Citation Nr: 21031210 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 17-22 215 DATE: May 20, 2021 REMANDED Entitlement to service connection for bronchiectasis is remanded. Entitlement to service connection for asthma is remanded. Entitlement to service connection for emphysema is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1980 to March 1986, from November 1988 to September 2005. In March 2021, he testified at a virtual hearing held before a Veterans Law Judge (VLJ). A transcript of the hearing is of record. The Veteran contends that his alpha-1 antitrypsin (A-1AT) deficiency, a genetic condition, was aggravated by his exposure to fossil fuel and burning oil wells while stationed in Kuwait and as a result he developed asthma, emphysema and bronchiectasis. In support of his claim, is medical opinion from a private physician who opined that the Veteran's preexisting A-1AT deficiency was more likely than not aggravated and/or accelerated as a result of his frequent exposure jet fumes over his 17 years in the Air Force and from burning oil well during his Gulf War service. However, he did not explain what evidence supported his conclusion or provide a rationale for the opinion. There is also no indication that the physician reviewed actual service treatment records. Also while he referenced several research studies to support his opinion, the physician did not submit the studies themselves. See medical opinion from F. Kueppers, M.D., dated March 16, 2016. However, in a March 2017 VA opinion, an examiner concluded that the Veteran's A-1AT deficiency clearly and unmistakably existed prior to service and was not aggravated beyond its natural progression by an in-service event, injury or illness. It was explained that although service records showed treatment for upper respiratory infections including flu-like symptoms, and bronchitis, these conditions improved with treatment, thus there was no evidence of aggravation of the A-1AT deficiency. The examiner also noted that the private medical opinion was speculative and there was no evidence the physician reviewed the service records. In addition, the research studies were not a conclusion of fact and were not specific to the Veteran's case. The Board notes that a congenital or hereditary disease can be service connected if it first manifests during service, or where it preexisted service but was aggravated or worsened beyond its normal progression as a result of service. VAOPGCPREC 67-90 (July 18, 1990). On the other hand, service connection may not be granted for a congenital or developmental defect, as they are not considered a disease or injury for the purpose of service connection. 38 C.F.R. §§ 3.303(c), 4.9. However, if a congenital defect is subject to a superimposed injury or disease, service connection can be warranted for the additional disability. VAOPGCPREC 82-90 (July 18, 1990). In this case, the VA examiner did not address whether the Veteran's preexisting A-1AT deficiency was a congenital disease that was aggravated or worsened beyond its normal progression as a result of service; or whether it was a congenital defect subject to a superimposed disease or injury for which service connection is warranted for the resultant disability. The Board finds that the examination report is inadequate, and an additional medical opinion is needed. Hayes v. Brown, 9 Vet. App. 67, 73 (1996). Once VA undertakes the effort to provide an examination when developing a service-connection claim, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matters are REMANDED for the following action: Schedule the Veteran for VA examination with a pulmonary specialist. The specialist should elicit from the Veteran a history regarding the onset and progression of relevant symptoms, and the examination report should include a discussion of the documented medical history. Any medically indicated testing should be accomplished. The pulmonary specialist should identify all current respiratory disorders, including asthma, bronchiectasis, and COPD. a) Based upon the examination results and the review of the record, the specialist should determine whether A-1AT deficiency is a defect or disease. [For VA adjudication purposes, "disease" generally refers to a condition considered capable of improvement or deterioration, whereas "defect" generally refers to structural or inherent abnormalities or conditions that are more or less stationary in nature.] b) If the A-1AT deficiency is considered a congenital defect, the specialist should state whether there is any evidence of superimposed disease or injury during service that to include exposure to jet fumes and/or burning oil wells resulted in additional disability. If so, identify the additional disability(ies). c) If the AAT deficiency is considered a congenital disease, the specialist should state whether manifestations of the disease preexisted the Veteran's service and if so whether the respiratory complaints/symptoms documented in service treatment records represent a worsening beyond the natural progression of the Veteran's A-1AT deficiency. d) For each disorder that is not congenital and/or did not preexist service, the specialist should state whether such disorder, including asthma bronchiectasis and COPD, at least as likely as not (50 percent or better probability) (i) began during active service, (ii) manifested within one year after discharge from service, or (iii) was noted during service with continuity of the same symptomatology since service. The specialist must explain the underlying rationale for all opinions expressed. If an opinion cannot be made without resorting to speculation, a full and complete explanation for this conclusion should be provided. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bryant, Jeana R 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.