BVA9507585 DOCKET NO. 93-14 716 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to an increased evaluation for bronchial asthma with chronic obstructive pulmonary disease (COPD), currently evaluated as 60 percent disabling. 2. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARINGS ON APPEAL Appellant and his daughter ATTORNEY FOR THE BOARD L. M. Barnard, Counsel INTRODUCTION The veteran served on active duty from May 1942 to September 1943. This appeal arises from a March 1990 rating decision of the St. Petersburg, Florida, Department of Veterans Affairs (VA), Regional Office (RO), which denied entitlement to the benefits sought. This was confirmed and continued by a rating action issued in July 1990. In March 1991, the Atlanta, Georgia RO issued a rating action which denied the benefits sought, and which was continued by a rating action issued in June 1991. In August 1991, the veteran testified at a personal hearing; in October 1991, the hearing officer continued the denials. Subsequent rating actions were issued in October 1991 and June 1992. The veteran testified at a second hearing in August 1992, and a rating action was issued in November 1992. REMAND The veteran contends, in essence, that his bronchial asthma with COPD is more disabling than the current disability evaluation would suggest. He states that he suffers from labored breathing, two to three pillow orthopnea, and pain in the center of his chest. He asserts that he has a persistent, productive cough, that is occasionally accompanied by blood. He claims to experience shortness of breath at rest, as well as after walking as little as one block. He also states that he has been unable to work since 1975 because of his illness. Therefore, he believes that his claims should be granted. VA has a duty to assist the veteran in the development of all facts pertinent to his claims. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.103(a) (1994). This includes the duty to obtain VA examinations which provide an adequate basis upon which to determine entitlement to the benefits sought, as well as the duty to obtain all relevant outpatient treatment records. Littke v. Derwinski, 1 Vet.App. 90 (1991). In those cases which are concerned with the veteran's entitlement to individual unemployability due to service-connected disabilities, it is incumbent upon VA to obtain an examination which includes an opinion as to what effect the veteran's service-connected disability has upon his ability to work. Friscia v. Brown, No. 93-766 (U.S. Vet.App. December 21, 1994). In those cases which present a complicated disability picture, examinations by specialists are recommended. Hyder v. Derwinski, 1 Vet.App. 221 (1991). VA has a duty to acknowledge and consider all regulations which are potentially applicable based upon the assertions and issues raised in the record and to explain the reasons used to support the conclusion. Schafrath v. Derwinski, 1 Vet.App. 589 (1991). These regulations include, but are not limited to, 38 C.F.R. § 4.1, that requires that each disability be viewed in relation to its history and that there be an emphasis placed upon the limitation of activity imposed by the disabling condition, and 38 C.F.R. § 4.2 which requires that medical reports be interpreted in light of the whole recorded history, and that each disability must be considered from the point of view of the veteran working or seeking work. These requirements for the evaluation of the complete medical history of the claimant's condition operate to protect claimants against adverse decision based upon a single, incomplete or inaccurate report and to enable VA to make a more precise evaluation of the disability level and any changes in the condition. In the instant case, it is noted that the veteran had been receiving individual unemployability between December 1972 and June 1986, when the benefits were reduced due to his incarceration. Following his release, these benefits continued to be denied, although his evaluation for his pulmonary disability was maintained at the 60 percent level. A review of the examinations conducted in September 1991 and May 1992 did not contain any opinion as to the effect that the veteran's service-connected bronchial asthma and COPD have upon his ability to work. Such an opinion is necessary in order to determine the veteran's entitlement to individual unemployability benefits. Furthermore, a complete examination is essential to ascertain the current degree of disability caused by the veteran's pulmonary disease. The last outpatient treatment records date from July 1991. The RO should ascertain whether additional treatment records are available. During his August 1992 personal hearing the veteran stated that he had now developed a heart condition as a result of his service-connected COPD. This claim appears to be inextricably intertwined with his claim for an increased rating. According to Harris v. Derwinski, 1 Vet.App. 180 (1991), all issues which are inextricably intertwined with an issue on appeal must be determined before the issue on appeal can be decided. Under the circumstances of this case, it is the finding of the undersigned that additional assistance is necessary, and this case is REMANDED to the RO for the following: 1. The RO should contact the Lake City, Florida VA Medical Center and request that they provide copies of the veteran's outpatient treatment records developed between July 1991 and the present. 2. Once the above-requested records have been obtained and associated with the claims folder, the RO should provide the veteran a complete pulmonary examination in order to fully assess the current nature and degree of severity of his service- connected bronchial asthma with COPD. All indicated special studies, to include, but not limited to, a chest x-ray and pulmonary function studies, should be accomplished. The examiner should render an opinion as to the effect that the veteran's pulmonary condition has upon his ability to work. The claims folder must be made available to the examiner prior to the examination so that the veteran's entire medical history can be taken into consideration. 3. The RO should also afford the veteran a complete cardiac examination in order to determine whether the veteran currently suffers from a heart condition as a result of his service-connected pulmonary disability. All indicated special studies deemed necessary to make this determination should be accomplished. The claims folder must be made available to the examiner prior to the examination so that the veteran's entire history can be taken into consideration. 4. The RO should then review the evidence of record and determine whether the veteran's heart condition can be service connected as secondary to his service- connected pulmonary disability. In the event that the veteran's claim remains denied, he and his representative should be provided with an appropriate supplemental statement of the case, and an opportunity to respond, and the case should be returned to the Board for further appellate consideration if otherwise in order. C. P. RUSSELL Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1994).