Citation Nr: 18154920 Decision Date: 12/04/18 Archive Date: 11/30/18 DOCKET NO. 16-58 481A DATE: December 4, 2018 REMANDED Entitlement to a rating in excess of 10 percent disabling for service-connected ischemic heart disease (coronary artery disease, status post coronary artery bypass graft) prior to October 18, 2016, and in excess of 60 percent thereafter, is remanded. Entitlement to a rating in excess of 10 percent disabling for service-connected scar of the mid sternum and left thigh associated with ischemic heart disease (coronary artery disease, status post coronary artery bypass graft), is remanded. Entitlement to a compensable rating for service-connected scar on right lower extremity associated with ischemic heart disease (coronary artery disease, status post coronary artery bypass graft), is remanded. Entitlement to a compensable rating for service-connected scar on left lower extremity (1 scar on medial thigh, 1 scar on medial ankle, and 1 scar left lower thigh) associated with ischemic heart disease (coronary artery disease, status post coronary artery bypass graft), is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU). REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from February 1971 to September 1973. In a December 2016 rating decision, the RO increased the Veteran’s rating for his service-connected ischemic heart disease (coronary artery disease, status post coronary artery bypass graft). The RO granted a 60 percent rating effective October 18, 2016. However, as higher ratings are still available, the issue remains on appeal. See AB v. Brown, 6 Vet. App. 35, 39 (1993). In Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court of Appeals for Veterans Claims (Court) held that a TDIU claim is part of an increased rating claim when such claim is raised by the record. The Board finds that the evidence, specifically the December 2012 statement by the Veteran, reasonably raises a claim for TDIU pursuant to the holding in Rice and has added that issue to the cover page. The Board notes that the Veteran’s December 2012 statement also raised the issue of service connection for claudication in his bilateral lower extremities due to his service-connected ischemic heart disease. However, the record indicates that the RO is still working on the Veteran’s claim. Therefore, such is not before the Board at this time. Entitlement to a rating in excess of 10 percent disabling for service-connected ischemic heart disease (coronary artery disease, status post coronary artery bypass graft) prior to October 18, 2016, and in excess of 60 percent thereafter; entitlement to a rating in excess of 10 percent disabling for service-connected scar of the mid sternum and left thigh, a compensable rating for service-connected scar on right lower extremity, and a compensable rating for service-connected scar on left lower extremity (1 scar on medial thigh, 1 scar on medial ankle, and 1 scar left lower thigh) all associated with ischemic heart disease (coronary artery disease, status post coronary artery bypass graft). Relevant to the Veteran’s claims for increased ratings for his ischemic heart disease and associated scars, the Court has held that, where the record does not adequately reveal the current state of a claimant’s disability, fulfillment of the statutory duty to assist requires a contemporaneous medical examination, particularly if there is no additional medical evidence that adequately addresses the level of impairment of the disability since the last examination. Allday v. Brown, 7 Vet. App. 517, 526 (1995). The record reflects that the Veteran was most recently afforded a VA Heart Conditions examination and a VA Scars/Disfigurement examination in October 2016. The Board finds that contemporaneous examinations are necessary as the Veteran has alleged significantly worsening symptoms since his last VA examinations. Specifically, the Veteran has alleged that his conditions are far worse than is represented by his current ratings. Therefore, the Board finds that a remand is required in order to determine the Veteran’s current level of impairment with regard to his service-connected ischemic heart disease and associated scars. See Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994); VAOPGCPREC 11-95 (1995). Entitlement to a TDIU. The Board finds that the claim for entitlement to a TDIU is inextricably intertwined with the claims remanded herein, the outcomes of which could possibly have bearing on whether the Veteran meets the schedular criteria for TDIU benefits during the entirety of the appeal. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Due to the amount of time which will pass on remand, updated treatment records should be obtained and associated with the record. The matters are REMANDED for the following action: 1. Obtain updated treatment records. 2. Schedule the Veteran for VA examinations to determine the current severity of his service-connected ischemic heart disease and associated scars. The claims file must be made available to the examiner. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Unger, Associate Counsel