Citation Nr: 1029614 Decision Date: 08/06/10 Archive Date: 08/16/10 DOCKET NO. 10-19 157 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Boston, Massachusetts THE ISSUE Entitlement to an initial disability rating for chronic obstructive pulmonary disease (COPD) with an asthmatic component, rated 30 percent disabling prior to December 28, 2006, and as 60 percent disabling thereafter. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD J Fussell INTRODUCTION The Veteran served on active duty from February 1952 to February 1954. This case initially came before the Board of Veterans' Appeals (Board) on appeal from a November 2001 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Boston, Massachusetts, which in pertinent part denied service connection for asthma. The Veteran appealed that decision and after the Board remanded the case in August 2006, service connection for COPD with an asthmatic component was granted in an April 2009 Board decision. The April 2009 Board decision was effectuated by a July 2009 rating decision which granted service connection and assigned an initial 30 percent disability rating, both effective June 25, 2001 (date of receipt of claim). The Veteran appealed that decision and, subsequently, a March 2010 rating decision granted an increase in the 30 percent rating for that disorder to 60 percent, effective December 28, 2001 (date that VA outpatient treatment (VAOPT) records revealed that the Veteran was taking corticosteroids). Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2009). 38 U.S.C.A. § 7107(a)(2) (West 2002). The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The record shows that the Veteran has twice had a coronary artery bypass grafting procedure. Also, there is evidence that he has hypertension. A September 2007 chest X-ray revealed that his heart was slightly enlarged but still within normal limits. A June 2008 echocardiogram revealed bilateral atrial enlargement. The Veteran has recently reported that he was hospitalized at a VA Medical Center for pneumonia which he alleges was due to his service-connected COPD with an asthmatic component. He has not specified the inclusive dates of that hospitalization and the records of that hospitalization are not on file. A review of the record shows that the Veteran has been taking 220 mcg. of Mometasone since December 28, 2006. Information on file, obtained from the Internet, indicates that Mometasone is a corticosteroid. The March 2010 rating decision which granted an increase to 60 percent for the service-connected COPD with an asthmatic component found the Veteran was not taking a "high dose" of corticosteroid, as required under 38 C.F.R. § 4.97, Diagnostic Code 6602 (setting forth the rating criteria of bronchial asthma) for a 100 percent rating. However, it is not clear to the Board what dosage level constitutes a "high dose" under Diagnostic Code 6602. In this regard, the Board notes that 38 C.F.R. § 4.97, Diagnostic Code 6604 (setting for the rating criteria for COPD) provides for a 100 percent rating under a variety of circumstances for a 100 percent rating, including if the Veteran has cor pulmonale (right heart failure) or pulmonary hypertension. Here, it is not clear whether the Veteran's hypertension is pulmonary hypertension. Also, the Veteran reported in May 2010 that his service connection pulmonary disorder had worsened. A veteran is entitled to a new VA examination where there is evidence that the condition has worsened since the last examination. Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994); VAOPCGPREC 11-95 (1995); see also 38 C.F.R. § 3.327 (a reexamination will be requested whenever there is a need to verify the current severity of a disability). Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2009). Expedited handling is requested.) 1. Contact the Veteran and request that he provide place and the inclusive dates of his recent VA hospitalization. The RO should then obtain the discharge summary of that period of hospitalization and the relevant treatment records. 2. Afford the Veteran a VA pulmonary examination to determine the extent and severity of the service-connected COPD with an asthmatic component. All indicated studies should be performed, and the rationale for all opinions expressed should be provided. The Veteran's claim files should be made available to the examiner prior to the examination, and the examiner is to indicate in the report whether the file was reviewed. The examiner should render specific findings with respect to the existence of the following: a) What is the Veteran's FEV-1 (Forced Expiratory Volume in one second)? b) What is the Veteran's FEV-1/FVC (Forced Expiratory Volume in one second to Forced Vital Capacity (FEV-1/FVC)? c) What is the Veteran's Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB))? d) Does the Veteran have more than one attack of asthma per week with episodes of respiratory failure? e) Does the Veteran require daily use of systemic (oral or parenteral) high dose corticosteroids or immune-suppressive medications? f) Does the Veteran have maximum exercise capacity less than 15 ml/kg/min oxygen consumption (with cardiac or respiratory limitation)? g) Does the Veteran have cor pulmonale (right heart failure)? h) Does the Veteran have right ventricular hypertrophy? i) Does the Veteran have pulmonary hypertension? j) Does the Veteran have episode(s) of acute respiratory failure? k) Does the Veteran require outpatient oxygen therapy? In addressing these matters, the examiner should clarify the significance of the Veteran's documented hypertension and particularly whether it is pulmonary hypertension. Also, the examiner should clarify whether the finding of bilateral atrial enlargement is indicative of cor pulmonale. In particular, the examiner should clarify whether any dosage level of corticosteroid that the Veteran now uses is a "high dose" as required for a 100 percent disability rating. The report of the examination should include a complete rationale for all opinions expressed. 3. The Veteran is hereby notified that it is his responsibility to report for all examinations, to cooperate in the development of the claim, and that the consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158, 3.655. In the event that the Veteran does not report for any ordered examination, documentation should be obtained which shows that notice scheduling the examination was sent to the last known address. It should also be indicated whether any notice that was sent was returned as undeliverable. 4. Thereafter, any other development deemed necessary should be accomplished and the claim should be readjudicate. 5. If the benefit remains denied, the Veteran and any representative, should be provided with a supplemental statement of the case (SSOC). The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). _________________________________________________ DEBORAH W. SINGLETON Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2009).