Citation Nr: 18148125 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 15-24 467 DATE: November 6, 2018 REMANDED Service connection for a bilateral lung disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1962 to December 1963. The case is on appeal from an August 2013 rating decision. In June 2017, the Board remanded the matter for further development. Further action to ensure compliance with the Board’s remand directives is needed. Service connection for a bilateral lung disorder is remanded. The Veteran seeks service connection for a current lung disorder, which he contends is related to his exposure to Napalm during service. He adds that he was not issued any protection while using Napalm. Military records confirm that the Veteran trained with a portable flame thrower and worked on a Flame Thrower vehicle during service, and the Veteran’s exposure to Napalm during service has been conceded. See October 2017 Administrative Decision. Service treatment records (STRs) contain no record of any lung complaints. However, blood work done less than a year after the Veteran’s separation from service found hypochromia and anisocytosis with macrocytosis; and private medical records dating from 1970 chronicle years of breathing/respiratory complaints, including cough, shortness of breath, and dyspnea on exertion; diagnosed over the years as sarcoidosis, restrictive lung disease, obstructive lung disease, bronchiectasis, and asthma; and treated over the years with steroids, antibiotics, anti-inflammatories, and dilators. VA medical records confirm that the Veteran, a lifelong non-smoker, currently suffers from multiple lung disorders, including centrilobular emphysema, bronchiectasis, and calcified pleural plaques. See, e.g., March 20, 2013 CT scan report, which reflects diagnoses of “Centrilobular emphysema” and “Stable right-sided basilar pleural calcification, presumed postinflammatory or posttraumatic.” See also July 2003 CT scan report. In November 2012, the Veteran filed his claim for service connection for a bilateral lung disorder. In support of his claim he submitted an article entitled “Napalm and its Effects on Human Beings,” which describes the obvious catastrophic physical effects of Napalm on human beings, and the internal injury that takes place. According to the author, Once combined with haemoglobin, carbon monoxide suppresses the oxygen carrying capacity of the blood pigment, thereby inhibiting the function of haemoglobin in supplying oxygen to the tissues. Carbon monoxide also seems to have an effect on the iron-containing cells and combines readily with the respiratory enzymes, bringing about direct disturbances of cellular respiration in addition to those caused by the lack of oxygen. The chemical effects of carbon monoxide depend on its concentration in the surrounding air. With as little as one per cent, it is toxic. In correspondence dated in April 2014, the Veteran stated that a VA pulmonologist had told him “that Napalm could have been the source of my bilateral lung conditions.” The Veteran added that he did not know if that physician had included those remarks in the Veteran’s records. In June 2017, the Board remanded the matter for further development, including a Formal Finding regarding the Veteran exposure to Napalm during his stateside service, and then a VA examination. As noted above, in an Administrative Decision dated in October 2017, the Veteran’s exposure to Napalm during service was conceded. In November 2017, a VA examination was done. During the examination the Veteran complained of increasing shortness of breath. According to the examiner, the Veteran’s current lung disorders include asthma; emphysema; and calcified pleural plaques. The examiner then averred that it is less likely than not that the Veteran’s asthma and emphysema is the result of Napalm exposure in the service on the grounds that chest x-rays in 1964 were “normal” and “there are no studies that show a causal relationship of napalm including when ignited and late onset asthma.” However, the Board observes that the exact phraseology on the 1964 chest x-ray report was “essentially negative.” Moreover, and contrary to the Board’s June 2017 remand directives, the examiner did not discuss the articles submitted by the Veteran on the effects of Napalm; which is particularly remiss in light of the hemoglobin abnormalities discovered by VA in 1964. Additionally, while the 2013 CT scan diagnosis was calcified plaques of “inflammatory or traumatic origin,” the 2017 VA examiner simply stated the plaques were not due to Napalm exposure and provided no rationale for that assertion/did not discuss the matter further. The Board thus finds that the Veteran should be afforded a new VA examination. The matter is REMANDED for the following action: Schedule the Veteran for an examination by an appropriate physician (preferably a Lung disorders or Pulmonology Specialist, if possible but not required) for an opinion regarding the issue of service connection for a lung disorder. The entire claims file must be reviewed. The examiner is then requested to opine, for each lung disorder found on examination and in treatment records (including, but not limited to centrilobular emphysema, bronchiectasis, calcified pleural plaques, and asthma), whether it is at least as likely as not that the disorder began during, or is related to, any incident of active duty service, including the Veteran’s work with flame throwers and exposure to Napalm during service. In formulating this opinion, the examiner must address the 1964 laboratory findings of hypochromia and anisocytosis with macrocytosis; and the articles submitted by the Veteran regarding the effects of Napalm. (Continued on the next page)   A discussion of the facts of the case and the scientific and medical principles involved will be of considerable assistance to the Board. JOHN J. CROWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Childers, Counsel