Citation Nr: 22012258 Decision Date: 03/03/22 Archive Date: 03/03/22 DOCKET NO. 15-20 443 DATE: March 3, 2022 REMANDED Entitlement to service connection for chronic obstructive pulmonary disease (COPD) including emphysema, to include as secondary to asbestos exposure and service-connected pulmonary nodules is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1977 to June 1981. This matter comes before the Board of Veterans' Appeals (Board) from a March 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing with the undersigned in October 2017. A transcript of that hearing has been added to the Veteran's file. This issue was previously remanded by the Board in April 2020 and has since been returned for further adjudication. Although the Board regrets additional delay, remand is necessary to properly address the Veteran's claim. Initially, the Board finds that a remand is necessary to obtain an additional medical opinion as to whether the Veteran's COPD/emphysema was caused by his conceded in-service asbestos exposure. The July 2021 VA examiner concluded that the Veteran's COPD/emphysema was not related to his service. However, it does not appear that the VA examiner conceded the Veteran's in-service asbestos exposure, as she noted that the most recent chest x-rays from May 2021 showed no definite radiographic manifestations of prior asbestos exposure. Second, the July 2021 examiner stated that the Veteran's pulmonary nodules would not progress, or cause COPD, or aggravate his COPD. However, the examiner stated that the Veteran's pulmonary nodules were not caused by asbestos exposure in service, but the Veteran's pulmonary nodules are in fact service-connected based on asbestos exposure in service. As such, remand is necessary to obtain an opinion on whether the Veteran's pulmonary nodules caused or aggravated his COPD/emphysema. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all outstanding treatment records relevant to treatment for COPD/emphysema. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of the unavailability of the records. 2. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion on the etiology of the Veteran's COPD/emphysema. (a) The examiner should provide an opinion as to whether the Veteran's COPD/emphysema was caused by his conceded in-service exposure to asbestos. In offering this opinion, the examiner should consider the July 22, 2103 note in the VA treatment records from H.C.S., M.D. stating that "any exposure to asbestos can put a person at risk for COPD/Emphysema related to asbestos and mesothelioma." The examiner should also address the significance of the July 2019 VA examiner's notation that the Veteran's COPD/emphysema represents an "obstructive defect." Specifically, the examiner should explain whether asbestos exposure causes obstructive lung defects, as opposed to any other kind of lung abnormalities, i.e., restrictive disease, etc. (b) The examiner should provide an opinion as to whether the Veteran's COPD/emphysema was either (a) caused by, or (b) aggravated by (worsened beyond natural progression) his asbestos-related pulmonary nodules. The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as the Board is precluded from making any medical findings. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Hofmeister 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.