Citation Nr: 21028710 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 20-04 228A DATE: May 11, 2021 REMANDED Entitlement to service connection for a lung disorder (claimed as chronic obstructive pulmonary disease (COPD)) is remanded. Entitlement to service connection for a psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from August 1956 to September 1959. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2017 rating decision by the Regional Office (RO). In March 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing has been associated with the record. 1. Entitlement to service connection for a lung disorder is remanded. The Veteran asserts he was exposed to asbestos in service and has submitted an article about the USS Randolph, the ship that he served aboard while in the Navy. The article indicates that Veterans who served aboard the USS Randolph were likely exposed to asbestos during their time at sea. Moreover, the article states that Veterans who worked in the engine and boiler spaces were especially at risk for asbestos exposure as those areas typically held the highest concentration of asbestos. See Correspondence received March 2018. The Veteran also asserts he has a lung disorder as a result of his in-service exposure to asbestos. The question for the Board is whether the Veteran has a lung disorder that is either caused or aggravated by his in-service asbestos exposure. Importantly, although the issue on appeal was claimed and developed as one for service connection for COPD, it has been expanded to entitlement to service connection for a lung disorder. Such is appropriate given the nature of the claim and the evidence in the record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). In particular, the Veteran was provided a VA examination in June 2018. At that time, the examiner diagnosed COPD and opined that the condition was less likely than not related to his in-service exposure to asbestos. The examiner explained for rationale that the Veteran did not have a diagnosis of asbestosis. Furthermore, the examiner noted that COPD had a clear and distinctive diagnosis and treatment. Ultimately, the examiner held that there was no nexus indicating that exposure to asbestos causes COPD. However, in addition to her opinion, the examiner included a peer-reviewed article entitled, "Asbestos-Related Pleuropulmonary Disease." The article indicates that the spectrum of pleuropulmonary disorders associated with asbestos exposure includes asbestosis, pleural disease (benign asbestos effusion, focal and diffuse benign pleural plaques), and malignancies. The article characterized asbestosis as slowly progressive, diffuse pulmonary fibrosis caused by the inhalation of asbestos fibers. Furthermore, it indicated that a chest radiograph in individuals with asbestosis usually reveals small bilateral parenchymal opacities with multinodular or reticular pattern, often associated with pleural abnormalities. See June 2018 VA Examination. A review of the record shows that in November 2017, the Veteran underwent a computerized tomography (CT) scan of his chest. The impression from that diagnostic test was that the Veteran had mild emphysema and bilateral peripheral interstitial opacities, nonspecific. See Private Treatment Record received February 2018. More recent private treatment records show that in March 2021, results of a CT scan of the Veteran's chest revealed pleural parenchymal scarring and fibrosis with groundglass and semisolid opacities. Additionally, the treatment record indicates that the Veteran has a nodularity in his left lung base and the private physician indicated the Veteran had probable asbestos related lung disease and pleural thickening. See Private Treatment Record received April 2021. In light of the foregoing evidence an addendum medical opinion is necessary to clarify whether the Veteran has an asbestos-related lung disorder. Additionally, with respect to the diagnosis of COPD, in March 2021, the Veteran submitted a second article from the Mayo Clinic, which states "asbestos exposure does not directly cause COPD, but it can increase a person's risk of developing the condition." See Correspondence received March 2021. Accordingly, the addendum medical opinion must also consider the contents of this article and address whether the Veteran's in-service exposure to asbestos may have contributed to his COPD. 2. Entitlement to service connection for a psychiatric disorder is remanded. The Veteran's claim for service connection for an acquired psychiatric disorder is inextricably intertwined with his claim for service connection for COPD, as it is claimed as secondary. Accordingly, remand for this inextricably intertwined claim is also required. The matters are REMANDED for the following actions: 1. With the Veteran's assistance, make reasonable efforts to obtain any outstanding and relevant treatment records, to include any VA and private treatment records. 2. Following the above development, obtain a VA medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran's lung disorder. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner. If it is determined that the requested opinions may not be provided without an examination, such should be arranged. a) The examiner should identify any current diagnoses for a lung disorder present during the course of the claim. b) The examiner should determine whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's lung disorder is etiologically related to his active duty service, to include exposure to asbestos. In rendering the above opinion, the examiner should discuss the article submitted in March 2021, which, in pertinent part, indicates that exposure to asbestos can increase an individual's risk of developing COPD. The examiner must also address the Veteran's February 2018 private treatment record showing that he has a diagnosis of mild emphysema, and his March 2021 private treatment record that indicates that the Veteran has probable asbestosis related lung disease and pleural thickening, pleural parenchymal scarring and fibrosis with groundglass and semisolid opacities and, a nodularity in the left lung base. 3. If, and only if, the Veteran's lung disorder is found to be etiologically related to service, an examination should be arranged for an examiner to opine as to whether it is as least as likely as not (i.e., 50 percent probability or greater) that the Veteran has a diagnosed acquired psychiatric disorder, to include depression and anxiety, that is caused or aggravated by his lung disorder. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Talton, John H. 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.