Citation Nr: 22014708 Decision Date: 03/14/22 Archive Date: 03/14/22 DOCKET NO. 19-08 834 DATE: March 14, 2022 REMANDED Service connection for a respiratory disability, to include granuloma of the lung with persistent cough, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from August 2011 until his honorable discharge in August 2015. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2018 decision by a Regional Office of the United States Department of Veterans Affairs (VA). In October 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. Service connection for a respiratory disability, to include granuloma of the lung with persistent cough, is remanded. During his active service, the Veteran's military occupation specialty (MOS) was as a chemical, biological, and radiation nuclear defense specialist. A June 2018 VA examiner diagnosed the Veteran with lung granuloma. As explained by the examiner, "A granuloma is a small area of inflammation in tissue. Granulomas are most often the result of an infection and most frequently occur in the lungs but can occur in other parts of the body as well. Granulomas are often found incidentally on a chest X-ray done for some other reason and usually without symptoms." The Veteran asserts that he had a prior diagnosis of asthma in 2018, persistent cough since service, and lung granuloma due to exposure to (1) teargas exposure during military training; (2) drinking contaminated water while stationed at Camp Pendleton; and (3) exposure to fuel toxins from diesel-powered equipment. The June 2018 VA examiner offered an opinion on the etiology of the Veteran's lung granuloma; the examiner did not diagnose the Veteran with any other respiratory disability. The examiner opined that the Veteran's lung granuloma was less likely than not due to military service. The examiner's rationale for the opinion, however, is inadequate. The examiner merely stated that the Veteran's assertions of lung problems due to teargas exposure were inconsistent with his lung granuloma. The examiner failed to explain why. Rather, the examiner merely listed facts, including no use of an inhaler, lack of in-service lung problems, despite a 2011 respiratory infection, and an unsupported assertion that "his story and physical examine is inconsistent." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("It is the fully articulated, sound reasoning for the conclusion . . . that contributes probative value to a medical opinion."). The examiner provided no logical connection among these facts to the opinion offered. The Board observes that during his June 2015 separation medical examination, he reported having a persistent cough within one week following exposure to teargas during training in a chemical, biological, radiological, and nuclear protective equipment (CBRN) chamber. He made additional statements about his persistent cough to the examiner. The examiner did not address any of this relevant evidence. See Dalton v. Peake, 21 Vet. App. 23, 3940 (2007) (a medical opinion is inadequate if it does not take into account a veteran's reports of symptoms and history, even if recorded in the course of the examination). Accordingly, the matter is REMANDED for the following actions: 1. Obtain any of the Veteran's outstanding VA medical records and associate them with the claims file. 2. After any additional records are associated with the claims file, obtain an addendum opinion from an appropriately qualified clinician addressing the onset and etiology of the Veteran's respiratory disability. The entire claims file must be made available to and be reviewed by the examiner, including a copy of this REMAND order. If the examiner decides an examination is necessary, then one shall be provided. The examiner is asked to provide an opinion regarding the following: (a.) Identify whether the Veteran has had asthma, persistent, intermittent, or otherwise, since his military service. Please explain your conclusion. Please see May 30, 2018, VA medical record documenting a "longstanding" history of asthma; February 15, 2018, VA medical record indicating "Normal pulmonary function tests do not exclude asthma." (b.) Identify whether the Veteran has had any respiratory disability since the filing of his claim for service connection in May 2018. Please explain your conclusion. Please see June 2018 VA examination. (c.) Please identify whether it is at least as likely as not (50 percent probability or more) that the Veteran's lung granuloma is a residual of an in-service event, injury, or illness, to include (i) an in-service respiratory disability, (ii) exposure to teargas, (iii) exposure to fumes from diesel-powered equipment, or (iv) contaminated water. (d.) Please identify whether it is at least as likely as not (50 percent probability or more) that any other respiratory disability had its onset in or is otherwise etiologically related to an in-service event, injury, or disease, to include (i) an in-service respiratory disability, (ii) exposure to teargas, (iii) exposure to fumes from diesel-powered equipment, or (iv) contaminated water. In rending his or her opinion, the examiner should consider and, if deemed relevant, address the following, in addition to any other relevant evidence: (a.) The Veteran's lay statements contained in various documents of records that he suffered persistent cough and/or asthma in service and thereafter. (b.) The Veteran's lay statements about being exposed to teargas, fumes from diesel-powdered equipment, and contaminated water. (c.) The June 2015 separation examination documenting a persistent cough that began one week following exposure to teargas as part of training. The examiner is reminded to consider the Veteran's lay statements regarding the nature and onset of a respiratory disability, including any evidence concerning continuity of symptomatology, as he is legally permitted to report his symptoms, past medical history, and experiences. The examiner must not opine on the credibility of the Veteran. The examiner may, however, discuss whether there is any medical reason to accept or reject the Veteran's assertion of a respiratory disability in service or the assertion that an in-service event, injury, or illness led to a respiratory disability. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). A clear and detailed rationale for the opinion(s), including a discussion of the facts and medical principles involved, should be provided as it will be of considerable assistance to the Board. Please do not simply list the facts on which you relied. The examiner is informed that reliance on a lack of treatment and/or gap between discharge from military service and diagnosis of a disability, without explaining why such evidence is significant, may be considered an insufficient rationale. The examiner is informed that the absence of contemporaneous service treatment records or medical records in general, standing alone, without explaining why such evidence is significant, may be considered insufficient rationale. If the examiner determines a disability was acute rather than chronic, the examiner should explain how he or she arrived at that conclusion rather than providing a conclusory opinion. For example, what evidence led to that conclusion, what would the examiner expect to see if a condition was chronic, how do the Veteran's lay statements, if any, affect the conclusion? If the examiner relies on medical treatises, the examiner should identify the treatises. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. F. Sawka, 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.