Citation Nr: 21039793
Decision Date: 07/01/21	Archive Date: 07/01/21

DOCKET NO. 17-21 751
DATE: July 1, 2021

REMANDED

Entitlement to service connection for chronic obstructive pulmonary disease as a result of exposure to herbicides is remanded.

REASONS FOR REMAND

The Veteran served honorably with the United States Army from October 1967 to May 1969.  He died in September 2018.  The appellant is his surviving spouse and has been substituted for the Veteran for purposes of processing the claim to completion. 

This matter comes before the Board of Veterans' Appeals (Board) from a rating decision from a Department of Veterans Affairs (VA) Regional Office (RO).  A Board hearing was held in February 2020.  A transcript is of record.

This matter was remanded for further development in June 2020. The purpose of the remand was to obtain an addendum opinion to ascertain whether the Veteran's COPD was aggravated by his service-connected posttraumatic stress disorder (PTSD). In December 2020, a VA examiner opined that the Veteran's COPD was not aggravated by the Veteran's PTSD as medical literature did not support such a relationship and the Veteran's use of oxygen was due to the severity of his disease. In rendering this opinion, the examiner failed to address treatment medical records which the Veteran asserted supported an increase in severity of his COPD. The examiner also failed to address the appellant's contentions that the Veteran suffered from PTSD related panic attacks which worsened his breathing and in turn his oxygen use. 

Recognizing the potential shortfalls of the December 2010 opinion, an addendum was obtained in February 2021. The examiner opined against the Veteran's claim but in so doing confused the issues. Specifically, the examiner's rationale and opinion were predicated on the Veteran's COPD not aggravating his PTSD, instead of opining whether his COPD was aggravated by his PTSD.  This error renders the opinion inadequate. A remand remains necessary to obtain an adequate addendum opinion.

The matter is REMANDED for the following action:

Obtain a VA opinion from an appropriate clinician to determine the nature and etiology of the Veteran's COPD. After reviewing the claims file, the examiner should provide an opinion as to whether it is at least likely as not that the Veteran's COPD: 

(*) was proximately due to the Veteran's service-connected PTSD. 

(*) underwent any incremental increase in disability, regardless of its permanence, due to the service-connected PTSD. 

The term "incremental increase in disability" means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any "incremental increase in disability" need not be permanent. 

In rendering this determination, the examiner must:

(*) address the contentions raised on Board Hearing. Specifically, the appellant's assertions of the Veteran experiencing worsening PTSD which matched his increased use of oxygen and albuterol/medication to treat his COPD in May 2014. Worsening symptoms included increased panic attacks and hypervigilance. Note, the appellant asserts that when neighbors visited their home, the Veteran would become overwhelmed with anger/irritability and required more oxygen. The appellant also reported that the Veteran generally had a "short fuse" and was therefore prone to angry outburst and exacerbation of his PTSD symptoms.  PTSD examination in October 2017 confirms irritability and angry outbursts are associated with his PTSD

(*) address the findings of the December 2015 VA examiner that the Veteran's COPD (with required continuous oxygen infusion) was a medical diagnosis relevant to the understanding of management the Veteran's PTSD.  Such a finding is suggestive that the two conditions might indeed be interrelated.

 

 

MICHAEL A. HERMAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. L. Burroughs, 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.