Citation Nr: 18144449 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 10-43 701 DATE: October 24, 2018 REMANDED The issue of entitlement to service connection for heart disease is remanded. The issue of entitlement to a total disability evaluation based on individual unemployability due to service connected disorders is remanded. REASONS FOR REMAND The appellant served on active duty from June 1970 to March 1972, to include service in the Republic of Vietnam. These issues, as well as a claim of entitlement to service connection for headaches to include due to a head injury, were most recently before the Board of Veterans’ Appeals (Board) in September 2017. At that time the case was remanded for further development. Following that development, the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina granted entitlement to service connection for migraine headaches. As that was a full grant of benefits with respect to that issue, that portion of the appeal is no longer before the Board. The RO confirmed and continued the denials of entitlement to service connection for heart disease and a total disability evaluation based on individual unemployability due to service connected disorders. Thereafter, the case was returned to the Board for further appellate consideration. In October 2014, the appellant had a hearing at the RO before the undersigned Veterans Law Judge. Heart Disease In part, the appellant contends that heart disease has been aggravated by his service-connected diabetes mellitus and that service connection is, therefore, warranted on a secondary basis. Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. Significantly, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310. In March 2018, the appellant was examined by a board-certified cardiologist to determine nature and etiology of any heart disease found to be present. The examiner diagnosed congestive heart failure, cardiomyopathy, and an implanted automatic implantable cardioverter defibrillator. Following the examination, the examiner opined that the appellant’s service-connected type II diabetes mellitus carried an associated increased cardiovascular death risk, and that diabetes mellitus would have an “at least as likely effect” on the natural progress of the appellant’s congestive heart failure. The examiner, however, was unable to provide a baseline level of severity of the congestive heart failure prior to the aggravation or earliest medical evidence following aggravation, because it was unknown when the appellant had been diagnosed with diabetes or how low he had been diabetic. Notably, VA treatment records show that a confirmed diagnosis of type II diabetes mellitus has been present since at least February 19, 2009. Given that the examiner was unable to locate this information, further development is in order. Individual unemployability The issue of entitlement to a total disability evaluation based on individual unemployability due to service connected disorders will be held in abeyance pending resolution of the claim of service connection for heart disease. In light of the foregoing, further development of the record is warranted. Accordingly, the matters are REMANDED for the following action: 1. Return the case to the board-certified cardiologist who examined the appellant in March 2018. Ask the cardiologist to review the appellant’s medical history and establish a baseline level of severity for the appellant’s congestive heart failure prior to the aggravation cited by the examiner or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity. The cardiologist is to be advised that the appellant has carried a diagnosis of type II diabetes since February 19, 2009. If the March 2018 examiner is unavailable, transfer the record to a different board-certified cardiologist for review and establishment of the baseline. If the examiner finds that an additional examination is necessary, such an examination must be scheduled. 2. When the foregoing actions have been completed, undertake any additional indicated development. Then, readjudicate the issues of entitlement to service connection for heart disease and entitlement to a total disability evaluation based on individual unemployability due to service connected disorders. By this remand, the Board intimates no opinion as to the final disposition of any unresolved issue. The appellant need take no action unless he is notified to do so. However, he is advised that he has the right to submit any additional evidence and/or argument on the matters the Board has remanded to the RO. 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 of Veterans’ Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. 38 U.S.C. §§ 5109B, 7112. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Harold A. Beach, Counsel