Citation Nr: 22011998 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 18-41 189 DATE: March 2, 2022 REMANDED Entitlement to service connection for asthma is remanded. REASONS FOR REMAND The Veteran served on ACDUTRA from August 2010 to December 2010, with additional periods of ACDUTRA and INACDUTRA until she left the Reserves in June 2013. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2016 rating decision. In October 2021, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing is in the claims file. 1. Entitlement to service connection for asthma is remanded. The Veteran seeks service connection for asthma, asserting that her asthma began during annual training on February 5, 2012, and has continued and worsened. The Veteran sought treatment on February 6, 2012, the day after her training, and was diagnosed with exercise-induced asthma. A September 2016 VA examiner opined that the Veteran's asthma is at least as likely as not incurred during service as the Veteran reported asthma symptoms developed during a training exercise in active duty in 2012. However, the Veteran reported that her asthma began on February 5, 2012, during a drill weekend while serving in the Reserves, which appears to be during a period of INACDUTRA. For periods of INACDUTRA, service connection is warranted if the disability arose from an injury incurred or aggravated in the line of duty; or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident occurring during such training. 38 U.S.C. § 101(24)(c) (emphasis added). For periods of ACDUTRA, service connection is warranted if the disability arose from a disease or injury incurred or aggravated in the line of duty. 38 U.S.C. § 101(24)(b) (emphasis added). Here, there does not appear to be an injury associated with the Veteran's asthma on February 5, 2012. However, the Veteran served several periods of ACDUTRA and INACDUTRA during her Reserve service. Remand is warranted to clarify the periods of the Veteran's ACDUTRA and INACDUTRA service, including the nature of the February 5, 2012 service. In a November 2016 letter, the Veteran's treating nurse practitioner opined that the Veteran's asthma occurred while on active duty per the Veteran's reports. The nurse practitioner explained that the Veteran suffered an initial asthma exacerbation during routine active duty exercises in August 2012 and has since been formally diagnosed. However, as noted above, the Veteran reported an asthma attack on February 5, 2012, and was diagnosed February 6, 2012, which suggests to the Board that the opinion is based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 461(1993). An April 2019 VA examiner opined that the Veteran's asthma is less likely than not incurred in or caused by service. The VA examiner explained that exercise is not an independent risk factor for asthma but rather a trigger of bronchoconstriction in patients with underlying asthma. The VA examiner further explained that there is actually some speculation that decreased physical activity is a risk factor for asthma. However, the VA examiner did not have the opportunity to address the Veteran's later reports, including her assertions that exposure to mold and gas chamber inhalation during service caused her asthma. An October 2019 treatment record notes that the Veteran's exercise-induced asthma worsened and progressed to moderate persistent asthma during her military service. The physician noted that the Veteran was exposed to gas chamber inhalation during a military training exercise that made breathing much worse, that she was exposed to mold in the barracks during service, and that she was exposed to a climate change when she moved and trained in Arkansas. The physician noted that any of these variables, including mold exposure, climate change, and inhalational injury, could have worsened her asthma. Once the Veteran's periods of service are confirmed, the Regional Office should obtain VA medical opinion regarding whether her asthma is the result of a disease or injury incurred or aggravated during a period of ACDUTRA or an injury incurred or aggravated during a period of INACDUTRA, with consideration of the Veteran's reports, including her assertions that exposure to mold and gas chamber inhalation during service caused her asthma. In addition, the Veteran asserts that her asthma may be secondary to her service-connected disabilities. The Veteran has reported that her physician told her that her anxiety and asthma trigger each other. See November 2018 Regional Office Hearing Tr., p. 5. The Veteran's anxiety is service connected. Accordingly, remand is also warranted to obtain VA medical opinion regarding whether the Veteran's service-connected psychiatric disability caused or aggravated her asthma. The Veteran is also service connected for back and right lower extremity radiculopathy disabilities. A September 2019 VA treatment record notes that the Veteran has not been exercising in part due to fear of exacerbating her back pain. The January 2020 VA back and peripheral nerve examinations note limitations in mobility and walking, climbing, and lifting due to the service-connected back and right lower extremity conditions. In light of the April 2019 VA examiner's comment that decreased physical activity is a risk factor for asthma, and the Veteran's report that she was not exercising due to her service-connected back disability, VA medical opinion should also be obtained regarding whether the Veteran's service-connected back and right lower extremity radiculopathy disabilities caused or aggravated her asthma. While this matter is on remand, outstanding private and VA treatment records should be obtained, including VA treatment records from April 2020 to the present. The matters are REMANDED for the following action: 1. Clarify the periods of the Veteran's service, including any active duty, ACDUTRA, and INACDUTRA service, including confirming the nature of the Veteran's February 5, 2012 service. 2. After securing any necessary authorization, obtain any private treatment records as the Veteran may identify relevant to her claim. 3. Obtain any additional VA treatment records, to include VA treatment records from April 2020 to the present. Associate with the claims file all potentially relevant documents scanned into Vista Imaging or CPRS but not associated with the Veteran's claims file. 4. After clarifying the periods of service and obtaining outstanding records to the extent possible, ask the appropriate examiner to review the Veteran's file. The necessity of an in-person examination is left to the discretion of the examiner. The examiner should opine regarding whether it is at least as likely as not that the Veteran's asthma disability: (a) is from an injury incurred or aggravated in a period of INACDUTRA; (b) began during or is the result of a disease or injury incurred or aggravated in a period of active duty or ACDUTRA; or (c) is caused or aggravated by one of the Veteran's service-connected disabilities, including her psychiatric disability, her back disability, and her right lower extremity radiculopathy disability. Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected condition. The examiner should consider all medical and lay evidence of record. The examiner should specifically comment on the September 2016 VA opinion and the October 2019 treatment record's notations that the Veteran's exercise-induced asthma worsened and progressed to moderate persistent asthma during her military service, that the Veteran was exposed to gas chamber inhalation during a military training exercise that made breathing much worse, that she was exposed to mold in the barracks during service, and that she was exposed to a climate change when she moved and trained in Arkansas, and that any of these variables, including mold exposure, climate change, and inhalational injury, could have worsened her asthma. The examiner should also specifically address the Veteran's report that her physician told her that her anxiety and asthma trigger each other. The examiner should also specifically address the Veteran's report in a September 2019 VA treatment record that she was not exercising due to fear of exacerbating her back pain and the Veteran's functional limitations noted in her January 2020 VA back and peripheral nerve examinations in light of the April 2019 VA examiner's comment that decreased physical activity is a risk factor for asthma. The examiner is asked to explain the reasons behind any opinions expressed. 5. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Purcell, 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.