Citation Nr: 18153848 Decision Date: 11/29/18 Archive Date: 11/28/18 DOCKET NO. 15-14 331 DATE: November 29, 2018 REMANDED Entitlement to service connection for a respiratory disorder, claimed as a cough, congestion, and breathing problems due to burn pits, is remanded. REASONS FOR REMAND The Veteran had active service from September 2012 to September 2013, to include service in Afghanistan from November 2012 to August 2013. He also had prior and subsequent reserve service, including periods of active duty for training from June 2002 to August 2002 and June 2003 to September 2003. The Veteran was awarded the Combat Action Badge (CAB), among other decorations. On his April 2015 substantive appeal, the Veteran requested a video conference hearing. In an October 2018 correspondence, he withdrew his prior request for a hearing. As the record does not contain any additional requests for an appeals hearing, the Board deems the Veteran’s request for a hearing to be withdrawn. See 38 C.F.R. § 20.702 (2018). 1. Entitlement to service connection for respiratory disorder is remanded. Although the further delay entailed by remand is regrettable, current adjudication of the Veteran’s claims would be premature. Undertaking additional development prior to a Board decision is the only way to ensure compliance with the duty to assist, as required. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2018). The Veteran claims that his respiratory symptoms, including a cough, congestion, and breathing problems, are related to exposure airborne hazards during service, to include exposure to fumes from burn pits. In March 2014, the Veteran underwent a VA Gulf War General Medical Examination, which included a respiratory conditions examination. During the clinical evaluation, the Veteran reported exposure to multiple airborne toxins to include cesspool odors (no direct physical contact or handling of fecal materials), burn pit smoke/fumes, kerosene heater fumes, diesel exhaust/fumes, JP8 fuel (direct-handling as well as fumes), dust from convoy operations, and dust storms without the benefit of respiratory protection. He reported that he developed a non-productive cough with dry hacking. No complaints of fever, chills, or night sweats were indicated. He indicated that his symptoms have persisted since his discharge from active service. A radiological evaluation of the Veteran’s chest, dated January 2014, revealed normal findings. However, a prior evaluation in October 2013 revealed scattered bilateral peribronchial cuffs, right greater than left, and a dense nodule around the right 5th-6th posterior rib interspace, which was consistent with a granuloma. No focal consolidations or pleural effusions were seen. The examiner indicated that the Veteran did not currently have and had never been diagnosed with a respiratory condition. However, the examiner suggested that the Veteran’s disability pattern represented a diagnosable chronic multi-symptoms illness with a partially explained etiology. In support of the stated conclusion, the opinion noted that the claimed exposures were consistent with study results in published medical journals and texts, referencing known exposures in the region. Thus, despite the absence of a formal diagnosis, the examiner indicated that the Veteran’s condition appears diagnosable, although one has not yet been considered. The examiner opined that the Veteran’s respiratory disability pattern was is at least as likely as not caused by or is a result of his airborne hazardous exposures during his Southwest Asia tour. While the examiner indicated that the Veteran had service in Southwest Asia, the Board notes that the Veteran’s service in Afghanistan is not considered to be within the Southwest Asia theater of operations for establishing service connection under 38 C.F.R. § 3.317 for diseases and disorders associated with undiagnosed illness or chronic multisymptom illness of unknown etiology. Accordingly, the Board finds that further clarification is required to determine whether the Veteran has a current disability for which service connection may be granted. Additionally, the record indicates that the Veteran’s continues to serve in the Connecticut Army National Guard. Thus, on remand all updated service treatment records, including any periodic health assessments, should be obtained. Therefore, this matter is REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities. After securing any necessary releases, the AOJ should request any relevant records identified. In addition, obtain updated VA treatment records. If any requested records are unavailable, the Veteran should be notified of such. 2. Obtain the Veteran’s complete service treatment records, to include documents pertaining to his ongoing service in the Connecticut Army National Guard. Document all requests for information as well as all responses in the claims file. If any requested records are unavailable, the Veteran should be notified of such. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any respiratory condition. All indicated tests should be conducted and the results reported. The examiner must identify any respiratory disorder present since September 2013 and address the significance, if any, of the October 2013 chest x-ray findings, including the impression of scattered bilateral peribronchial cuffs and a likely granuloma. For any diagnosed respiratory condition, the examiner must opine whether it is at least as likely as not incurred during service, or is otherwise related to service, to include the Veteran’s reported exposure to cesspool odors, burn pit smoke/fumes, kerosene heater fumes, diesel exhaust/fumes, JP8 fuel, dust from convoy operations, and dust storms. In so opining, the examiner should specifically note the Veteran’s reports of a persistent dry cough during and since active service and his August 2013 Post Deployment Health Re-Assessment where he endorsed having a cough for more than three weeks and was assessed with a “chronic cough.” A complete rationale should be provided for all opinions and conclusions expressed. If the examiner is unable to offer an opinion 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). 4. Thereafter, re-adjudicate the claim. If the benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC) and an adequate opportunity to respond before returning the matters to the Board for further adjudication, if otherwise in order. J. A. Anderson Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Whitaker, Associate Counsel