Citation Nr: 22018577 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 18-51 270 DATE: March 29, 2022 REMANDED Entitlement to service connection for lung cancer, to include as due to in-service asbestos exposure, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from May 1964 to December 1967. The Veteran testified at a November 2021 Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. Entitlement to service connection for lung cancer, to include as due to asbestos exposure, is remanded. Remand is necessary to obtain a new VA examination if necessary. When VA undertakes to obtain an opinion, it must ensure that the opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Here, in a December 1966 STR, the Veteran complained of pain in the chest when breathing. The Veteran stated that he has experienced these symptoms for the past four months. The Veteran stated the symptoms are intermittent and occur two to four times a day and last from several minutes to a few hours. The medical provider stated the symptoms are not related to exercise, eating, or heavy lifting. The medical provider found the Veteran's cardiac examination to be within normal limits. The medical provider came to the impression that the etiology of the Veteran's symptoms was musculoskeletal. The Veteran's certificate of release or discharge from active duty (DD214) indicates the Veteran's MOS is a machinist's mate. A May 2002 VA memorandum stated the Veteran's military occupational specialty (MOS) as a machinist has probable exposure to asbestos. In a September 2012 VA treatment record, the medical provider explained the Veteran's chest X-ray (CXR) was negative for evidence of asbestosis. In a November 2015 VA treatment record, the medical provider found calcified pleural plaques to be present bilaterally in the Veteran's chest. The April 2016 VA examiner opined that the Veteran's lung cancer is less likely than not caused by service, to include exposure to asbestos. The examiner reasoned that the Veteran's extensive smoking history is at least as likely as the cause of his current adenocarcinoma. The examiner, however, stated that the Veteran does have calcified pleural plaques that were noted on his positron emission tomography (PET) scan. The examiner stated that pleural plaques are by far the most common indication of significant exposure to asbestos, and he was a machinist with exposure to asbestos during service. The examiner stated that currently, the Veteran does not have more serious asbestos related disease like asbestosis or mesothelioma. The examiner stated that if these diseases were to develop, then they would be at least as likely as not incurred in or related to the Veteran's asbestos exposure. In a February 2017 statement in support of claim, the Veteran stated he is requesting a new VA examination because he feels the VA examiner did not perform due diligence. In a February 2017 VA treatment record, the Veteran was seen for follow-up of lung cancer and chronic obstructive pulmonary disease (COPD). The medical provider assessed the Veteran to have pleural plaques. After imaging, the medical provider's impression is there are small pleural plaques and calcifications bilaterally that may represent prior asbestos exposure. In February 2017, the Veteran submitted medical literature stating that asbestos exposure can increase the risk of lung cancer and that the major issue with asbestos exposure is that these diseases may not appear for 10 to 45 years after the individual was initially exposed. In November 2021, the Veteran submitted a July 2019 private treatment record concluding that the Veteran's lungs have the appearance and distribution of asbestosis and the bilateral calcified pleural plaque formation characteristic of prior asbestos exposure. In the February 2020 private treatment record, submitted by the Veteran in November 2021, the medical provider stated the Veteran has dependent density in the lungs that looks like early asbestosis. Finally, in a July 2020 treatment record, the medical provider stated the Veteran has been suffering from progressive shortness of breath and dyspnea that has worsened since the 1970s. The medical provider stated the Veteran has persistent difficulty breathing and coughing, all of which have been progressively worsening. The medical provider stated these symptoms impair his activities of daily living. The medical provider stated the Veteran has definite prior asbestos exposure during military service. The medical provider concluded that the Veteran suffers from asbestosis on the basis of his exposure history, appropriate latency period, characteristic imaging findings confirming "bilateral pleural plaque formation characteristic of prior asbestos exposure," and the Veteran's significant pulmonary symptoms. The medical provider stated the Veteran has an elevated risk of progressive debilitation due to the asbestos related bilateral pleural plaques. Therefore, a remand is required to obtain a new VA examination and opinion to address the February 2017 literature submitted by the Veteran and the July 2019 and February 2020 private treatment records from Dr. D.P with a diagnosis of asbestosis. The matters are REMANDED for the following action: Obtain a new VA examination from an appropriate clinician regarding the Veteran's lung cancer, to include as due to asbestos exposure. The clinician is to first determine if the Veteran has a diagnosis of asbestosis. The examiner is then required to provide an opinion finding whether: It is at least as likely as not that the Veteran's lung cancer is related to active service, to include the Veteran's in-service asbestos exposure and December 1966 in-service treatment for chest pain. If the Veteran is found to have asbestosis, the examiner must also opine as to whether it is at least as likely as not that: The Veteran's lung cancer was caused by asbestosis, or The Veteran's lung cancer was aggravated beyond its natural progression by asbestosis. The examiner must address the literature submitted by the Veteran in February 2017, the July 2019 and February 2020 private treatment records from Dr. D.P. finding a diagnosis of asbestosis, and the Veteran's statements, contentions, and Board hearing testimony in the context of these opinions. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Thompson, 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.