Citation Nr: 18145942 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 16-33 168 DATE: October 30, 2018 REMANDED Entitlement to service connection for a pulmonary disorder, to include chronic obstructive pulmonary disease (COPD), hypoxemic respiratory failure emphysema, pleural calcified plaque, and pleural nodules, to include as due to exposure to asbestos, is remanded. Entitlement to an initial compensable rating for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from May 1969 to May 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Anchorage, Alaska. A videoconference Board hearing was held at the RO in August 2018 before the undersigned Veterans Law Judge (VLJ) and the hearing transcript has been obtained and associated with the record. A claim for service connection may encompass claims for service connection of any condition that may reasonably be encompassed by several factors, including the Veteran’s description of the claim, the symptoms the Veteran describes and the information the Veteran submits or that the Secretary obtains in support of the claim. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). In light of the diagnoses in the Veteran’s medical treatment records, the issue on appeal has been characterized as entitlement to service connection for a pulmonary disorder, to include chronic COPD, hypoxemic respiratory failure, emphysema, pleural calcified plaque, and pleural nodules, to include as due to exposure to asbestos, so as to consider all reported symptoms in accordance with Clemons. The appeals are REMANDED to the Agency of Original Jurisdiction (AOJ). VA will notify the appellant if further action is required. 1. Entitlement to service connection for a pulmonary disorder, to include COPD, hypoxemic respiratory failure, emphysema, pleural calcified plaque, and pleural nodules, to include as due to exposure to asbestosis The Veteran contends that his pulmonary disorders were caused by exposure to asbestos and other toxic fumes during his military service onboard the USS Oriskany as a boiler attendant from 1969 to 1971. The Veteran’s DD 214 confirmed that he was onboard the USS Oriskany and that his military occupational specialty was FN or fireman, which has a highly probable designation regarding asbestos exposure. He further testified at the August 2018 Board hearing that he worked maintaining and cleaning the boilers. He stated it was hot and dirty work where he breathed in the fumes and vapors. He stated his skin was covered with soot from the boilers. The Veteran described crawling inside the boilers to clean and scrape the soot of the pipes. The Veteran testified he noticed respiratory symptoms during the first week of his duties which including coughing, a dry mouth, runny nose, shortness of breath. The Veteran also submitted articles which stated that Navy veterans tasked with maintaining the carriers’ boilers and engine rooms were at high risk for exposures. Resolving reasonable doubt in favor of the Veteran, the Board finds that he was exposed to asbestos during active service. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. In an August 2018 medical opinion, Dr. HP, opined that the Veteran’s disabilities were caused by or a result of Naval boilerwork and toxic fume exposures. A medical examination report must contain a reasoned medical explanation for any opinion provided. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Given the Veteran’s lay statements that his symptoms started soon after he began his duties working on boilers, the diagnoses of record, the Veteran’s contention that he was exposed to asbestos and other toxic exposures (such as fumes and soot), and the positive nexus opinion without a rationale, a VA clarification and opinion is warranted. 2. Entitlement to an initial compensable rating for bilateral hearing loss Remand is required for a current VA examination. When a claimant asserts, or the evidence shows, that the severity of a disability has increased since the most recent rating examination, an additional examination is appropriate. VAOPGCPREC 11-95 (April 7, 1995); Snuffer v. Gober, 10 Vet. App. 400 (1997). Here, according to the Veteran July 2016 Substantive Appeal, he stated that his bilateral hearing loss has gotten worse has he has a “very difficult time of hearing.” The Board notes that the most recent VA audiological examination took place in January 2015. Therefore, given the Veteran’s contention that his bilateral hearing loss has worsened, a new VA examination to determine the current severity is warranted. The matters are REMANDED for the following action: 1. Contact the appropriate VA Medical Center(s) and obtain and associate with the claims file all outstanding records of treatment since June 2016. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified and this should be documented for the record. Required notice must be provided to the Veteran and his representative. 2. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 3. After any additional records are associated with the claims file, obtain an opinion regarding the etiology of each diagnosed pulmonary disorder, to include COPD, hypoxemic respiratory failure, emphysema, pleural calcified plaque, and pleural nodules. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that each diagnosed pulmonary disorder, to include COPD, emphysema, pleural calcified plaque, and pleural nodules, had onset in, or is otherwise related to, active service. For purposes of the examination only, the examiner must presume the Veteran was exposed to asbestos, soot, and other toxic fumes. The VA examiner is asked to address the relevant service treatment records, post-service treatment records, the August 2018 opinion from Dr. HP and the attached images, and the Veteran’s lay statements regarding his symptomatology. 4. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to determine the severity of the service-connected bilateral hearing loss. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The relevant Disability Benefits Questionnaire must be utilized. 5. Notify the Veteran that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claims, and that the consequences for failure to report for a VA examination without good cause may include denial of the claims. 38 C.F.R. §§ 3.158, 3.655 (2018). In the event that the Veteran does not report for any scheduled examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Yoo, Counsel