements made by the Appellant and the body of this Remand Order, prior to preparing the requested opinions. The examiner should provide an opinion for EACH respiratory or cardiovascular disease found to have caused or contributed to the Veteran's death, including but not limited to COPD, aortic and mitral valve replacement, and coronary artery disease. In providing the requested opinions, the examiner should specifically address the length and nature of the Veteran's presumed asbestos exposure; the Veteran's history of smoking and quitting at age 30; as well as the relationships between asbestos exposure and any relevant disability. If the examiner finds that a relevant disability was caused in part by asbestos exposure, the examiner should discuss the likelihood that, but for the asbestos exposure, the Veteran would have developed that disability. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Josey, 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.