Citation Nr: 21040388 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 18-26 021 DATE: July 3, 2021 REMANDED Entitlement to service connection for emphysema and scarred lung, to include as due to asbestos exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1968 to October 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in January 2020, at which time it was remanded to obtain an addendum VA opinion. In November 2019, the Veteran testified before the undersigned at a Travel Board hearing. A transcript of that hearing has been associated with the virtual file and reviewed. Entitlement to service connection for emphysema and scarred lung, to include as due to asbestos exposure is remanded. The Veteran contends that he has emphysema and scarred lungs due to exposure to asbestos while carrying out his duties in service. A March 2018 VA examiner documented the Veteran to have a diagnosis of emphysema with a date of diagnosis from 2016. He was seen in the emergency department with chest pain and was noted to have asymptomatic emphysematous changes in the left lower lobe on a December 2016 x-ray. The examiner opined that the Veteran's emphysematous scarring was less likely as not incurred in or the result of asbestos exposure in service. The rationale was that the Veteran worked in administration and any exposure to asbestos was likely very low. Rather, his smoking history and other environmental exposures were more likely the cause of his disabilities. At his November 2019 Board hearing, the Veteran testified that the data processing occupation documented in his records was not completely accurate. He explained that he did not do well in school while in the Navy, so when he went back to the ship he no longer at the same job. See11/07/2019 Hearing Transcript, at 3-4. Once back on the ship he had such duties as cleaning fan rooms, changing filters, scraping wax coatings, cleaning bilge areas in engine room, and fire watch duty in the shipyard without mask, gloves, or protection. Id.at 3-4, 8-9. Personnel records show that the Veteran was dropped from Navy Schools Command in May 1969 for lack of application. The case was remanded to obtain an addendum opinion that considered these additional duties. The Veteran underwent another VA examination in February 2020. It was noted that asbestos exposure was conceded. However, it was documented that he did not have and had never been diagnosed with a respiratory condition. The Veteran reported having a chest x-ray that showed scarring on his lungs when he went to the emergency room in 2016, but the examiner noted that the documents were not available on the day of examination. The Veteran also reported that he had not seen a lung specialist in over a year and did not follow a primary care physician. A computed tomography (CT) scan from November 2019 noted trace biapical pleuroparenchymal scarring evident, but there was no diagnosis of chronic obstructive pulmonary disease (COPD)/emphysema. A February 2020 chest x-ray was not definite for evidence of scarring, asbestosis, or COPD. The examiner determined that while the Veteran had asbestos exposure, he did not have a current, chronic diagnosis of asbestosis or other pulmonary condition. It was also noted that there was no biopsy of the lungs in the medical records to determine the cause of the scarring. Based on the above, remand is necessary to clarify whether a current diagnosis of a respiratory condition, including emphysema. The 2020 VA examiner did not address the 2018 VA examiner's diagnosis of emphysema and the emphysematous changes in the left lower lobe on a December 2016 x-ray. It is also noted that the 2020 VA examiner did not have all the available records, including the 2016 chest x-ray, to properly opine on any lung scarring. Therefore, an addendum opinion is necessary which adequately addresses all relevant evidence of record. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007) (holding that once VA undertakes the effort to provide an examination when developing a claim, even if not statutorily obligated to do so, VA must ensure that the examination provided is adequate). This matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding the Veteran's claim for a respiratory disorder, including emphysema and lung scarring. If the clinician determines that a physical examination is required, then an examination is to be scheduled. The Veteran's claims file, including this Remand, is to be made available to and reviewed by the examiner. (a) The clinician must clarify whether the Veteran has had a respiratory disability, including emphysema present during the appeal period (beginning March 22, 2017). If any previously diagnosed respiratory disability is not confirmed, the clinician is to address the prior diagnosis of record and indicate whether it was misdiagnosed. Please explain your reasoning. (b) The clinician must address the following: 1) The March 2018 VA examiner's diagnosis of emphysema; 2) the December 2016 and February 2020 chest x-rays; 3) and the November 2019 CT scan. (c) For EACH diagnosed disability, including emphysema and scarred lung, the clinician must provide an opinion regarding whether it is at least as likely as not (probability of approximately 50 percent) related to an in-service injury, event, or disease, including asbestos exposure related to his duties of cleaning fan rooms, changing filters, scraping wax coatings, cleaning bilge areas in engine room, and fire watch duty in the shipyard. See 11/07/2019 Hearing Transcript, at 3-4, 8-9. A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Cruz, Karla 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.