Citation Nr: 18155558 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 16-41 321 DATE: December 4, 2018 REMANDED Entitlement to an initial rating in excess of 30 percent for coronary artery disease (CAD) with ischemic heart disease (IHD) is remanded. REASON FOR REMAND The Veteran served on active duty from December 1965 to February 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, MO. The Board acknowledges the Veteran’s representative’s request for a stay of proceedings pending completion of other claims under the RAMP program. The claims were adjudicated in a rating decision completed on September 11, 2018 and a notification letter was sent on October 18, 2018. As the claims are now complete and given the disposition below, the Board finds no prejudice will attach by issuing this decision. In addition, the Board notes the Veteran’s representative’s October 30, 2018 motion for an extension of time to submit additional evidence and prepare a brief. Given that the Board is further developing the claim as set out below, the Veteran’s representative will have ample time to gather additional evidence and submit a brief during the course of the Board’s requested development, rendering the motion moot. Entitlement to an initial rating in excess of 30 percent for CAD with IHD is remanded. The Veteran’s most recent VA examination for his CAD occurred in October 2013. He has contended, among other things, that his service-connected CAD has worsened to the degree that it warrants a higher disability rating since the last review. The Veteran reports emergency room visits in June 2015 and October 2015 for chest pain and shooting arm pain. As there may have been changes in the Veteran’s symptomology, the Board finds a new VA examination is needed to evaluate the Veteran’s claim. There also appears there may be additional relevant records of treatment. These should be sought as indicated below. The Veteran was initially granted a 10 percent rating for CAD on a November 2012 rating decision. After an error was discovered, the Veteran was granted a 30 percent rating on December 2013. The Veteran disputes this rating. He contends that his prior hospitalizations for two stent procedures and the use of nitroglycerin for chest pain were not addressed in prior reviews. He also contends his service-connected CAD has worsened to the degree that it warrants a higher disability rating since the last review. The Veteran reports emergency room visits in June 2015 and October 2015 for chest and shooting arm pain. See August 2016 Form 9. This evidence suggests worsening of the Veteran’s CAD. The Veteran’s most recent VA examination for his CAD occurred in October 2013. Consequently, as there may have been changes in the Veteran’s symptomology, the Board finds a new VA examination is needed to evaluate the Veteran’s claim. The matter is REMANDED for the following action: 1. Provide the Veteran an opportunity to identify any relevant outstanding private treatment records and any other relevant evidence pertaining to his claim. The identified records should be sought. The AOJ should schedule the Veteran for an appropriate VA examination determine the severity of his coronary artery disease. The entire claims file should be made available to the individual designated to examine the Veteran. The examiner should conduct all diagnostic testing required for evaluating the current severity of coronary artery disease, including metabolic equivalents (METs) and ejection fraction measurements, as well as, symptoms experienced upon diagnostic testing. The examiner should distinguish the symptoms and effects of the Veteran’s service-connected coronary artery disease, from those attributable to any other disability. If it is not medically possible to do so, the examiner should clearly so state. When the development requested has been completed, the case should again be reviewed by the AOJ on the basis of the additional evidence. If the benefit sought is not granted, the AOJ should furnish the Veteran and his attorney a supplemental statement of the case and a reasonable opportunity to respond before returning the record to the Board for further review. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Jaigirdar, Associate Counsel