Citation Nr: 18142626 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 14-40 935 DATE: October 17, 2018 REMANDED The issue of entitlement to an increased (compensable) disability rating for status post right lower lobe resection (lung cancer) residuals, including the question of whether reduction of the 100 percent disability rating to 0 percent lung cancer residuals effective from June 1, 2014 was proper, is remanded for additional development. The issue of entitlement to special monthly compensation (SMC) at the housebound rate from June 1, 2014 is remanded for additional development. The issue of entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service in the U.S. Army from July 1968 to April 1971, and in the U.S. Navy from July 1973 to June 1980, and from September 1980 to October 1990. These matters are on appeal from a March 2014 rating decision. In June 2018, the Veteran and his spouse testified at a Travel Board hearing before the undersigned. A transcript of that proceeding is of record. 1. Increased Rating/Reduction for Lung Cancer Residuals from June 1, 2014 The effect of the right lower lobe removal on the Veteran’s pulmonary functionality and whether such manifestations of lung cancer residuals are distinguishable from manifestations of the nonservice-connected COPD are not clear from the current record. The October 2013 VA reviewer opined, in pertinent part, that the diseased lung that was removed would have no bearing on FEV-1 values but nonservice-connected COPD would have an effect on such values; however, the VA reviewer provided no rationale to support the medical opinion on why the lung removal would have no effect on FEV-1 values. The February 2014 VA examiner noted that losing a portion of the lung had impacted the Veteran’s vital capacity, which seems to contradict the October 2013 VA medical opinion. The March 2013 VA examiner opined that COPD was exacerbated by lung resection which has decreased his vital capacity, which suggests that some portion of pulmonary impairment at least partially may be due to the service-connected lung cancer residuals. Furthermore, at the Board hearing, the Veteran indicated that his breathing may have worsened since the last VA examination performed in 2014. For these reasons, a remand for a new VA examination with a medical opinion and updated VA treatment records is needed. 2. SMC at the Housebound Rate from June 1, 2014 Because a decision on the remanded issues of whether the rating reduction for the lung cancer residuals was proper and a TDIU could significantly impact a decision on the issue of SMC at the housebound rate effective from June 1, 2014, the issues are inextricably intertwined; therefore, a remand of the SMC appeal is required. 3. TDIU Because the issue of a TDIU was raised at the Board hearing as part of the increased rating appeal, and the Veteran testified that VA vocational rehabilitative counseling determined in 2007 that he was unable to be retrained and maintain gainful employment, a remand to provide proper TDIU notice and obtain vocational rehabilitation records is needed. The matters are REMANDED for the following actions: 1. Obtain the Veteran’s VA treatment records from July 2014 to the present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of the service-connected lung cancer residuals. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the service-connected lung cancer residuals alone and discuss the effect of the Veteran’s lung cancer residuals on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The examiner should discuss whether and to what extent the right lobe resection causes any current difficulty in breathing. The examiner should also discuss whether any current respiratory symptoms and functional impairment attributable to the nonservice-connected COPD are distinguishable from respiratory symptoms and functional impairment attributable to lung cancer residuals and, if so, explain why/how such a distinction can be made. 3. Provide the Veteran with TDIU notice. 4. Obtain the Veteran’s vocational rehabilitation records. S. C. KREMBS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Ferguson, Counsel