Citation Nr: 21068770 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 16-49 412 DATE: November 12, 2021 REMANDED Entitlement to service connection for a pulmonary disability to include interstitial lung disease, claimed as the result of herbicide agent and jet fuel exposure, is remanded. REASONS FOR REMAND The Veteran had active service from October 1965 to February 1969. He served in the Republic of Vietnam. The Veteran appeared at a March 2021virtual hearing before a Veterans Law Judge. The transcript is of record. In May 2021, the Board of Veterans' Appeals (Board) informed the Veteran that the Veterans Law Judge who conducted the March 2021 hearing had left the Board and he therefore had the right to an additional hearing before a different Veterans Law Judge. In May 2021, the Veteran indicated that he did not want an additional hearing. Entitlement to service connection for a pulmonary disability to include interstitial lung disease, claimed as the result of herbicide agent and jet fuel exposure, is remanded. The Veteran served in the Republic of Vietnam with the Air Force. His military occupation was aircraft fuel system technician. The Veteran is presumed to have been exposed to herbicide agents while in the Republic of Vietnam. His in service exposure to aviation fuels is conceded. A September 2021 pulmonary evaluation conducted for the Department of Veterans Affairs (VA) conveys that: "while the Veteran has offered lay statements that he believes his interstitial lung disease is due to prior herbicide exposure and while the Veteran has never been a smoker, this does not change the fact that herbicide agents are not an established primary etiology of interstitial lung disease in the medical literature;" "additionally, there is no evidence of additional exposures having occurred during service which are established to cause interstitial lung disease in the medical literature;" and "the most common etiology of interstitial lung disease is idiopathic without any specific underlying etiology." An October 2021 written statement from M. Wilkinson, M.D., states that he was treating the Veteran for chronic obstructive pulmonary disease and pulmonary fibrosis/interstitial lung disease. The doctor opined that "the most likely explanation for his lung problems is his exposure to Agent Orange and jet fuels while he was in the military" and "exposure to Agent Orange and jet fuels are recognized risk factors in the development of interstitial lung disease and chronic obstructive pulmonary disease and in the absence of any smoking history or other exposures are the most likely causative agents for [the Veteran's] lung problems." VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Given the conflicting findings of record as to the nature and etiology of the claimed pulmonary disability, the Board finds that further VA pulmonary examination is needed. Clinical documentation dated after September 2021 is not of record. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran's claims. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider, including M. Wilkinson, M.D., who has treated any pulmonary disability. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Obtain any VA treatment records not of record, to include those pertaining to treatment after September 2021. 3. Schedule the Veteran for a VA pulmonary examination to assist in determining the nature and etiology of any identified pulmonary disabilities and any relationship to active service. The examiner must review the record, including the October 2021 written statement from M. Wilkinson, M.D., and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (Continued on the next page) (a) Diagnose all pulmonary disabilities found. (b) Opine as to whether it is at least as likely as not (50 percent probability or greater) that any identified pulmonary disability had its onset during active service or is related to any incident of service, including the Veteran's presumed herbicide agent exposure and his conceded in service exposure to aviation fuels. The examiner should specifically address the October 2021 written statement from M. Wilkinson, M.D. J. T. HUTCHESON 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.