Citation Nr: 21032867 Decision Date: 05/28/21 Archive Date: 05/28/21 DOCKET NO. 18-45 387 DATE: May 28, 2021 REMANDED Entitlement to service connection for chronic obstructive pulmonary disease (COPD, claimed as chronic respiratory disease) is remanded. Entitlement to service connection for basilar scarring of the lungs is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1957 to November 1960 and from October 1961 to August 1962. He is a recipient of the Korean Defense Service Medal. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for chronic obstructive pulmonary disease (COPD) , claimed as chronic respiratory disease is remanded. 2. Entitlement to service connection for basilar scarring of the lungs is remanded. The Veteran asserts he has a respiratory disability due to military service. At the Veteran's July 2016 VA examination, an examiner provided a diagnosis of COPD and also noted an October 2015 chest X-ray revealed minimal basilar scar. The examiner opined that the claimed respiratory condition is not related to service. During the April 2021 Board hearing, the Veteran asserted that he had pneumonia and/or symptoms of pneumonia during service, which included deployment to Korea. He asserted that in addition to having these symptoms, he had exposure to diesel fumes in his living quarters in Korea. Specifically, the Veteran testified that he had exposure to diesel gas within the tent he occupied. He explained that in order to create heat, the soldiers would use potbelly stoves inside of their tents. The potbelly stoves had a smokestack that would exhaust fumes through the top of the tent. However, when the wind would blow, the exhaust would come back into the tent. He also testified that he and others also kept the large 55-gallon drums containing diesel gas inside of their tents in order to keep the gas in a liquid state. In April 2021, the Veteran submitted an article from the U.S. Army Public Health Command (USAPHC) regarding health implications due to diesel and jet propellant- 8 (JP-8) exhaust which among other things, mentioned that persons with existing respiratory conditions; routine and/or higher exposures; or who smoke had potentially higher risk of effects. At the hearing before the undersigned, the Veteran also asserted that his current basilar lung scar is a result of pneumonia during service, to include as a result of the multiple x-rays for treatment/observation, and/or his exposure to diesel fumes. He contends that he developed scarring of the lungs from the multiple X-ray exposures of his chest for pneumonia treatment and monitoring. The Board notes that service treatment records indeed demonstrate multiple x-rays were taken of the Veteran's chest within a seven-day period in January, February, and April 1958. The July 2016 VA examiner's rationale noted that basilar scarring is multifactorial in nature and saying it was due to the Veteran's pneumonia in-service would be mere speculation. However, the examiner did not consider whether the Veteran's exposure to radiation from the multiple X-rays taken during service could have caused the basilar scarring, which the Veteran reports was first identified sometime in the early 1970s. As the VA opinion does not reflect consideration of whether the reported in-service exposure to diesel fumes caused the current COPD or basilar lung scar, an addendum opinion is needed. The examiner is also asked to consider whether there is any causal relationship between the multiple X-rays taken during service and the basilar lung scar. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran's COPD and basilar lung scar. The option for an in-person examination is left to the examiner's discretion. The examiner must review the claims file, to include a copy of this Remand. The examiner is asked to provide a response to the following: a) Is the Veteran's COPD at least as likely as not related to service, including inhaling diesel fumes inside his living quarters as summarized above? b) Is the Veteran's basilar lung scar at least as likely as not related to service, including as a result of undergoing multiple chest X-rays in service and/or the reported exposure to diesel fumes? The examiner must provide a rationale to support the opinions. In doing so, the examiner is asked to review the USAPHC article that the Veteran has provided and to consider the Veteran's April 2021 hearing testimony, which is briefly summarized above, about living in tents with use of potbelly stoves as a heat source and storing 55-gallon drums with diesel gas inside. The examiner is further advised that service treatment records show two to three X-rays were performed within a seven-day period in January, February, and April 1958. D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Telamour, 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.