Citation Nr: 22014609 Decision Date: 03/14/22 Archive Date: 03/14/22 DOCKET NO. 15-06 508A DATE: March 14, 2022 REMANDED Entitlement to service connection for residuals of pneumonia, to include pneumoconiosis and sleep apnea, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1981 to June 1986, October 1990 to February 1991, and April 1994 to August 1994, with subsequent service in the National Guard. In June 2019, the Board denied the Veteran's claim for service connection for residuals of pneumonia. The Veteran appealed the denial of the claims to the United States Court of Appeals for Veterans Claims (Court). Counsel for the Veteran and the Secretary of VA (the parties) filed a Joint Motion for Remand (JMR). The parties agreed that the Board's June 2019 denial of entitlement to service connection for residuals of pneumonia should be vacated and remanded because the Board erred when it (1) did not provide the Veteran with a Board hearing and (2) failed to provide an adequate statement of reasons or bases as to whether the Veteran's pneumoconiosis and sleep apnea constituted residuals of the in-service pneumonia. The Board notes that the Veteran was provided a Board video conference hearing in May 2021. A transcript of the hearing is associated with the record. In July 2021, based on the JMR, the Board remanded this appeal to obtain a medical opinion that addresses whether the Veteran has any residuals of the in-service pneumonia, to include pneumoconiosis and sleep apnea. Unfortunately, while a medical opinion was obtained in November 2021, the Board finds that the November 2021 medical opinion is inadequate as the VA examiner did not provide an adequate rationale. Here, the Veteran contends that while he was deployed to Turkey, in support of Operation Northern Watch, he was diagnosed and treated for typical pneumonia, which he contends was likely due to his exposure to burn pit residue. The Veteran further contends that, as a result, he suffers from recurrent upper respiratory issues, to include pneumonia, bronchitis, and obstructive sleep apnea. See May 2014 Notice of Disagreement. Additionally, in a May 2019 Appellate Brief, the Veteran contends that he suffers from pneumoconiosis that was incurred in service, in part due to burn pit exposure. The Veteran also contends that he has a possible diagnosis of COPD as a residual of his in-service pneumonia. See May 2021 Hearing Transcript. Here, in a November 2021 medical opinion, the VA examiner noted that the Veteran does not have a primary lung condition, other than obstructive sleep apnea. The VA examiner noted that while the Veteran has obstructive sleep apnea, he opined that "there is no medical literature suggesting that OSA [obstructive sleep apnea) could be caused from a history of pneumonia, especially in a setting of high BMI." However, the Board finds that this opinion is inadequate, as the examiner only generally states that the Veteran's obstructive sleep apnea is not related to his in-service pneumonia and that the medical literature did not support a medical relationship but did not address the specific facts of the case. See Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (a medical opinion that relies on the absence of general medical literature supporting nexus without discussing the specific facts of the case is inadequate). Given such, the Board finds the opinion to be conclusory and, therefore, inadequate. See Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Given such, a remand to obtain an addendum opinion with an adequate rationale is warranted. See Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. With respect to the Veteran's claim on appeal, request an addendum opinion from the November 2021 VA medical examiner, (if unavailable, then from a qualified medical professional), that addresses the following: Whether the Veteran's obstructive sleep apnea is a residual of the Veteran's in-service pneumonia that is at least as likely as not related to the Veteran's service. The November 2021 VA examiner noted that "there is no medical literature suggesting that OSA [obstructive sleep apnea) could be caused from a history of pneumonia, especially in a setting of high BMI." Please explain why the Veteran's sleep apnea is not related to his in-service pneumonia, by explaining the etiology and pathology of the Veteran's obstructive sleep apnea. If the VA examiner opines that the Veteran's sleep apnea is related to the Veteran's BMI, please explain the basis of that opinion. Any opinion expressed by the VA examiner must "contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). If the examiner determines that he/she cannot provide an opinion without resorting to speculation, the examiner should explain the inability to provide an opinion, identifying precisely what facts could not be determined. In particular, he/she should comment on whether an opinion could not be provided because the limits of medical knowledge have been exhausted or whether additional testing or information could be obtained that would lead to a conclusive opinion. Jones v. Shinseki, 23 Vet. App. 382, 389 (2010) (The Agency of Original Jurisdiction should ensure that any additional evidentiary development suggested by the examiner be undertaken so that a definite opinion can be obtained. 2. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Abdelbary, 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.