Citation Nr: 21075009 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 18-55 206 DATE: December 17, 2021 REMANDED Entitlement to a rating in excess of 30 percent for residuals of lung adenocarcinoma status post right lower lobe lobectomy is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1965 to November 1967. He testified at a virtual Board hearing before the undersigned in September 2021. In March 2016, the Veteran submitted a claim for increased rating for his service-connected residuals of lung adenocarcinoma status post right lower lobe lobectomy, which is currently rated 30 percent disabling. Under Diagnostic Code 6844, post-surgical residuals of lobectomy are rated under the General Rating Formula for Restrictive Lung Disease. See 38 C.F.R. § 4.97. More specifically, Diagnostic Code 6844 uses pulmonary function tests (PFTs) to obtain Forced Expiratory Volume in one second (FEV-1), the ratio of FEV-1 to Forced Vital Capacity (FEV-1/FVC), and Diffusion Capacity of the Lung for Carbon Monoxide by Single Breath Method (DLCO (SB)) readings upon which the ratings are based. In addition to service-connected residuals of lung adenocarcinoma, the Veteran also has chronic obstructive pulmonary disease (COPD), an obstructive lung disease, which private treatment records state is worse with exertion. See December 2019 private treatment record. Significantly, service connection is not in effect for COPD. See October 23019 and August 2020 rating decisions. The most recent VA respiratory conditions examination in September 2018 found that the Veteran's lung cancer was in remission, and FVC % predicted most accurately reflected the Veteran's level of disability. No reasons and bases were provided for this opinion. Moreover, the examiner noted the Veteran also had emphysema, but did she attempt to separate out the symptoms of his service-connected disability from any nonservice-connected disability. After reviewing the evidence of record, the Board finds that remand is necessary for a thorough examination that considers which symptoms are attributable to service-connected residuals of lung adenocarcinoma status post right lower lobe lobectomy (as distinguished from any nonservice-connected respiratory disabilities, to include the obstructive lung diseases of COPD and emphysema), as well as the most reliable indicator of the symptoms from each. Finally, the Veteran and his attorney contend the Veteran's exercise capacity (measured in metabolic equivalents (METs) better represents the functional impairment caused by his service-connected lung disability. See November 2018 VA Form 9, September 2021 hearing transcript. The examiner should comment on this as well, and undertake any additional tests indicated. Prior to the examination, up to date treatment records should be associated with the claims file. The matter is REMANDED for the following actions: 1. Undertake appropriate development to obtain any outstanding VA or private medical records. 2. Thereafter, afford the Veteran an appropriate VA examination to evaluate the severity of his service-connected residuals of lung adenocarcinoma status post right lower lobe lobectomy. The electronic claims file and this remand must be made available to the examiner for review in conjunction with the examination. The examination report must document all functional impairment the Veteran experiences due to his service-connected residuals of lung adenocarcinoma status post right lower lobe lobectomy. It should also specifically distinguish (with explanation) any impairment due wholly to nonservice-connected pathology (including that from COPD and emphysema) from that associated with the Veteran's service-connected residuals of lung adenocarcinoma status post right lower lobe lobectomy. All required pulmonary function tests (PFTs) must be accomplished in accordance with 38 C.F.R. § 4.96, which states, in pertinent part, that PFTs must include results of DLCO (SB) (Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method), FEV-1 (Forced Expiratory Volume in one second), and FVC (Forced Vital Capacity). Pre- and post-bronchodilator studies must be performed, unless the results of pre-bronchodilator PFTs are normal, or the examiner determines that post-bronchodilator studies should not be performed and provides an explanation for why this is so. If the examiner determines that DLCO (SB) testing would not be useful or valid, a full explanation must be provided. If there is a disparity between the results of PFTs, the examiner must state which test result most accurately reflects the level of disability and must provide an explanation for that finding. The examiner must also provide an opinion as to whether the Veteran's exercise capacity (measured in metabolic equivalents (METs) better represents the functional impairment caused by his service-connected lung disability than PFTs. A complete rationale for all opinions or determinations must be provided. If the examiner is unable to provide an opinion without resorting to speculation, he or she must explain why this is so. The examiner must indicate whether there was any further need for information or testing necessary to make a determination, and whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Fletcher, Kathleen 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.