Citation Nr: 21022679 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 19-03 198 DATE: April 19, 2021 REMANDED Entitlement to service connection for cystic fibrosis, to include related conditions is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1998 to October 2002. The Veteran testified before the undersigned at a March 2021 Board hearing. 1. Entitlement to service connection for cystic fibrosis, to include related conditions is remanded. The Veteran has diagnosed cystic fibrosis. See September 2017 Dr. M.S. correspondence. She contends that her cystic fibrosis caused related conditions which were treated during active duty but due to the miliary missing her cystic fibrosis diagnosis in service the effect on her body got worse and was aggravated during military service. See October 2017 notice of disagreement ( NOD ). Service treatment records ( STR s) include a July 1998 report of medical examination at enlistment, which indicated she had normal sinus, lungs and chest, and abdomen and viscera upon clinical evaluation. An August 2002 genetic counseling report indicated the Veteran has a R117H mutation in the cystic fibrosis gena, which is considered a “mild CF mutation that produces different clinical features.” The report indicated the Veteran is also positive for the 5T alias, which is not considered a classic cystic fibrosis mutation but is considered polymorphism. At her March 2021 Board hearing, the Veteran testified that during service she experienced digestive symptoms of diarrhea and constipation that are cystic fibrosis issues. Moreover, she reported that she experienced night hypoxia and sinus disease in service. She further testified that during military service in the summer of 1998 and she was required to be in a gas chamber and was told to take down her gas mask, which she reported did not work well and she had gas inside her gas mask. The June 2017 VA examiner opined that the Veteran’s cystic fibrosis is incurred or caused by the reports of cystic fibrosis in service. In a July 2017 VA addendum opinion, the examiner characterize the Veteran’s cystic fibrosis as a “congenital condition” and opined that cystic fibrosis was less likely than not aggravated beyond the normal progression. In a September 2017 statement, Dr. M.S. indicated the Veteran was born with cystic fibrosis and that several years of missed diagnoses went by that could have prevented the lung damage she now has. See September 2017 Dr. M.S. correspondence. The Board finds that remand is warranted as clarification is needed to determine whether the Veteran’s cystic fibrosis is a congenital disease or congenital defect and etiology of the cystic fibrosis, respectively. Additionally, at her March 2021 Board hearing, the Veteran testified that she receives private treatment from National Jewish Hospital and St. Joseph Hospital. These records should be obtained on remand. The matter is REMANDED for the following action: 1. Obtain any relevant VA treatment records and associate them with the claims file. 2. Obtain, if possible, records of relevant private evaluations and treatment the Veteran has received, to include records from National Jewish Hospital and St. Joseph Hospital. 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 above development 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 disability manifested by cystic fibrosis. 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: (a.) Is the Veteran’s cystic fibrosis a congenital defect, congenital disease, or neither? Please explain why. (A defect is a condition that can neither improve nor worsen. A congenital disease, for VA adjudication purposes, is a congenital condition that is subject to improvement and/or worsening.) (b.) If the Veteran’s cystic fibrosis is a congenital defect, is it subject to a superimposed disease or injury during service that resulted in additional disability? Please explain why. The examiner should address the Veteran’s reports that she experienced digestive symptoms of diarrhea and constipation that are cystic fibrosi issues and she experienced night hypoxia and sinus disease from her cystic fibrosis. (c.) If the Veteran’s cystic fibrosis is a congenital disease, is there clear and unmistakable evidence that it pre-existed service? Please explain why. The examiner must use the clear and unmistakable standard. The examiner should address: (1) the July 1998 STR report of medical examination at enlistment, which indicated she had normal sinus, lungs and chest, and abdomen and viscera upon clinical evaluation; (2) Dr. M.S.’s statement that the Veteran was born with cystic fibrosis; and (3) August 2002 genetic counseling report. (d.) If the Veteran’s cystic fibrosis is a congenital disease and it clearly and unmistakably pre-existed service, is there clear and unmistakable evidence that either (i) there was no increase in disability during service, or (ii) any increase in disability during service was due to the natural progression of the disease? Please explain why. The examiner must use the clear and unmistakable evidence standard and discuss: (1) The Veteran’s reports that her cystic fibrosis caused related conditions which were treated during active duty but due to the miliary missing her cystic fibrosis diagnosis in service the effect on her body got worse and was aggravated during military service, to include digestive symptoms of diarrhea and constipation, night hypoxia, sinus disease, and lung damage from being required to be in a gas chamber and (2) Dr. M.S.’ s September 2017 statement that the Veteran was born with cystic fibrosis and that several years of missed diagnoses went by that could have prevented the lung damage she now has. (e.) If the Veteran’s cystic fibrosis is a congenital disease that did not clearly and unmistakably pre-exist service, or that it pre-existed service but did not clearly and unmistakably increase in severity beyond natural progression during service, is it at least as likely as not (50 percent or greater probability) that the Veteran’s cystic fibrosis is related to service? Please explain why. In this circumstance only, the Veteran would be presumed sound upon entering service and the examiner may not rely on the presence of the disability prior to service. The examiner should address the June 2017 VA examiner’s opinion that the Veteran’s cystic fibrosis is incurred or caused by the reports of cystic fibrosis in service. 4. 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 S. Schick, 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.