Citation Nr: 18152382 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 16-15 480A DATE: November 21, 2018 REMANDED Entitlement to a higher initial disability rating for service-connected lung cancer, status post lobectomy with chronic obstructive pulmonary disease and interstitial fibrosis, currently evaluated as 10 percent disabling prior to May 31, 2017 and 30 percent thereafter, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from February 1966 to January 1970. In an August 2018 statement, the Veteran requested that his appeal be advanced on the docket due to his terminal illness. His private physician wrote a letter of support, also in August 2018, stating that the Veteran has had increasing trouble breathing from year to year with reduction in his projected life span, and that pulmonary fibrosis is a fatal illness without any curative remedies. The motion to advance the case on the docket is granted and the appeal is advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). The Veteran was provided with VA examinations assessing the severity and manifestations of his service-connected lung cancer, status post lobectomy with chronic obstructive pulmonary disease and interstitial fibrosis in August 2015, January 2016, and June 2018. Pulmonary Function Tests (PFTs) were performed at each of these examinations; with the examiners stating that the following tests most accurately reflected the Veteran’s level of disability: FEV-1/FVC at the August 2015 and June 2018 exams; and FEV-1 percent predicted at the January 2016 exam. In the August 2018 letter arguing that the Veteran’s disability warranted a higher disability rating, the Veteran’s private physician highlighted recent DLCO and FVC findings. As the various test results on PFTs conducted on certain dates are of sufficient disparity that the schedular evaluation would differ depending on which test result is used, explanation is found needed as to why a certain test result would most accurately reflect the level of disability. Further, given the “significant reduction” in lung functioning noted by the Veteran and reflected by PFTs performed in March 2018 and June 2018, an additional VA examination should be conducted to determine whether such decline has continued. As the Board is remanding this matter for further development, it should be noted that although the Veteran’s VA treatment records note that the Veteran is being followed at an INOVA hospital by a Dr. S. N. for his pulmonary fibrosis, private treatment records from this facility, other than a few from May 2017 and September 2017, are not of record. See April 2014 VA pulmonary outpatient note. The VA treatment records indicate that such records have been scanned into the Vista database, but the Board does not have the ability to access such records. On remand, if the Veteran’s INOVA treatment records are located in Vista, they should be associated with the claims file. If, however, such records are not in VA’s possession, the Agency of Original Jurisdiction should contact the Veteran and request any authorization necessary so that VA can obtain these records on his behalf. The matter is REMANDED for the following action: 1. Obtain any and all of the Veteran’s VA treatment records from June 2018 to the present. Additionally, obtain a copy of any relevant scanned reports from Vista Imaging or any other appropriate electronic records system, to include any concerning the Veteran’s private pulmonary treatment through INOVA and Dr. S. N, and associate them with the claims file. 2. Ask the Veteran to submit a new or updated VA Form 21-4142 for any relevant updated and/or outstanding private treatment records (i.e., those not presently associated with the claims file), including those pertaining to pulmonary treatment through INOVA and Dr. S. N. if not already available via Vista. Thereafter, make two requests for the identified and authorized records unless it is clear after the first request that a second request would be futile. Note: The Board is using initials to protect the identity of the Veteran. In all correspondence to the Veteran, the full name of the treatment provider should be used in order to aid him in responding to the request. 3. After associating all responsive documents with the claims file, schedule the Veteran for a VA examination by an examiner with sufficient expertise to fully assess the severity of the Veteran's service-connected pulmonary disorder. All pertinent evidence of record should be made available to and reviewed by the examiner. Any indicated studies, including PFTs, should be performed. Ensure the examiner provides all information required for rating purposes. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary, he or she should be directed to clearly explain why that is so. The examiner should state which pulmonary function test most accurately reflects the Veteran’s level of disability, and provide an explanation as to why that is so. To the extent possible, the examiner should address the determinations at the prior August 2015 and June 2018 examinations that FEV-1/FVC was the most accurate reflection, and at the January 2016 examination that the FEV-1 percent predicted was the most accurate reflection of the Veteran’s level of disability (e.g. are such determinations made on an observational basis at the time of examination and/or is a particular test result considered most reflective of disability resulting from this veteran’s particular service-connected pulmonary condition(s)?). (Continued on the next page)   4. After completing the above, and reviewing the requested medical examination report and opinion for completeness, conduct any further development deemed necessary in light of the expanded record and readjudicate the issue of entitlement to a higher initial disability rating for service-connected lung cancer, status post lobectomy with chronic obstructive pulmonary disease and interstitial fibrosis. If the benefits sought remain denied, the Veteran and his representative must be furnished a Supplemental Statement of the Case and given an opportunity to respond before the claims file is returned to the Board for further appellate consideration, if in order MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Solomon, Counsel