Citation Nr: 18145254 Decision Date: 10/26/18 Archive Date: 10/26/18 DOCKET NO. 13-30 517 DATE: October 26, 2018 REMANDED An initial compensable rating for residuals of a stroke (CVA), embolic in nature, from March 1, 1984 is remanded. A rating in excess of 30 percent for aortic insufficiency, status post aortic valve replacement, from October 1, 1983 is remanded. A total disability rating based on individual unemployability due to service connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1978 to January 1982. These claims were previously remanded by the Board in January 2018 for further development. 1. An initial compensable rating for residuals of a stroke (CVA), embolic in nature, from March 1, 1984 is remanded. The Veteran was afforded a new VA examination in March 2018. The Board finds this examination inadequate. The examiner did not address the Veteran’s reported symptoms of vertigo and migraines, as directed in the Board’s previous January 2018 remand. Therefore, a new VA examination must be obtained. 2. A rating in excess of 30 percent for aortic insufficiency, status post aortic valve replacement, from October 1, 1983 is remanded. As explained in the previous January 2018 remand, in December 2017, the Veteran’s representative argued that the Veteran’s May 1983 VA examination was inadequate because the examiner did not have access to the claims file. The Veteran has been rated pursuant to Diagnostic Code (Code) 7016, for a heart valve replacement (prosthesis); the rating criteria for Code 7016 changed during the pendency of the appeal, effective January 12, 1998. Prior to January 12, 1998, Code 7016 provided that a 100 percent rating was warranted for one year following implantation of prosthetic valve; thereafter, the disability would be rated as rheumatic heart disease (Code 7000), with a minimum rating of 30 percent disabling. 38 C.F.R. § 4.104, Code 7016 (1988). The Board found that a retroactive medical opinion was needed to determine whether the Veteran has experienced any of the old Code 7000 and 7016 criteria at any time during the appeal period. The Veteran was afforded a new VA examination in March 2018. The examiner did not adequately explain the findings or address the Veteran’s reports of shortness of breath. Therefore, a new examination must be obtained. 3. A total disability rating based on individual unemployability due to service connected disabilities (TDIU) is remanded. The matter of entitlement to TDIU is inextricably intertwined with the Veteran’s other claims; accordingly, adjudication must be deferred. The matters are REMANDED for the following action: 1. The AOJ should arrange for an examination (or examinations, as necessary) with an examiner other than the March 2018 examiner, to determine the nature and severity of the residuals of the Veteran’s service-connected CVA. After review of the record (including this Board remand), the examiner should respond to the following: (a) Please consider all symptoms that the Veteran has reported as due to his CVA, to include migraines and vertigo, and opine as to whether such symptoms are AT LEAST AS LIKELY AS NOT (50% OR GREATER PROBABILITY) due to his CVA. Please explain why. [The Veteran should ensure he discusses all symptoms he believes are attributable to his CVA with the VA examiner.] (b) For any symptom that is attributed to the Veteran’s service-connected CVA, please identify the severity of such symptom. If a separate VA examination specific to that symptom is necessary to make such, such should be completed. 2. A detailed explanation (rationale) is required for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested.) 3. After the development in the first instruction is completed, the AOJ should forward the Veteran’s claims file to a medical provider, other than the March 2018 examiner, to determine the nature and severity of the Veteran’s aortic insufficiency during the pendency of the appeal. After review of the record (including this remand), the examiner should respond to the following: (a) Has the Veteran had a definitely enlarged heart; severe dyspnea on exertion; elevation of systolic blood pressure, or such arrhythmias as paroxysmal auricular fibrillation or flutter or paroxysmal tachycardia; and more than light manual labor is precluded at any time since October 1, 1983? (b) Has the Veteran had definite enlargement of the heart confirmed by roentgenogram and clinically; dyspnea on slight exertion; rales, pretibial pitting at end of day or other definite signs of beginning congestive failure; and more than sedentary employment is precluded since October 1, 1983? A detailed explanation (rationale) is required for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested.) [CONTINUED ON NEXT PAGE] The Board notes that this case was previously remanded and recognizes that the complex and intertwined nature of the medical questions involved require significant work on the part of the medical examiner. The Board regrets the need to remand the matter again to the RO, however, the Board is unable to adjudicate the Veteran’s case until it has the requested information. Therefore, the Board must ask the VA examiner and the RO to ensure compliance with these directives (that is, full and thoroughly explained answers to each of the questions) to avoid additional delays in adjudication. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. D’Allaird, Associate Counsel