Citation Nr: 18143218
Decision Date: 10/18/18	Archive Date: 10/18/18

DOCKET NO. 17-56 118A
DATE:	October 18, 2018
REMANDED
Entitlement to an initial disability rating for coronary artery disease status post coronary artery bypass grafting (CABG) associated with herbicide exposure rated as 100 percent disabling from March 11, 1996, 30 percent disabling from March 1, 1997, 100 percent disabling from May 9, 2006, and 30 percent disabling from September 1, 2006, is remanded.
REASONS FOR REMAND
The Veteran served on active duty from August 1961 to October 1966.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Milwaukee, Wisconsin, which granted service connection for coronary artery disease status post CABG, tinnitus, and bilateral hearing loss.  Jurisdiction is now with the RO in Chicago, Illinois.  
The record shows that the Veteran timely submitted a notice of disagreement in November 2015 to the July 2015 rating decision, specifically disagreeing with the ratings assigned for his coronary artery disease and tinnitus.  An October 2017 statement of the case continued these ratings.  The Veteran timely filed a substantive appeal in November 2017 and limited his appeal to only the increased rating claim for his coronary artery disease.  Hence, the Board finds that the increased rating claim for tinnitus is not before it at this time.
The record indicates that the Veteran’s coronary artery disease status post CABG has worsened since his last VA examination.  The Board notes that the Veteran last underwent a VA examination for his heart disability was in May 2015, over three years ago.  Medical evidence dated since that time indicate worsening symptomatology and the need for continued treatment, to include a December 2015 cardiac catherization.  Therefore, a more contemporaneous medical examination is warranted. Green v. Derwinski, 1 Vet. App. 121 (1991) (VA has a duty to provide the Veteran with a thorough and contemporaneous medical examination, one which takes into account the records of prior medical treatment, so that the rating of the disability will be a fully informed one); Caffrey v. Brown, 6 Vet. App. 377 (1994) (an examination too remote for rating purposes cannot be considered “contemporaneous”).  
The Board notes that the Veteran submitted a February 2018 Disability Benefits Questionnaire completed by a private cardiologist showing the results of clinical testing; however, the cardiologist did not indicate whether the clinical findings (METs level) was due solely to the Veteran’s heart condition or whether it also considered the Veteran’s hypertension, knee arthritis, and chronic obstructive pulmonary disease.  Hence, to the extent possible, such distinction should be made the new VA examination.
The matter is REMANDED for the following action:
1. Obtain all outstanding medical records pertinent to the claim, to include the records from the Veteran’s January 2017 private hospitalization for treatment of chest pain.
2. Schedule the Veteran for a VA examination to determine the current severity of his coronary artery disease status post coronary artery bypass surgery.  Provide the claims file, including a copy of this REMAND, to the examiner for review.  The examiner should consider the February 2018 Disabilities Benefits Questionnaire completed by a private cardiologist.  To the extent possible, the examiner is asked to identify all specific symptomatology and clinical findings attributable solely to the Veteran’s cardiac disability from those of other disorders.  If such is not possible, the examiner should so indicate.  The AOJ should ensure that the examination report includes all necessary findings for rating purposes.

 
DELYVONNE M. WHITEHEAD
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	E. Ko, Associate Counsel