Citation Nr: 18145143 Decision Date: 10/26/18 Archive Date: 10/26/18 DOCKET NO. 16-37 895 DATE: October 26, 2018 REMANDED Entitlement to an initial evaluation in excess of 30 percent for coronary artery disease is remanded. Entitlement to an increased evaluation in excess of 10 percent for bilateral hearing loss is remanded. Entitlement to an initial evaluation in excess of 50 percent for posttraumatic stress disorder (PTSD) and alcohol abuse is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1967 to March 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. Regarding the issues of bilateral hearing loss, coronary heart disease, and PTSD, the Veteran was afforded VA examinations in August 2012, November 2013, January 2014, and February 2014. In June 2018, the Veteran’s representative asserted that the examinations do not accurately reflect the current severity of his disabilities. Additionally, in his notice of disagreement, the Veteran asserted that he had 40 percent ejection fraction related to his coronary heart disease. However, the VA examination does not document such a finding. Moreover, the Veteran indicated that he experienced impaired thoughts, inability to perform activities of daily living, memory retention, impaired impulse control, neglect of personal appearance, and the inability to establish and maintain relationships related to his service-connected PTSD. However, these symptoms were not noted during his VA examinations. Therefore, the Board finds that a VA examination is needed to ascertain the current severity and manifestations of the Veteran’s service-connected bilateral hearing loss, coronary artery disease, and PTSD. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994). The matters are REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request the Veteran provide the names and addresses of any and all healthcare providers who have provided treatment for his bilateral hearing loss, coronary artery disease, and PTSD. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate the records with the claims file. The AOJ should also secure any outstanding VA medical records. 2. After completing the foregoing development, the Veteran should be afforded a VA examination to ascertain the current severity and manifestations of his service-connected bilateral sensorineural hearing loss. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed, but should include the Maryland CNC test and a pure tone audiometry test. The examiner is requested to review all pertinent records associated with the claims file. The examiner should discuss the effect of the disability on his occupational functioning and daily activities. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history,” 38 C.F.R. § 4.1, copies of all pertinent records in the Veteran’s claims file must be made available to the examiner for review. 3. After obtaining any outstanding records, the Veteran should be afforded a VA examination to ascertain the current severity and manifestations of his service-connected coronary artery disease. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed, including current diagnostic testing. The examiner is requested to review all pertinent records associated with the claims file. The examiner should report all signs and symptoms necessary for rating the Veteran’s disability under the rating criteria. In particular, the examiner should state the number of workload METs resulting in dyspnea, fatigue, angina, dizziness, or syncope. He or she should also indicate whether the Veteran has had chronic congestive heart failure or more than one episode of acute congestive heart failure in the past year. The examiner should further state whether the Veteran has left ventricular dysfunction, and if so, the percent of ejection fraction. In addition, he or she should address whether there is evidence of cardiac hypertrophy or dilation on electrocardiogram, echocardiogram, or x-ray. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history,” 38 C.F.R. § 4.1, copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. After completing the foregoing development, the Veteran should be afforded a VA examination to ascertain the current severity and manifestations of his service-connected PTSD and alcohol abuse. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. It should be noted that the Veteran is competent to attest to observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should report all signs and symptoms necessary for rating the Veteran’s disability under the General Rating Formula for Mental Disorders. The findings of the examiner should address the level of social and occupational impairment attributable to the Veteran’s PTSD and alcohol abuse. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history” 38 C.F.R. § 4.1, copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claim file, must be made available to the examiner for review. 5. After completing the above actions, the AOJ should conduct any other development as may be indicated as a consequence of the actions taken in the preceding paragraphs. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K.M. Walker, Associate Counsel