Citation Nr: 21029910 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 17-61 320 DATE: May 17, 2021 REMANDED Entitlement to service connection for a lung disorder, to include asbestosis, asthma, and chronic obstructive pulmonary disease (COPD), is remanded. Entitlement to service connection for a heart disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1957 to April 1959. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in July 2017 by a Department of Veterans Affairs (VA) Regional Office. In February 2019, the Board remanded the case for additional development and it now returns for further appellate review. Entitlement to service connection for a lung disorder, to include asbestosis, asthma, and COPD. The Veteran contends he was exposed to asbestos in his office while on active service, and that his COPD is related to his asbestosis. See November 2017 VA Form 9 and September 2017 VA Form 21-686c. The Board observes that the Veteran's VA and private treatment records document a diagnosis of COPD, asthma, and asbestosis. Additionally, the Board observes that an October 2017 VA primary care note indicates the Veteran reported remote exposure to asbestos while in military service. In this regard, the Veteran's DD-214 reflects his military occupational specialty (MOS) was personnel clerk, which is not indicated to have exposure to asbestos in-service. However, at his September 2020 VA examination, the examiner stated, "there is no doubt he was exposed to asbestos... ." At his December 2019 VA examination, the VA examiner stated it is at least as likely as not the Veteran's asbestos [sic] is incurred in or due to service. As rationale, the examiner stated that asbestos exposure has been confirmed by Veteran multiple occasions. Asbestos was a very common building material at the time the Veteran served. In regard to the Veteran's COPD, the examiner stated such disorder was not caused or aggravated beyond its natural progression by asbestosis or vice versa. COPD is an obstructive disease, and asbestosis is interstitial disease, and as such the two have completely different disease processes. The cause of COPD is unknown. The Board finds this opinion inadequate to decide the claim. First, while the examiner states the two disorders may have different disease processes, and thus, asbestosis is not shown to cause COPD, the examiner also states the cause of COPD is unknown. Secondly, the examiner does not offer a rationale as to why asbestosis, known to weaken lungs, does not aggravate COPD. Further, the examiner appears to rely on the Veteran's oral history rather than medical record to determine whether he has an actual diagnosis of asbestosis. Thus, a remand is necessary in order to obtain an addendum opinion addressing such matters. In the September 2020 addendum opinion, the VA examiner stated that asthma and COPD are not conditions related to asbestos exposure. As rationale, the examiner stated that COPD is a lung disease that is due to smoking and causes an obstruction in the airway reducing airflow. Asbestosis, an interstitial lung condition, is scarring of the lungs causing plaques that lead to cancer, and there is no evidence the Veteran has the latter condition. In this regard, the Board notes in both private and VA treatment records reflect that the Veteran denies having ever been a smoker. Moreover, as the examiner did not provide a rationale for his opinion that the Veteran's COPD was less likely than not related to his conceded in-service exposure to asbestos in that he only noted that smoking was the most common cause of such disease, the Board finds that a remand is necessary in order to obtain an addendum opinion addressing such matter. Further, although mentioning asthma, the examiner did not provide an opinion as to the etiology of such disorder. Moreover, in November 2020, the Veteran submitted a letter from his private physician, Dr. I.A. that stated that the Veteran has a documented history of asbestosis. Thus, a remand is likewise necessary in order to obtain an addendum opinion addressing such matters. Heart Disorder The Board finds that a remand for the claim for service connection for a heart disorder is also warranted as the issue appears to be potentially intertwined with the claim for asbestosis. In this regard, a December 2019 VA medical opinion indicated that the Veteran's CAD was at least as likely than not aggravated beyond its natural progression by asbestosis, but not by his COPD. As such, a remand for the Veteran's heart disorder claim is warranted. See Harris v. Derwinski, 1 Vet. App. 180, 183 (issues are "inextricably intertwined" when a decision on one issue would have a "significant impact" on a Veteran's claim for the second issue). The matters are REMANDED for the following action: 1. Forward the record, to include a copy of this Remand, to an appropriate VA clinician for an addendum opinion. After a review of the record, the clinician is asked to address the following inquiries: (a.) List all current lung or respiratory diagnoses pertaining to he Veteran. Specifically indicate whether the Veteran has a diagnosis of asbestosis. (b.) For each diagnosis, state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's lung disorder is related to his conceded in-service exposure to asbestos. (c.) If the Veteran is found to have a diagnosis of asbestosis, is it at least likely as not (50 percent or greater probability) that COPD or asthma is caused or aggravated by asbestosis? (d.) If service connection for a lung disorder is granted, obtain a medical opinion regarding whether the Veteran's heart disorder is either caused or aggravated by the service-connected lung disability. Please note that for secondary service connection, "aggravation" need not be permanent in nature. See Ward v. Wilkie, 31 Vet. App. 233, 241-42 (2019). (e.) A rationale for any opinion offered should be provided. 2. Then, readjudicate the claims on appeal. Romina A. Casadei Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. M. Kelly, 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.