Citation Nr: 18161237 Decision Date: 12/31/18 Archive Date: 12/31/18 DOCKET NO. 15-01 903 DATE: December 31, 2018 REMANDED Entitlement to service connection for chronic bilateral shoulder pain is remanded. Entitlement to service connection for chronic neck pain due to degenerative arthritis is remanded. Entitlement to a rating in excess of 60 percent from February 8, 2013 for asthma is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from October 1987 to February 1990. This appeal to the Board of Veteran’s Appeals (Board) arose from a March 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office. The Veteran has perfected a timely appeal. See June 2013 Notice of Disagreement; February 2014 Statement of the Case (SOC); December 2014 Substantive Appeal (VA Form 9). The Veteran requested a hearing before the Board. The requested hearing was conducted in July 2018 by the undersigned Veterans Law Judge. A transcript of the hearing is associated with the file. The Board notes that during the July 2018 hearing, the Veteran asserted that he was satisfied with the 30 percent rating assigned from April 23, 2012 to February 8, 2013. The Board withdrew that aspect of the appeal. Therefore, as it concerns the issue of an increased rating for asthma, the Board will only consider if the Veteran is entitled to a rating in excess of 60 percent from February 8, 2013. 1. Entitlement to service connection for chronic bilateral shoulder pain and chronic neck pain due to degenerative arthritis is remanded. After a thorough review of the Veteran's claims file, the Board has determined that additional evidentiary development is necessary prior to the adjudication of the Veteran’s claims of entitlement to service connection for chronic bilateral shoulder pain and chronic neck pain due to degenerative arthritis. The Veteran asserts that his current neck and shoulder conditions are due to an event that occurred in service. Specifically, the Veteran states that a bunkbed fell on top of him, rendering him unconscious. He was taken to the hospital for treatment. Since that incident, the Veteran maintains that he has experienced pain due to that event. The service treatment records do note the bunkbed incident detailed by the Veteran and hospital treatment records as a result of that incident. The Veteran was afforded a VA examination for his neck and shoulders in March 2013. The examiner noted the Veteran’s claim that a bunkbed fell on top of him during service. The examiner opined that his neck and shoulder pain are due to mild degenerative arthritis in the cervical spine. The examiner opined that it is not caused by an in-service injury due to that fact that the condition is a natural progressive change in joint, and the inability to locate any documented civilian medical records from 1990 to 2011 with treatment of neck and shoulder problems. Private medical records were received subsequent to the examination. In a December 2014 addendum opinion, the examiner’s rationale, after review of the private medical records, for the negative nexus opinion was that his October 1989 physical examination before separation showed normal shoulder and cervical spine condition. In a VA medical letter dated June 2013, a VA nurse practitioner stated that the Veteran has been under his care for chronic neck and back pain. MRI testing showed degenerative disc disease of the cervical spine with mild compression deformity of the C5, C6, and C2 with disc desiccation. It was his opinion that the Veteran’s injury is at least likely than not related to the injury he sustained when the bunkbed collapsed on him during service. No further rationale was provided to support this conclusion. The Veteran’s service treatment records detailing the bunkbed incident and his treatment at a hospital were added to the claim’s file subsequent to the VA examination and the opinion. There is no indication that the VA nurse practitioner reviewed the service treatment records when rendering his opinion. The Board finds that the current medical nexus opinions of record are not sufficient to determine whether there is a nexus between the Veteran’s current conditions and his in-service injury. The Board finds that a remand is necessary in order to obtain another examination and opinion that includes the review of the service treatment records. 2. Entitlement to a rating in excess of 60 percent from February 8, 2013 for asthma is remanded. After a thorough review of the Veteran's claims file, the Board has determined that additional evidentiary development is necessary prior to the adjudication of the Veteran’s claim of entitlement to a rating in excess of 60 percent for his service-connected asthma from February 8, 2013. The Veteran contends that his condition is more severe than what is reflected in the 60 percent rating. In the last VA respiratory examination conducted June 2016, the results of the pulmonary function test were considered invalid. The examiner stated that the results of the test were questionable due to the Veteran’s inability to perform the maneuvers according to the ATS standards. Further, the examiner stated that the Veteran’s poor efforts transitioned into noncompliance when he no longer followed commands despite instruction, demonstration, and coaching. Since the FEV-1 scores are a part of consideration for the 100 percent criteria, and affording the Veteran the benefit of the doubt, the Board finds it necessary that a new examination is warranted for a new pulmonary function test to be conducted in order to determine those results. The matters are REMANDED for the following action: 1. Provide the Veteran an opportunity to identify any pertinent treatment records for his claimed disabilities of chronic neck and shoulder pain and asthma. The RO/AMC should secure any necessary authorizations. 2. Additionally, all updated VA treatment records should be obtained. If any requested outstanding records cannot be obtained, the Veteran should be notified of such. 3. Once all available, relevant medical records have been received, and associated with the claims file, the AOJ should refer the Veteran's entire claims file to a medical professional of appropriate expertise to provide an addendum opinion (or, if the VA examiner determines that it is necessary, schedule the Veteran for a VA examination) to address the nature and etiology of the Veteran’s diagnosis of chronic neck pain due to degenerative arthritis and chronic shoulder pain. The claims file and a copy of this REMAND should be made available to the examiner for review. After record review and examination, the VA examiner should offer his or her opinion with supporting rationale as to the following inquiries: (a) Does the Veteran have a current diagnosis of chronic neck pain due to degenerative arthritis and chronic bilateral shoulder pain? (b) If the answer to (a) is yes, is it at least as likely as not (50 percent or greater probability) that the Veteran's conditions were incurred in, caused by, or etiologically related to the Veteran's service? The examiner should address the in-service bunkbed incident and hospital treatment records when rendering the opinion. 4. Schedule the Veteran for a VA respiratory examination to determine the current nature and severity of his service-connected asthma. Any and all indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished, including pulmonary function test. The claims file should be made available to the examiner for review. a) Conduct a pulmonary function test, including FEV-1 and FEV-1/FVC results. The report of the result should be incorporated into the examination report. b) Discuss the frequency and duration of any use of systemic (oral or parenteral) high dose corticosteroids or immuno-suppressive medications since February 8, 2013. The frequency of the Veteran's attacks with episodes of respiratory failure should be discussed. The basis for each opinion is to be fully explained with a complete discussion of the pertinent lay and medical evidence of record and sound medical principles, including the use of any medical literature or studies, which may reasonably explain the medical analysis in the study of this case. All opinions should be supported by a clear rationale, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Syesa Middleton, Associate Counsel