Citation Nr: 1324186 Decision Date: 07/30/13 Archive Date: 08/07/13 DOCKET NO. 10-46 172 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Buffalo, New York THE ISSUE Entitlement to a rating in excess of 10 percent for pulmonary sarcoidosis with soft tissue density at the right lung apex. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD M. Riley, Counsel INTRODUCTION The Veteran served on active duty from August 1969 to August 1991. This case comes before the Board of Veterans' Appeals (Board) on appeal from a May 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Buffalo, New York, which, in pertinent part, continued a 10 percent evaluation for the Veteran's service-connected pulmonary sarcoidosis. In May 2011, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of this hearing is of record. In a November 2010 statement accompanying her substantive appeal, the Veteran raised the issues of entitlement to service connection for a skin rash and asthma as secondary to service-connected pulmonary sarcoidosis. The Agency of Original Jurisdiction (AOJ) has not yet adjudicated these issues, and it is not currently before the Board. The claims are referred to the AOJ for the appropriate action. 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 Board finds that additional development is necessary before a decision may be rendered in this case. Initially, the Board observes that the Veteran has not received notice of VA's duties to notify and assist her in developing evidence to substantiate the claim for an increased rating. Furthermore, the Veteran testified during the May 2011 videoconference hearing that she has received private treatment with a pulmonary specialist for her service-connected sarcoidosis. VA has a duty to obtain relevant records of treatment reported by private physicians. Massey v. Brown, 7 Vet. App. 204 (1994). The Veteran must receive notice of VA's duties to notify and assist and attempts must be made to obtain the private medical records referenced by the Veteran. The Board also finds that a new VA examination is required to determine the current severity of the Veteran's service-connected pulmonary disability. The most recent VA examination was conducted in April 2010, more than three years ago. The Veteran testified in May 2011 that her disability had worsened and a new VA examination is required. Snuffer v. Gober, 10 Vet. App. 400 (1997) (the Veteran is entitled to a new VA examination where there is evidence that the condition has worsened since the last examination); Caffrey v. Brown, 6 Vet. App. 377 (1994); VAOPGCPREC 11-95 (1995). Accordingly, the case is REMANDED for the following action: 1. Send the Veteran a letter that complies with 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) regarding the claim for an increased rating for pulmonary sarcoidosis with soft tissue density at the right lung apex. 2. Provide the Veteran medical release forms and ask that she execute them to allow VA to obtain records of medical treatment from her private health care providers, including her pulmonologist, Dr. Lawrence Kramer in Watertown, New York. 3. If appropriate medical release forms are received, obtain records of treatment from the private physicians and facilities identified by the Veteran. Associate the records with the Veteran's paper or virtual claims file. If unsuccessful in obtaining this evidence, inform the Veteran and her representative and request them to provide the outstanding evidence. 4. Obtain records of treatment from the Syracuse VA Medical Center (VAMC) for the period from April 2013 to the present. Associate the records with the Veteran's paper or virtual claims file. 5. Afford the Veteran an appropriate VA examination to determine the severity of the service-connected sarcoidosis. The Veteran's claims file must be made available to the examiner for review in connection with the examination. The examination must include a PFT and the reported results must include findings for: FEV-1; FEV- 1/FVC; and DLCO (SB) (unless the examiner states why DLCO testing would not be useful or valid), and maximum oxygen consumption. The examination report must include pre-bronchodilator and post-bronchodilator studies unless the examiner determines that post-bronchodilator studies should not be done and states why. The examiner should also determine whether the Veteran's sarcoidosis is manifested by any of the following: a) Pulmonary involvement with persistent symptoms requiring a chronic low dose (maintenance) or intermittent use of corticosteroids; or, b) Pulmonary involvement requiring systemic high dose (therapeutic) corticosteroids for control; or, c) Cor pulmonale, or; cardiac involvement with congestive heart failure, or; progressive pulmonary disease with fever, night sweats, and weight loss despite treatment. The examiner should also note to what extent the above findings are solely attributable to the service-connected sarcoidosis with a soft tissue density at the right lung apex or are the result of a nonservice-connected disability such as the Veteran's diagnosed asthma. If possible, the symptoms of each pulmonary disability should be differentiated from one another. If this is not possible, the examiner should so state and provide a full explanation for all expressed opinions. 6. Then, readjudicate the claim on appeal. If the benefit sought on appeal is not fully granted, issue a supplemental statement of the case before returning the case to the Board, if otherwise in order. The appellant has the right to submit additional evidence and argument on the matter 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. 2012). _________________________________________________ MICHAEL MARTIN 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) (2012).