Citation Nr: 22040194 Decision Date: 07/13/22 Archive Date: 07/13/22 DOCKET NO. 20-23 899 DATE: July 13, 2022 REMANDED Entitlement to service connection for asthma, to include as secondary to service-connected disabilities and/or exposure to herbicide agents is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from December 1963 to December 1965, to include service in the Republic of Vietnam. This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2019 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded this matter in October 2020, June 2021, October 2021, and January 2022 for additional development. 1. Entitlement to service connection for asthma, to include as secondary to service-connected disabilities and/or exposure to herbicide agents is remanded. The Veteran contends that his service-connected disabilities aggravated his asthma beyond the natural progression of the disease. See June 2021 Appellant Brief. In its January 2022 Board remand, the Board ordered a VA medical opinion to be performed by a VA physician of appropriate expertise (i.e., a pulmonologist) to determine whether the Veteran's asthma was caused or aggravated by his service-connected disabilities. A VA medical opinion was obtained in March 2022, performed by a physician's assistant who only discussed two of the Veteran's service-connected disabilities. Another medical opinion was obtained by a VA physician whose specialty was listed as internal medicine in April 2022. The VA examiner stated that the Veteran's asthma was not proximately caused by any of his service-connected disorders, simply listing each service-connected disability and writing "the condition is not an established primary etiology of asthma in the medical literature." See April 2022 VA Examination. In regard to aggravation, the VA examiner stated that the Veteran's asthma was treated adequately with inhalers and other medicine, showed normal pulmonary function testing and fell within the natural history of the condition. The VA examiner did not discuss or mention the Veteran's service-connected disabilities in his aggravation opinion. Finally, the VA examiner did not discuss any of the Veteran's lay contentions in his opinion, despite being instructed to do so in the January 2022 Board remand. The Board finds the April 2022 VA examination inadequate, as it does not comply with the Board remand: it is not clear if the examiner has expertise in pulmonology and the examiner did not discuss the Veteran's lay contentions. Additionally, the examiner's explanation for his negative nexus was conclusory and did not provide adequate rationale. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Accordingly, a new medical opinion warranted. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion by a VA physician of appropriate expertise (i.e., a pulmonologist) to determine the nature and etiology of the Veteran's asthma. The entire claims file and a copy of this REMAND must be made available to the examiner in conjunction with the examination. The examiner must note in the examination report that the evidence in the claims file has been reviewed. The examiner must provide an opinion as to the medical probability that the Veteran's asthma was either (i) caused by, or (ii) aggravated by his service-connected disabilities. The examiner must discuss each disability separately. The examiner must provide separate opinions for questions (i) and (ii). In addressing the matter of aggravation, the examiner should note that it is not required that the claimed disabilities are shown to be aggravated beyond natural progression "predominantly" by a service-connected disability, but rather, whether there is any contributing degree of aggravation beyond natural progression by a service-connected disability. Additionally, aggravation under 38 C.F.R. § 3.310(b) does not require that there be "permanent" worsening of the nonservice-connected disability. Any increase in disability is sufficient. The examiner is advised that the Veteran is competent to report his medical history, including the onset of symptoms, and such lay contentions in the record must be acknowledged and considered in formulating any opinion (Continued on the next page) A supporting rationale for all opinions expressed must be provided. The examiner must specifically address the Veteran's contentions in the June 2021 Appellate Brief. If the examiner is unable to provide any opinion as requested, the examiner should fully explain the reason why such opinion could not be rendered. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mohammad, Tahmina 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.