Citation Nr: 21074080 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 15-40 315 DATE: December 14, 2021 REMANDED Entitlement to service connection for a pulmonary disability is remanded. Entitlement to an evaluation in excess of 30 percent prior to October 16, 2019 and in excess of 50 percent thereafter for posttraumatic stress disorder (PTSD) is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1966 to October 1969, with service in Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision by the Department of Veterans Affairs (VA). This case was remanded in July 2019 for further development. In June 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge; a transcript of that hearing is of record, but a significant portion of the testimony is inaudible. VA contacted the Veteran in September 2021 and he declined a new hearing. See September 2021 Report of General Information. As a result, the Board finds that it may proceed with adjudication. After the Board's remand, the Agency of Original Jurisdiction (AOJ) increased the rating for the Veteran's PTSD to 50 percent, effective October 16, 2019. See August 2020 rating decision. The issue has been recharacterized accordingly. The Board sincerely regrets the additional delay, but remand is necessary to ensure there is a complete record on which to decide the Veteran's case. 1. Entitlement to service connection for a pulmonary disability. The Veteran asserts that his respiratory issues are a result of his exposure to herbicide agents in Vietnam, asbestos, excessive petroleum products, automotive work, or the tropical conditions of Vietnam. See April 2014 correspondence. He asserted that he has positive opinions from Dr. Lipper, Dr. Patel, and Dr. Yu stating that his condition is related to his service in Vietnam. See correspondence received September 2019. As discussed in the last Board remand, Dr. Yu's January 2016 opinion is inadequate because there was no rationale; instead, Dr. Yu described a history of treatment without explaining why the disabilities are due to service. Dr. Lipper's January 2016 opinion is nearly an exact duplicate of Dr. Yu's opinion and is inadequate for the same reason. Opinions by Dr. Lipper in September 2015 and October 2015 treatment records are inadequate because they have no rationale, are speculative, and discuss "occupational exposure" instead of the Veteran's military service. Finally, Dr. Patel's February 2013 and February 2014 opinions that the Veteran's interstitial lung disease and pulmonary hypertension were more likely than not related to the Veteran's exposure to organic dust and asbestos during service are also inadequate because they have no rationale. As such, none of the opinions by these physicians are adequate and they are afforded no probative weight at this time. If the Veteran wishes to obtain an addendum opinion with an adequate rationale, he is welcome to do so. An October 2019 VA examiner diagnosed several pulmonary disabilities: chronic obstructive pulmonary disorder (COPD), chronic bronchitis, pulmonary nodules, and pleural-based thickening. The examiner opined that all four disabilities were less likely than not related to service; however, all four opinions relied merely on the absence of evidence. As a result, all the opinions are inadequate, and remand for new opinions is necessary. 2. Entitlement to an evaluation in excess of 30 percent prior to October 16, 2019 and in excess of 50 percent thereafter for PTSD. During an October 2019 VA PTSD examination, the Veteran reported treatment with Dr. Florek from 2012 to 2018. While letters from Dr. Florek are of record, complete treatment records have not been received or sought. As a result, remand to attempt to obtain private treatment records is necessary. November 2019 VA treatment records reflect that the Veteran was having an exacerbation of his PTSD symptoms. In light of Green v. Derwinski, 1 Vet. App. 121 (1991) and Snuffer v. Gober, 10 Vet. App. 400, 403 (1997), and because the matter must be remanded anyway, the Board finds that a new examination is warranted. 3. Entitlement to TDIU. Currently, the Veteran does not meet the schedular requirements to be entitled to TDIU. See 38 C.F.R. § 4.16(a). Thus, the Board will refer the matter to the Director, Compensation Service, for extraschedular consideration of TDIU. See 38 C.F.R. § 4.16(b). The matters are REMANDED for the following action: 1. The AOJ should obtain copies of VA treatment records from March 2020 to the present. 2. The AOJ should obtain, if possible, records of relevant private evaluations and treatment the Veteran has received, to include from Dr. Florek. The Veteran must assist in the matter by identifying his private healthcare providers and by submitting releases for VA to obtain any private records identified. 3. After the development in the first two directives is completed, the AOJ should arrange for a VA medical opinion, with examination or telehealth interview of the Veteran only if deemed necessary by a medical professional, to determine the nature and likely cause of any pulmonary disability. The examiner should review the claim file (including this remand) and note such review was conducted. Based on review of the record, the examiner should provide an opinion with detailed rationale that responds to the following: For each pulmonary disability diagnosed, is it at least as likely as not (50% or greater probability) that such disability was either incurred in or otherwise related to the Veteran's military service, to include possible exposure to asbestos, herbicide agents, dust, excessive petroleum products, and the tropical conditions of Vietnam? Please explain why. The examiner may not rely solely on the absence of evidence in service treatment records or medical records immediately after service. The examiner may not rely solely on the absence of a presumption of a relation to herbicide agents. 4. After the development in the first two directives is completed, the AOJ should arrange for an examination of the Veteran to assess the current severity of his service-connected PTSD. The examiner must review the entire record (including this remand) in conjunction with the examination and note such review was conducted. The examiner should provide a full description of the disability and report all signs and symptoms associated with the Veteran's disability. 5. The AOJ should refer this case to the Director, Compensation Service, for extraschedular consideration of TDIU pursuant to 38 C.F.R. § 4.16(b). 6. If upon completion of the above action the issues remain denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Sandler, 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.