Citation Nr: 21032050 Decision Date: 05/25/21 Archive Date: 05/25/21 DOCKET NO. 17-50 645 DATE: May 25, 2021 REMANDED Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1969 to December 1971. These matters are before the Board of Veterans' Appeals (Board) on appeal from a January 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at an August 2020 hearing and a transcript is associated with the claims file. See August 2020 Hearing Transcript. Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is remanded. The Veteran contends that his COPD is the result of his service-connected adenocarcinoma. He testified that he experienced an onset of shortness of breath after surgery for his service-connected adenocarcinoma and that his physicians told him his breathing problems were related to this disability. The Veteran's representative submitted an April 2021 brief arguing that an internet medical article indicates 40 to 70 percent of patients that have lung cancer also have COPD even though they never smoked a cigarette. See April 2021 Appellate Brief. The record reflects a diagnosis of chronic obstructive pulmonary disease (COPD). VA examination in December 2019 shows the Veteran has history of COPD, adenocarcinoma of the lung in 2009, and squamous cell carcinoma of the lung in 2019. See December 2019 Examination. Additional development is needed before the Board can adjudicate the Veteran's claim. VA's duty to assist includes a duty to provide a medical examination or obtain a medical opinion where it is deemed necessary to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). In addition, once VA undertakes the effort to provide an examination when developing a service connection claim, even if not statutorily obligated to do so, 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). As explained below, the Board finds that an addendum opinion is required concerning the etiology of the Veteran's COPD. The Veteran was afforded a VA examination in September 2016 and a VA addendum opinion was provided in October 2016. After reviewing the claims file and examining the Veteran, the examiner found that the Veteran had COPD. The examiner opined that the Veteran's COPD was more likely than not due to his history of smoking. However, the examiner did not provide a rationale for their conclusion. In October 2020, the Board remanded this claim for further development, to include obtaining a medical opinion to address the Veteran's contentions that his current COPD disability was caused or aggravated by his service-connected lung cancer. VA obtained a February 2021 medical opinion. As to causation, in a February 2021 opinion, a VA examiner opined that it was more likely than not that the Veteran's COPD is due to his significant smoking history. The examiner opined that the Veteran's smoking history places him at a high risk for developing COPD and that this was the most likely etiology of his COPD, and not his service-connected lung cancer. See February 2021 Opinion. As to aggravation, the examiner opined that COPD and lung cancer are two different conditions and that lung cancer does not cause obstructive airway disease leading to COPD. The examiner found that there was no baseline of COPD that could be determined based on a lack of medical evidence to show initial severity of COPD, but that regardless of baseline, the Veteran's COPD was not aggravated beyond a normal progression of the disease by service connected lung cancer. Here, the examiner's only rationale supporting their opinion was that COPD was an obstructive airway disease and lung cancer was not. This statement does not provide a reasoned medical explanation regarding the Veteran's asserted relationship between COPD and his service-connected lung cancer. In particular, the rationale indicates that lung cancer does not cause COPD while concluding the COPD was not aggravated by lung cancer. While lung cancer may not be an obstructive airway disease that leads to the development of COPD, the examiner's rationale does not inform the Board as to how this fact precludes aggravation of COPD beyond the normal progression of the disease. Although the examiner finds that smoking tobacco was the most likely etiology of the Veteran's COPD, the medical rationale supporting the examiner's opinion regarding aggravation of COPD by lung cancer is inadequate for adjudication purposes. The Board finds that the February 2021 opinion is inadequate because it provides a conclusion without a sufficiently reasoned explanation to support it. Therefore, remand is necessary in order to obtain an addendum opinion. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file updated VA treatment records. 2. Forward the claims file, to include a copy of this remand, for an addendum opinion as to the nature and etiology of the Veteran's COPD. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. After reviewing the claims file, the reviewing clinician should provide an opinion on the following questions: Is it at least as likely as not (50 percent probability or greater) that the Veteran's COPD is aggravated beyond the normal progression of the disease by lung adenocarcinoma? The examiner must address the April 2021 appellate brief regarding an internet medical article indicating 40 to 70 percent of patients that have lung cancer also have COPD even though they never smoked a cigarette and how this evidence applies to the Veteran's medical history and claim for COPD as secondary to lung cancer. The examiner should also consider the Veteran's post-service treatment records and his lay statements reflected in the claims file. The examiner should provide a complete rationale for any opinion provided, explaining how medical knowledge and the Veteran's medical history support any conclusions reached. If an opinion cannot be provided without additional examination of the Veteran, an examination should be afforded. If the examiner cannot provide any requested opinion without resorting to speculation, they should expressly indicate this and provide a supporting rationale (Continued on the next page) as to why an opinion cannot be made without resorting to speculation. J. B. FREEMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Trickey 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.