Citation Nr: 18151507 Decision Date: 11/20/18 Archive Date: 11/19/18 DOCKET NO. 15-03 559A DATE: November 20, 2018 REMANDED Entitlement to an increased disability evaluation for coronary artery disease status post bypass grafting in excess of 10 percent from January 1, 2011, and in excess of 60 percent from January 14, 2014 is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1969 to March 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to an increased disability evaluation for coronary artery disease status post bypass grafting in excess of 10 percent from January 1, 2011, and in excess of 60 percent from January 14, 2014 is remanded. The Board finds that a remand is necessary to obtain a VA examination with an opinion. The Veteran is appealing the 10% evaluation assigned for his service-connected coronary artery disease status post bypass grafting from January 1, 2011, and the 60% evaluation assigned from January 14, 2014. He asserts that an Ischemic Heart disease (IHD) Disability Benefits Questionnaire (DBQ) conducted in February 2012, in which the physician assigned the Veteran a METs of 3-5, without attributing such to his peripheral vascular disease, is enough to warrant a higher evaluation. See December 2012 notice of disagreement and February 2015 Form 9. The evidence of record shows that the Veteran received a VA examination of the heart in April 2012. The examiner noted a diagnosis of IHD characterized as coronary artery disease (CAD). Further, the examiner noted that the Veteran had a METs level of >3-5. She also indicated that the Veteran’s left ventricular ejection fraction (LVEF) was 71 percent on testing in August 2011. The same examiner, in a July 2012 addendum opinion, stated that the Veteran’s estimated METs of > 3-5, was not solely based on his cardiac condition but due to other limitations including peripheral vascular diseases, and that the level of his disability, at that time, solely due to his cardiac condition, was an estimated METs of >7-10. In opining, however, the VA examiner did not provide a rationale to her conclusions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran received an IHD DBQ in February 2012, and in March 2013. In both DBQs, Dr. I. P., a private treating physician, assigned the Veteran a METs of 3-5, without attributing his levels to peripheral vascular disease. In both questionnaires, however, the private physician based the Veteran’s METs on an August 2011 diagnostic test, which was conducted three years before the Veteran was service connected for peripheral vascular disease. See August 2014 VA Notification Letter. As such, his opinion lacks clarity regarding the effect of the Veteran’s service-connected peripheral vascular disease on his CAD. The matter is REMANDED for the following action: 1. Obtain any updated VA treatment records since they were last associated with the claims file. 2. Thereafter, schedule the Veteran for a VA examination to evaluate the current severity of his CAD. The examiner should be provided with the Veteran’s claims file, including this remand order. The VA examiner must afford the Veteran appropriate testing to obtain current ejection fraction and METs readings or provide an explanation for why the testing cannot be performed, along with an estimation of such readings. The impact on his employment should assessed as well. Further, the examiner should clearly address the effect of the Veteran’s peripheral vascular disease on his METs and/or EF readings. In particular, the Board is seeking clarity as to how the July 2012 VA examiner was able to conclude that his METs reading of > 3-5 was not based solely on his cardiac condition. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD O. Onyeozili, Law Clerk