Citation Nr: 20003377 Decision Date: 01/14/20 Archive Date: 01/14/20 DOCKET NO. 17-64 625 DATE: January 14, 2020 REMANDED Entitlement to a rating in excess of 20 percent for the residuals of a shell fragment wound to the right lung is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from March 1967 to March 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2017 rating decision by the Nashville, Tennessee, Regional Office (RO) of the Department of Veterans Affairs (VA). 1. Entitlement to a rating in excess of 20 percent for the residuals of a shell fragment wound to the right lung is remanded. The Veteran contends that his service-connected residuals of a shell fragment wound to the right lung has worsened. In an October 2019 brief in support of the claim his service representative asserted that a September 2016 VA examination was not consistent and did not fully consider the Veteran’s lay statements and contentions. The specific statements and contentions believed to be pertinent to the claim were not identified. The September 2016 VA examiner found post-bronchodilator testing was not completed and noted that such testing was not indicated due to the absence of signs of obstruction and the potential risk from cardiac effects and possible arrhythmias. There is no indication that the VA examiner considered these bronchodilator concerns to be permanent. A November 2017 statement of the case continued the assigned 20 percent rating under diagnostic code 6818 as continuously rated at that level for 20 years or more. It is significant to note, however, that effective October 7, 1996, VA revised its rating criteria for traumatic respiratory injuries, removing diagnostic code 6818 and creating diagnostic code 6843 for traumatic chest wall defect that was to be rated under a general rating formula for restrictive lung diseases. See 61 Fed. Reg. 46,728 (Sep. 5, 1996). Although post-bronchodilator studies are not required under the revised criteria, 38 C.F.R. § 4.96(d)(4), when the examiner determines that they should not be done and states why, as the Veteran contends his service-connected disability has increased in severity an additional examination is required for an adequate determination. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from September 2016 to the present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected residuals of a shell fragment wound to the right lung. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria, to include consideration of any specific lay statements and contentions. Pulmonary function tests (PFT’s) are required, unless specifically exempted based upon maximum exercise capability testing, diagnoses such as pulmonary hypertension, episodes of acute respiratory failure, or required outpatient oxygen therapy. Post-bronchodilator studies are required if PFT’s are completed, unless the examiner determines that they should not be done and states why. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, based on the other evidence of record and the Veteran’s statements. If it is not possible to provide a specific measurement 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). MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Douglas The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.