Citation Nr: 18158155
Decision Date: 12/14/18	Archive Date: 12/14/18

DOCKET NO. 13-30 134
DATE:	December 14, 2018
REMANDED
Entitlement to a rating in excess of 10 percent prior to November 19, 2013 and in excess of 30 percent thereafter for coronary artery disease (CAD) is remanded.
REASONS FOR REMAND
The Veteran served on active duty from January 1962 to October 1976.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Huntington, West Virginia. 
Entitlement to a rating in excess of 10 percent prior to November 19, 2013 and in excess of 30 percent thereafter for coronary artery disease (CAD) is remanded.
In November 2017, the Board remanded the matter to afford the Veteran a VA examination to determine the current severity of his CAD since there was evidence of worsening since the last VA examination.  There is evidence that the Veteran failed to RSVP to an examination scheduling and therefore his appointment was canceled.  However, it is unclear if the Veteran ever received notification of the appointment as there is evidence that he has appeared for many appointments with the VA before and after the scheduled VA examination appointment date.  Therefore, the Board finds that a remand is necessary to afford the Veteran another opportunity to attend a VA examination. Efforts should be made to verify the Veteran’s current mailing address and notification of the scheduled VA examination appointment is to be documented in the Veteran’s electronic claims folder.
The matter is REMANDED for the following action:
Verify the Veteran’s current mailing address and then schedule the Veteran for an appropriate VA cardiology examination (by a physician) to determine the current severity of the Veteran’s service-connected CAD, including the approximate level of dyspnea on exertion attributable to the CAD as opposed to the Veteran’s chronic obstructive pulmonary disorder (COPD) and other co-morbidities.  The electronic claims folder, including a copy of this remand, must be made available to the examiner for review.  A copy of the letter notifying the Veteran of the scheduled appointment should be associated with the electronic claims folder.  The examiner should conduct all necessary testing, keeping in mind that the last examination report relied on testing from 2014, and the Veteran reports that his condition has worsened.  
Additionally, the examiner is asked to opine as to whether the Veteran’s METs level is an accurate measure of the severity of the Veteran’s CAD, and if not, whether it is possible to accurately determine the level of severity of the Veteran’s CAD based on other objective testing and given the Veteran’s other co-morbidities including COPD. Is it possible to estimate what percentage of the Veteran’s breathing difficulty is related to the CAD as opposed to his COPD and other medical conditions?
A complete rationale for all opinions reached is required. 
 
Michael Pappas
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	L. Baskerville