Citation Nr: 18152596 Decision Date: 11/23/18 Archive Date: 11/23/18 DOCKET NO. 15-02 038 DATE: November 23, 2018 REMANDED Entitlement to service connection for a respiratory disorder, to include chronic obstructive pulmonary disease (COPD), is remanded. Entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to service-connected IHD and/or diabetes mellitus, and/or claimed psychiatric disorders, is remanded. Entitlement to an evaluation in excess of 10 percent for ischemic heart disease (IHD) with ischemic cardiomyopathy, to include the propriety of the reduction from 100 percent to 10 percent disabling, effective October 1, 2014, is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran had active duty service from September 1964 to August 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from July 2011, July 2014, and October 2017 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board hearing in July 2018. Regardless of the appeal of the TDIU issue independent of the claim filed in March 2017, the Board has jurisdiction over that claim as part and parcel of the claim for increased evaluation of the Veteran’s IHD. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Initially, the PTSD and OSA claims were denied by the AOJ in an October 2016 rating decision. The Veteran submitted a timely Notice of Disagreement, VA Form 21-0958, with respect to those issues in February 2017. As of this decision, the AOJ has not issued a statement of the case as to those issues. Accordingly, the Board must remand those issues. See Manlincon v. West, 12 Vet. App. 238 (1999); see also 38 C.F.R. § 19.9(c). Regarding the respiratory issue, the evidence demonstrates that the Veteran has been diagnosed as having COPD/emphysema. The Veteran has asserted on appeal, and particularly during his July 2018 hearing, that his respiratory disorder is related to his herbicide exposure during service. Alternatively, he has contended that he was exposed to asbestos during his service aboard naval vessels and that his bunk was below the gun deck and that his bunk would be covered in asbestos after the guns fired. VA has already conceded that the Veteran is presumed to have been exposed to herbicides as a result of his service, and IHD and diabetes mellitus are service connected. Likewise, the Veteran is shown to have served on naval vessels during his period of service. As of this time, no VA examination has been afforded to the Veteran. Consequently, the Board finds that the low threshold for obtaining a VA examination in this case has been met and a remand is necessary in order for such to be accomplished. See 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Regarding the IHD issue and the propriety of the reduction, the Board notes that the initial 100 percent evaluation was based on an April 25, 2012 Disability Benefits Questionnaire (DBQ) completed by his private physician. In that DBQ, Dr. F.E.G. noted that a diagnostic exercise test had been performed in April 2012, which yielded a finding of 7.0 METs. He additionally noted that a diagnostic exercise test had not been completed, indicated that the Veteran had dyspnea and fatigue, and checked both the boxes indicating estimates of 1-3 METs and >3-5 METs. Dr. F.E.G. also noted that the Veteran had a chronic respiratory disorder that affected his METs. Dr. F.E.G. filled out another DBQ examination form in January 2014 that noted the April 2012 stress test which yielded a finding of 7.0 METs. The form also indicated that a diagnostic exercise test had not been completed and checked of boxes indicating estimates of 1-3 and >3-5 METs. Based on the internal inconsistency noted in both the April 2012 and January 2014 DBQs, the Board finds that a remand of the IHD issue is necessary in order to clarify those reports with Dr. F.E.G. See Savage v. Shinseki, 24 Vet. App. 259 (2011) (VA has a duty to return for clarification unclear or insufficient examination reports even when they do not originate from VA medical personnel). Moreover, it does not appear that any attempt to obtain the April 2012 diagnostic exercise test noted in Dr. F.E.G.’s DBQ has been made, nor does it appear that any treatment records from Dr. F.E.G. other than the submitted DBQ’s have been obtained. Accordingly, on remand, the Board also finds that any outstanding private and VA treatment records should also be obtained. See 38 U.S.C. § 5103A(b), (c); 38 C.F.R. § 3.159(b). Finally, the TDIU issue is remanded as inextricably intertwined with the above remanded issues. See Henderson v. West, 12 Vet. App. 11, 20 (1998); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matter is REMANDED for the following action: 1. Furnish to the Veteran and his representative a statement of the case with regard to the claims of service connection for a psychiatric disorder, to include PTSD, and obstructive sleep apnea, to include as secondary to service-connected IHD and/or diabetes mellitus, and/or claimed psychiatric disorders. The issues should be returned to the Board only if a timely substantive appeal is received. 2. Obtain any and all VA treatment records not already associated with the claims file from the Seattle, Charleston, Jacksonville, and Gainesville VA Medical Centers, or any other VA medical facility that may have treated the Veteran and associate those documents with the claims file. 3. Attempt to contact Dr. F.E.G. and to clarify the April 2012 and January 2014 DBQ findings with respect to the METs findings from the diagnostic exercise test in April 2012 with the discrepancy in his estimated METs findings in section 4B of those reports. In particular, Dr. F.E.G. should be asked to clarify whether a diagnostic exercise test was conducted, and if so, to explain the inconsistency stated in section 4B. 4. Ask the Veteran to identify any private treatment that he may have had for his IHD and respiratory disorders, which is not already of record, to include any treatment records from Dr. F.E.G., as well as a copy of the April 2012 diagnostic exercise test noted in the April 2012 and January 2014 DBQ reports. After securing the necessary releases, attempt to obtain and associate those identified treatment records with the claims file. If any identified records cannot be obtained and further attempts would be futile, such should be noted in the claims file and the Veteran should be notified so that he can try to obtain those records on his own behalf. 5. Ensure that the Veteran is scheduled for a VA examination with an appropriate examiner in order to determine whether his respiratory disorder is related to his service. The claims folder must be made available to and be reviewed by the examiner. All tests deemed necessary should be conducted and the results reported in detail. Following examination of the Veteran and review of the claims file, the examiner should state all respiratory disorders found, to include COPD and/or emphysema. For any respiratory disorders found, the examiner should opine whether such at least as likely as not (50 percent or greater probability) began in service or is otherwise the result of military service, to include any exposure to asbestos he may have had due to his service aboard naval vessels, as well as any herbicide exposure he had during military service. The examiner is to accept as conclusive fact that the Veteran was exposed to herbicides during his military service. Finally, in addressing the above opinions, the examiner should consider any of the Veteran’s lay statements of record regarding onset of symptoms and any continuity of symptomatology since onset and/or since discharge from service. Finally, the examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Peters, Counsel