Citation Nr: 22016334 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 18-11 800 DATE: March 21, 2022 REMANDED Service connection for chronic obstructive pulmonary disease (COPD) is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1977 to March 1981. The case is on appeal from a July 2017 rating decision. The Board remanded the claim for additional development in September 2020 and August 2021. The Veteran seeks service connection for COPD. He asserts his COPD is secondary to his service-connected pulmonary tuberculosis (TB). He specifically asserts lung scarring caused by his service-connected TB in combination with his COPD affects his ability to breathe. See August 2017 Notice of Disagreement. Most recently, the Board remanded the claim in August 2021 for an additional opinion as it determined the VA opinion concerning secondary aggravation obtained in May 2021 pursuant to the Board's September 2020 remand was not entirely adequate to decide the claim. In this regard, the examiner did not indicate whether the Veteran's service-connected TB aggravated the Veteran's COPD. An additional opinion was obtained in September 2021. The examiner stated that it was at least as likely as not that the Veteran's COPD was aggravated beyond its natural progression by his service-connected TB. The examiner stated that the additive effect of smoking, pulmonary TB, and COPD culminate to current chronic respiratory failure requiring supplemental oxygen. She stated further in a December 2021 addendum opinion that the COPD made the Veteran short of breath, and the TB exacerbated the Veteran's shortness of breath. The RO obtained an additional opinion in January 2022. The examiner who provided the January 2022 opinion determined that it is less likely than not that the Veteran's current pulmonary function was aggravated by TB. The examiner explained the Veteran was diagnosed with TB in 1980 and received treatment at that time, and after treatment for TB in 1980 until 2013, the Veteran denied any pulmonary complaint, which in the examiner's opinion indicates the Veteran had no complaints related to his history of TB. He stated further, November 2021 pulmonary function testing post bronchodilator results were consistent with a normal value, thus indicating that the Veteran's current pulmonary function was less likely than not aggravated by his TB. The examiner also stated the Veteran's chest x-ray results indicate a primary diagnosis of COPD and explained that smoking is a known cause of COPD the Veteran was a long-time smoker (1.5 packs per day from 1978 to 2013). The Board finds that further medical development is needed to decide the Veteran's claim. First, the January 2022 opinion is deficient to the extent that it fails to address the favorable December 2021 addendum opinion. See Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994) (the Board may not simply adopt a medical examiner's opinion that fails to discuss favorable evidence of record, but must instead account for that favorable evidence with an adequate statement of reasons or bases). Second, while the pulmonologist's December 2021 opinion favorable concludes that the Veteran's service-connected TB aggravated his COPD because TB resulted in increased shortness of breath, the examiner failed to provide enough information for the Board to establish the baseline and current severities of the Veteran's COPD under the criteria set forth under 38 C.F.R. § 4.97, Diagnostic Code 6604. Such is required, by law, for VA to determine the extent of aggravation by deducting the baseline level of severity, as well as any increase in severity due to the natural progress of the disease, from the current level. 38 C.F.R. § 3.310(b). Accordingly, remand is needed. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records since August 2021. 2. Thereafter, schedule the Veteran for an examination (or telehealth interview, record review, etc., if an in-person examination is not feasible) by a qualified medical professional for an opinion to determine whether it is at least as likely as not (a degree of probability of 50 percent or higher) that the Veteran's service-connected TB aggravated his COPD. The examiner is to (i) address the favorable December 2021 opinion and (ii) determine the baseline and current severities of the Veteran's COPD under the criteria set forth under 38 C.F.R. § 4.97, Diagnostic Code 6604. If it the evidence of record or current medical science is unable to establish the Veteran's baseline and current severities, the examiner is to explain why. JOSHSUA CASTILLO Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Gray, 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.