Citation Nr: 21028835 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 20-08 437 DATE: May 12, 2021 REMANDED Entitlement to service connection for a respiratory disorder, other than asthma, to include emphysema and chronic obstructive pulmonary disease (COPD), is remanded. Entitlement to a compensable rating prior to January 9, 2021, and in excess of 30 percent thereafter, for asthma with chronic bronchitis, is remanded. REASONS FOR REMAND The Veteran had active duty service from February 1963 to January 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In September 2020, the Veteran testified at a videoconference hearing before the undersigned Veterans law Judge. A transcript of the hearing has been associated with the claims folder. In December 2020, the Board remanded the matter for further development, and it has been returned to the Board for further appellate review. However, an additional remand is warranted before the Board can properly adjudicate the claim. 1. Entitlement to service connection for a respiratory disorder, other than asthma, to include emphysema and COPD, is remanded. Pursuant to the Board's prior remand, a new examination and medical opinion were obtained in February 2021 to determine the etiology of the Veteran's respiratory disorders, to include COPD and emphysema. However, the Board finds the opinion is inadequate. With regard to COPD, the examiner found that COPD was less likely than not related to service, and that it was not proximately caused by the Veteran's service-connected asthma. Rather, the examiner attributed COPD to the Veteran's smoking history and indicated that this finding was noted by the Veteran's VA treating physician in a September 2017 treatment record. The Board notes, however, that in the September 2017 treatment note, the physician does indicate that the Veteran has a smoking history and that he may also have COPD; however, this finding is not definitive and is not supported by medical rationale. Additionally, this finding alone does not preclude the alternative that COPD may have been aggravated by the Veteran's service-connected asthma. With respect to emphysema, the examiner did not provide an etiology opinion but merely noted that emphysema is a chronic lung disease and is a type of COPD. Further, the examiner diagnosed the Veteran with pulmonary fibrosis but found that this condition was also caused by the Veteran's smoking and was less likely than not proximately due to the Veteran's service-connected asthma with bronchitis. However, the examiner did not provide a medical rationale to support this position. When VA provides an examination or obtains an opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Therefore, remand is necessary for an adequate etiology opinion regarding the Veteran's claimed respiratory disorders. 2. Entitlement to a compensable rating prior to January 9, 2021, and in excess of 30 percent thereafter, for asthma with chronic bronchitis is remanded. With regard to a compensable rating for service-connected asthma, the Board notes that the examiner in his September 2018 respiratory examination attributed the Veteran's limitation in pulmonary function to his asthma and emphysema. In addition, a January 2019 examiner found that the Veteran's limited pulmonary function and the use of medication were due solely to the Veteran's emphysema. Therefore, the Board finds the Veteran's increased rating claim is inextricably intertwined with his service connection claim for emphysema. See Harris v. Derwinski, 1 Vet. App. 180 (1991). Therefore, remand is warranted. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate them with the claims folder. 2. Schedule the Veteran for an appropriate VA examination to determine the nature, onset, and etiology of his respiratory conditions, to include emphysema, and COPD. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including this Remand. The examiner should provide an opinion as to the following questions: (a) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's emphysema, COPD, pulmonary fibrosis, or any other identified diagnosed respiratory disorder other than service-connected asthma, manifested during active service or is otherwise related to service, to include exposure to soot and toxins from ships during service. (b) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's emphysema, COPD, pulmonary fibrosis, or any other identified respiratory disorder, was proximately caused or was aggravated by the Veteran's service-connected asthma. (Aggravation is defined as a worsening of the disability beyond natural progression). The examiner should consider as credible the Veteran's lay statements that he was exposed to air pollution in the form of soot and toxins from ships during service and that his respiratory symptoms have worsened over time. The examiner must provide a complete rationale for any opinions expressed. If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so 3. Then, readjudicate the claims. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Laffitte, 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.