Citation Nr: 21074367 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 19-01 748 DATE: December 15, 2021 REMANDED Entitlement to residuals of a left pneumothorax is remanded. REASONS FOR REMAND The Veteran had active service from June 2007 to May 2015 in the U.S. Navy, including in combat. This appeal has a long procedural history. It comes before the Board of Veterans' Appeals (Board) on appeal from a June 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appointed his attorney to represent him before VA by filing a completed VA Form 21-22 at the RO in May 2018. A virtual Board hearing was held in September 2021 before the undersigned Veterans Law Judge and a copy of the hearing transcript has been added to the record. Having reviewed the record evidence, to include the Veteran's hearing testimony, the Board finds that the issue on appeal should be characterized as stated above. The Board notes that the RO adjudicated this Veteran's claim as part of the Benefits Delivery at Discharge (BDD) program (now known as the Pre-Discharge Program or Joint VA/Department of Defense Disability Evaluation System (DES)). The Veteran contends that his in-service treatment for a spontaneous left pneumothorax (or collapsed lung) in 2010 and 2014 resulted in current residuals, to include difficulty breathing, tender chest scars, and chest pain due to a thoracotomy tube used to treat his left pneumothorax. Unfortunately, a review of the record evidence indicates that additional development is required before the underlying claim can be adjudicated on the merits. The medical evidence is in conflict as to whether the Veteran experiences current disability due to residuals of a left pneumothorax which are related to active service. For example, on VA respiratory conditions Disability Benefits Questionnaire (DBQ) in January 2015, the diagnoses were spontaneous pneumothorax X 2, status-post thoracotomy tube X 2, and status-post pleurodesis. The VA examiner noted that, followed 2 spontaneous pneumothoraxes in 2010 and 2014 while the Veteran was on active service, both of which successfully treated with a chest (or thoracotomy) tube, he had pleurodesis in 2014 and had not experienced a pneumothorax since that time. This examiner also stated, "There is insufficient evidence to warrant the diagnosis or residual of chronic post thoracotomy pain. The Veteran had no pain with full [repetitive] breathing, and had no tenderness to light touch or firm palpation of his left chest and [left] chest scars." This examiner did not explain what he meant by "insufficient evidence" or otherwise clarify this statement. The Board notes in this regard that an opinion which finds insufficient evidence in the record is adequate only when it is clear that such insufficiency is predicated on a lack of knowledge among the medical community at large and not the insufficient knowledge of the specific examiner. See Jones v. Shinseki, 23 Vet. App. 382, 390 (2010). Thus, the Board finds that the January 2015 VA respiratory conditions DBQ is inadequate for VA adjudication purposes. On subsequent VA respiratory conditions DBQ in June 2015, a different VA examiner diagnosed the Veteran as having spontaneous pneumothorax and pleurodesis. A review of the VA Form 21-2507s related to both of these examinations does not indicate that either the January or June 2015 VA examiners was asked to state whether residuals of a left pneumothorax are related to active service. And neither examiner provided this opinion. Having reviewed the record evidence, it is not clear to the Board whether the Veteran experiences current residuals of a left pneumothorax which could be attributed to active service. Thus, the Board finds that, on remand, another examination should be provided which addresses this matter. The matters are REMANDED for the following action: 1. Conduct any appropriate development to obtain the Veteran's updated treatment records. 2. Schedule the Veteran for examination to determine the nature and etiology of his claimed residuals of a left pneumothorax. The claims file should be provided for review. Based on a review of the claims file and the results of the Veteran's examination (if held), the clinician is asked to identify any residuals of a left pneumothorax currently experienced by the Veteran. For each identified residual of a left pneumothorax currently experienced by the Veteran, the clinician is asked to state whether it is at least as likely as not (i.e., a 50 percent or greater probability) that it is related to active service or any incident of service, including as due to 2 separate spontaneous pneumothoraxes in 2010 and 2014. If the clinician finds that there is insufficient evidence to support a diagnosis of residuals of a left pneumothorax or to relate this diagnosis to active service, then he or she is asked to state whether this insufficiency is predicated on a lack of knowledge among the medical community at large. (Continued on the next page) A rationale must be provided for any opinion(s) expressed. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael T. Osborne, 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.