Citation Nr: 18159589 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 15-00 686A DATE: December 20, 2018 REMANDED Entitlement to service connection for chronic obstructive pulmonary disease, to include as secondary to service-connected deviated septum, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1950 to December 1957. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) denying the Veteran’s claim for service connection for chronic obstructive pulmonary disease (COPD). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). In September 2017, the Board reopened the claim for service connection for COPD and remanded for a complete VA examination, including consideration of the Veteran’s theory that his COPD is related to the fact that, because he can no longer breathe through his nose due to the service-connected septectomies, the air he breathes through his mouth is less well-filtered. In March 2018, the Board again remanded because the opinion provided after the September 2017 remand failed to discuss the possibility of a relationship between COPD and reduced air filtration of breathing through the mouth. Though the Veteran was scheduled for a VA examination after the March 2018 Board decision, in October 2018 the examination was canceled at the Veteran’s request. There is not of record any good cause or other explanation of why the Veteran canceled the examination. The Veteran maintains that an August 2011 letter from Dr. V.T., his VA primary care physician, suggested that the Veteran’s service-connected condition could be affecting his COPD. Within this letter, Dr. V.T. states that the Veteran was under his care, and the Board also notes an excerpt of a VA record that listed Dr. V.T.’s name next to some of the Veteran’s diagnoses. As Dr. V.T. has stated that he treated the Veteran for COPD and has suggested that the claimed nexus may exist, treatment records from Dr. V.T. would be relevant to the matter at hand. Unfortunately, those records are not within the claims file, and no attempt has yet been made to obtain them. The Board must therefore remand for these records. Sullivan v. McDonald, 815 F.3d 786 (Fed. Cir. 2016); 38 U.S.C. § 5103A(c); 38 C.F.R. § 3.159(c)(2). Given that the Board is remanding the matter, the Board will also direct the RO to offer the Veteran another VA examination notwithstanding the unexplained cancelation of the previously scheduled examination. The Board notes that pursuant to 38 C.F.R. § 3.655, when entitlement to a reopened claim cannot be established without an examination and the claimant, without good cause, fails to report for such examination, the claim must be denied. 38 C.F.R. § 3.655(a), (b). (Please note, this appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). Expedited handling is requested.) Accordingly, the matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records from Bakersfield VA Outpatient Clinic, to include treatment records of Dr. V.T., the Veteran’s physician who in an August 2011 letter indicated that the Veteran was under his care. 2. Then, arrange for the Veteran to undergo a VA respiratory examination with a pulmonary specialist to address the current nature and etiology of his COPD. The claims file must be made available to the examiner for review. The examiner is asked to review the pertinent evidence, including the Veteran’s lay assertions regarding the history of his symptomatology, and undertake any indicated studies. Based on the examination results, the examiner is asked to provide an expert medical opinion on each of the following questions: (i) Is it at least as likely as not (i.e., at least equally probable) that the Veteran’s COPD had its onset directly during the Veteran’s service or is otherwise causally related to any event or circumstance of his service, to include a septectomy in service? (ii) Is it at least as likely as not that the Veteran’s COPD was caused or aggravated by his service-connected residuals status post-septectomy? Please specifically discuss the Veteran’s statements that he can only breathe through his mouth, which results in him breathing unfiltered air through his mouth, thereby exposing his lungs to additional contaminants that otherwise would have been screened out by breathing through his nose. Also, please discuss the August 4, 2011 letter from Dr. V.T. suggesting a link between the nasal obstruction and the COPD, as well as the March 5, 2014 VA treatment record indicating a possible relationship between the Veteran’s breathing through his mouth and the COPD. In answering these questions, please articulate the reasons supporting all conclusions. Identify what facts and information, whether found in the record or outside the record, support your opinion, and explain how that evidence justifies your opinion. K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Davis, Associate Counsel