Citation Nr: 18144709
Decision Date: 10/25/18	Archive Date: 10/25/18

DOCKET NO. 16-09 630
DATE:	October 25, 2018
REMANDED
Entitlement to service connection for arteriosclerotic heart disease (coronary artery disease), secondary to varicose vein disabilities of the bilateral lower extremities, is remanded.
REASONS FOR REMAND
The Veteran served on active duty from July 1965 to July 1967. The Veteran appeals a January 2013 rating decision from the Department of Veteran Affairs (VA) Regional Office (RO) in Louisville, Kentucky. 
The Board notes that the Veteran had a Board hearing in April 2016.  In August 2018, the Veteran refused a new Board hearing after the retirement of April 2016 Veteran Law Judge who conducted the hearing.  Additionally, in May 2018, the Veteran elected to opt in his claims for total disability based on individual unemployability, and increased rating for varicose veins of the left and right lower extremities into the Rapid Appeals Modernization Program (RAMP).  As such, the Board currently lacks jurisdiction over those claims.  

1. Entitlement to service connection for arteriosclerotic heart disease (coronary artery disease), secondary to varicose vein disabilities of the bilateral lower extremities, is remanded.
The Veteran asserts that his coronary artery disease is caused by, or aggravated by his varicose veins in his left and right legs.  
The Veteran was afforded a VA exam in December 2012.  The Veteran was diagnosed with ischemic heart disease, and requires continuous medication.  The Veteran underwent a percutaneous coronary intervention in September 2010.  The VA examiner opined that the Veteran’s ischemic heart disease did not create a functional impact.  Additionally, the VA examiner opined that his ischemic heart disease was not caused by his varicose veins of the bilateral lower extremities because there is “no anatomic or physiologic basis to connect the conditions.” Notwithstanding, the VA examiner did not provide a medical opinion regarding whether the varicose veins of the bilateral lower extremities aggravated the Veteran’s ischemic heart disease.  Further, in November 2012, a VA vocational rehabilitation specialist stated that his heart condition “could be related to his varicose veins.” Thus, a new examination is warranted.     

The matter is REMANDED for the following action:
1. Obtain and associate with the record all VA and private treatment records for the Veteran. All actions to obtain the requested records should be fully documented in the record.  If they cannot be located or no such records exist, the Veteran and his representative should be so notified in writing. 
If possible, the Veteran and his representative are asked to submit these records themselves.  Provide the Veteran with the appropriate forms to obtain any private treatment records, or submit them.
2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s ischemic heart disease.
The examiner must opine whether the Veteran’s ischemic heart disease is at least as likely as not (50% probability):
a) proximately due to the result of the Veteran’s service connected varicose veins of the bilateral lower extremities; or 
b) aggravated (increased in severity) beyond its natural progress by the Veteran’s varicose veins of the bilateral lower extremities.
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3. After completing the aforementioned, and any further development deemed necessary, adjudicate the Veteran’s claim.  If the benefit sought on appeal is not granted in full, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and afforded an opportunity to respond before the file is returned to the Board for further appellate consideration.
 
John Crowley
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Timothy A. Campbell, Associate Counsel