Citation Nr: 20006659 Decision Date: 01/28/20 Archive Date: 01/27/20 DOCKET NO. 17-21 333 DATE: January 28, 2020 REMANDED Entitlement to service connection for a respiratory disability manifested as chronic cough is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from April 1995 to April 1999 and from March 2001 to March 2005 including deployments to Iraq and Afghanistan. He was awarded the Combat Action Ribbon. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a March 2015 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a December 2019 hearing, and a transcript of this hearing is of record. Entitlement to service connection for respiratory disability Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran’s claim so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The Veteran contends that he experiences a chronic cough caused by exposure to burn pits while deployed in Iraq and Afghanistan. See December 2019 Hearing Transcript. Service treatment records are silent for symptoms, diagnoses, or treatment for a respiratory disorder. In a December 2004 discharge physical examination, the Veteran denied any asthma, breathing problems, shortness of breath, wheezing, or use of an inhaler, and the examiner noted no respiratory system abnormalities. The Veteran was afforded a VA examination in February 2015. The examiner stated that the “Veteran complains of chronic nonproductive cough. There has been no medical diagnosis associate with this.” See February 2015 C&P Exam, p. 1. The examiner opined that “the Veteran complains of a chronic cough but does not meet diagnostic criteria for a respiratory disability. Cough is a symptom and not a diagnosis.” Id at. 2. Finally, the examiner opined that “no increased risk of cough was found to be associated with service in the Gulf War. Therefore, based on the rationale detailed above, it is considered less likely than not that this Veteran’s cough is etiologically related to Gulf War Service.” In a separate report, the same examiner noted that the Veteran did not have an undiagnosed illness or a diagnosed medically unexplained chronic multisymptom illness (MUCMI). The examiner noted that pulmonary function tests (PFT) were ordered. In October 2015, an outpatient clinician also ordered a chest X-ray and a search for the PFT results. In March 2016, a clinician noted that the X-ray and PFT were normal, but the Veteran still had a cough and decrease in stamina. In May 2017, a clinician noted that the Veteran possibly had restricted airway disease (RAD) from burn pit exposure and ordered new imaging and testing. In January 2018, a clinician noted that a PFT was normal and in February 2018 found that the Veteran did not have significant parenchymal disease but rather an exaggerated cough reflex that is benign. Nevertheless, the clinician continued to advise the use of bronchodilators. In September 2018, a clinician continued the investigation of potential RAD and noted that the Veteran worked as a city firefighter. In November 2018, a clinician noted that the PFTs remained normal but noted, “I cannot exclude the possibility of his current symptoms being related to inhaled exposures during military service, though felt to be less likely that adult onset asthma.” At the Veteran’s hearing, he testified that his claim is for a respiratory disability manifested by a chronic cough and pointed to his diagnosis of Reactive Airway Disease (RAD) as evidence of a respiratory disability. See December 2019 Hearing Transcript, pp 2-3. At the hearing, the Veteran testified that he noticed his respiratory dysfunction before he left service, and that it manifested by the Veteran becoming out of breath. Id at 4. The duty to assist includes providing a medical examination or obtaining an adequate medical opinion when such an examination or opinion is necessary to make a decision on the claim. 38 U.S.C. § 5103A (d) (West 2014); 38 C.F.R. § 3.159 (c)(4) (2016). Here, there is evidence to show that the Veteran has a current respiratory disability, the nature and etiology of which is unclear. The Veteran has provided credible testimony as to an in-service environmental exposure. However, there is not enough evidence of record to establish the exact etiology of the Veteran’s disability or the nexus between the two. As such, the Veteran should be afforded further development and a new examination to offer an opinion as to the nature and etiology of his respiratory disorder. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Accordingly, the case is REMANDED for the following actions: 1. Schedule a VA respiratory system examination by an appropriate examiner to determine the nature and etiology of his claimed respiratory disability. The examination report should reflect that the Veteran’s claims file was reviewed. An opinion is requested as to the following: Fully identify, diagnose, and describe any current respiratory disabilities. The examiner is to perform all necessary tests and studies. For each disability or disorder diagnosed, opine as to whether it at least as likely as not (i.e. a probability of 50 percent or more) that the condition had its onset during active service or within one year of separation from service, or, was caused or aggravated by active military service including exposure to burn pits or other airborne environmental hazards while deployed to Southwest Asia. The examiner should consider whether the recurrent cough symptoms are manifestations of undiagnosed illness or a diagnosed medically unexplained chronic multisymptom illness (MUCMI) associated with service in the Persian Gulf as outlined in 38 C.F.R. § 3.117 A complete rationale must be provided for all opinions offered. If an opinion cannot be provided without resort to mere speculation, the examiner is to explain in full detail why this is the case and identify what additional evidence (if any) would allow for a more definitive opinion. The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369. This appeal must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans’ Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Abels, Associate Counsel 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.