Citation Nr: 0814318 Decision Date: 05/01/08 Archive Date: 05/12/08 DOCKET NO. 03-15 505 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky THE ISSUES 1. Entitlement to an initial compensable evaluation an anxiety disorder. 2. Entitlement to an initial evaluation in excess of 30 percent for coronary artery disease (CAD) status post coronary artery bypass graft (CABG). REPRESENTATION Veteran represented by: Disabled American Veterans ATTORNEY FOR THE BOARD C. Kedem, Counsel INTRODUCTION The veteran served on active duty from January to May 1944. This matter comes to the Board of Veterans' Appeals (Board) from March 2002 and September 2003 rating decisions by which the RO granted VA benefits under 38 U.S.C.A. § 1151 for an anxiety disorder and for CAD status post CABG. The veteran is contesting the initial disability evaluations assigned. This case has been advanced on the Board's docket due to good cause shown. 38 U.S.C.A. § 7107 (West 2002); 38 C.F.R. § 20.900(c) (2007). The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND Unfortunately, the Board cannot proceed with a decision on the merits before certain procedural and evidentiary development is undertaken. The veteran's CAD status post CABG has not been comprehensively examined for well over six years. VA's statutory duty to assist includes the duty to conduct a thorough and contemporaneous examination so that the evaluation of the claimed disability will be a fully informed one. Green, 1 Vet. App. at 124. Thus, a cardiology examination must be ordered. The examining physician should describe the current state of the veteran's heart to include the CAD status post CABG. All symptoms and manifestations should be described in detail to include symptoms such as dyspnea, fatigue, angina, dizziness, syncope, or left ventricular dysfunction. In particular, testing should be conducted that will obtain the veteran's current ejection fraction and his METs workload. A rationale for all conclusions should be provided. All recent VA medical treatment records should be associated with the claims file. Finally, the RO should provide notice consistent with the Court's holding in Vazquez-Flores as described below. In the Board's view, the lack of proper Vazquez-Flores notice could prejudice the veteran, as showing increased disability for CAD requires the presence of very specific manifestations. See Sanders, supra. Regarding the veteran's anxiety disorder, the RO must arrange for a VA psychiatric examination to determine the current severity of the veteran's anxiety disorder to include all symptoms and manifestations thereof. Additionally, the examiner is to be asked to review the record in its entirety and opine regarding the level of the veteran's psychiatric impairment at the time of his coronary artery surgery in September 1999. The RO must provide the examiner with the criteria for rating psychiatric disabilities (0% to 100%) and ask that he or she determine which characterized the veteran's psychiatric disability at the time of his heart surgery. Accordingly, the case is REMANDED to the RO via the AMC for the following action: 1. Send the veteran a corrective VCAA notice that is consistent with the Court's holding in Vazquez-Flores. Specifically, the notice should (1) apprize the veteran of the specific requirements for showing increased disability for CAD; e.g., diagnostic codes 7005-7007 and (2) instruct the veteran to provide information or ask VA to obtain for him evidence related to the impact of any worsening of CAD on his employment and daily life. 2. Associate with the claims file all Huntington VA Medical Center clinical records dated from July 2007 to the present. 3. Schedule a VA cardiology examination to determine the current state of the veteran's heart to include the CAD status post CABG. All symptoms and manifestations should be described in detail to include symptoms such as dyspnea, fatigue, angina, dizziness, syncope, or left ventricular dysfunction. In particular, testing should be conducted that will obtain the veteran's current ejection fraction and his METs workload. All necessary diagnostic testing should be conducted, and a rationale for all conclusions should be provided. The examiner should indicate in the examination report that the claims file was reviewed. 4. Schedule a VA psychiatric examination. The examiner should be asked to (1) evaluate the current severity of the veteran's anxiety disorder to include all of its symptoms and manifestations. 5. The examiner should also be asked to review the claims file in its entirety and assess the level of psychiatric impairment at the time of the veteran's heart surgery in September 1999. The examiner should be provided the rating criteria for rating psychiatric disorders (0% to 100%) and asked which of the six rating criteria best characterized the state of the veteran's psychiatric disability at the time of his heart surgery. A rationale for all conclusions should be provided. The examiner should indicate in the report that the claims file was reviewed. 6. Readjudicate the issues on appeal. If the desired benefits are not granted, an appropriate supplemental statement of the case should be furnished. The case should then be returned to the Board if otherwise in order. (CONTINUED ON NEXT PAGE) The veteran has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or by the Court for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007). ______________________________________________ John E. Ormond, Jr. Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. 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) (2007).