Citation Nr: 21042240 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 20-01 245 DATE: July 12, 2021 REMANDED Entitlement to service connection for a chronic lung disorder is remanded. REASONS FOR REMAND The Veteran had active service in from February 1957 to February 1960, and from March 1960 to March 1966. This case comes to the Board of Veterans' Appeals (Board) on appeal from an October 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) which is the Agency of Original Jurisdiction (AOJ). The Veteran expressed timely disagreement with the AOJ's determination, and the present appeal ensued. The Veteran's claim was previously been before the Board in July 2020, when the claim was remanded to obtain medical records and to provide the Veteran with an addendum medical opinion. The required development has been completed, and the Veteran's claim has returned to the Board for further adjudication. Entitlement to service connection for a chronic lung disorder is remanded. The Veteran contends his current lung disability is the result of repeated in-service episodes of pneumonia. His service treatment records indicate three episodes of inpatient treatment for pneumonia, in December 1962, February 1964, and February 1966. While the Veteran's service treatment records are absent any ongoing or chronic disability resulting from pneumonia, the Veteran has experienced and been treated for multiple lung disabilities, including pleurisy, pulmonary nodules and chronic obstructive pulmonary disease (COPD), since his separation from service. The Board finds the medical evidence insufficient to adjudicate the Veteran's claim. While the Veteran was provided with a VA medical addendum opinion pursuant to the July 2020 Board remand, the opinion is inadequate. Although the August 2020 examiner determined that the in-service incidents of pneumonia differ etiologically from the Veteran's currently diagnosed COPD, the examiner did not provide an opinion on the impact the periods of pneumonia had on the Veteran's lungs, and whether those incidents increased the Veteran's susceptibility to lung disabilities diagnosed after separation. Further, the examiner relied on the time between the Veteran's separation and diagnosis with COPD for concluding that "no nexus is reasonable." For these reasons, the record for review by the Board remains inadequate for the purpose of readjudicating the Veteran's appeal. Thus, a remand is necessary to obtain an adequate nexus opinion. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Moreover, due to the heightened level of medical complexity involved in the Veteran's claim, the Board finds that the issues involved warrant an advisory medical opinion rendered by an independent medical expert. 38 U.S.C. § 5109. Thus, upon remand, the AOJ shall obtain an advisory medical opinion from an independent medical expert as set forth in the directives below. The matters are REMANDED for the following action: In light of the complexity of the Veteran's claims, the AOJ should obtain an advisory medical opinion by an appropriate specialist in pulmonology pursuant to 38 U.S.C. § 5109(a) and 38 C.F.R. § 3.328. The Veteran's claims file should be made available to and be reviewed by the specialist, including references to pneumonia in December 1962, February 1964, and February 1966, and the Veteran's treatment for pleurisy in August 1966, before rendering such an opinion. The specialist should then address the following: 1. Whether the Veteran has any current or previously diagnosed lung disabilities. 2. The specialist is requested to offer an opinion as to whether it is at least as likely as not (i.e., 50 percent probability or more) that the Veteran's lung disability is related to the Veteran's military service, including his episodes of pneumonia. 3. The specialist should further address whether the Veteran's in-service history of pneumonia resulted in a lung deficiency, increasing the Veteran's future susceptibility to chronic lung disabilities. In rendering these opinions, the specialist is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the specialist rejects the Veteran's reports, he or she must provide an explanation of such rejection. The specialist is not to improperly discount the Veteran's lay statements or mistakenly primarily rely on an absence of medical evidence in the Veteran's service treatment records to support his or her conclusions. The complete rationale for all opinions rendered should be set forth and a discussion of the facts and medical principles involved in formulating such opinions would be of considerable assistance to the Board, especially in light of the complexities of these issues. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. W. Morgan, 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.