Citation Nr: 18159482 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 15-14 660 DATE: December 20, 2018 REMANDED Entitlement to a higher initial disability rating for service-connected coronary artery disease (CAD) status post coronary artery bypass graft and stenting is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran had a period of honorable service in the Army from October 1965 to October 1967. The Veteran withdrew his request for a hearing in November 2018. 1. Entitlement to a higher initial disability rating for coronary artery disease is remanded. The Veteran contends that his service-connected coronary artery disease (CAD) disability warrants higher ratings than initially assigned. A 30 percent rating is effective prior to October 17, 2011, a 60 percent rating is effective prior to May 31, 2012, and a 30 percent rating is effective since May 31, 2012. The Board also notes that the Veteran was assigned several temporary total evaluations during the appeal period, including from September 19, 2006 to January 1, 2007, from July 11, 2008 to September 1, 2008, from June 9, 2009 to August 1, 2009, and from December 3, 2013 to February 1, 2014. Therefore, these periods of temporary total evaluations will not be considered in the Veteran’s appeal. The Veteran was afforded a VA examination for his CAD disability in August 2010 and the examination was adequate for rating purposes at that time. The Veteran asserts that numerous hospitalizations and the severity of his symptomatology prevented employment throughout the period on appeal. See Veteran’s Memorandum of Law. VA cardiac rehabilitation discharge records indicate the Veteran’s METs level was between 3-5 in July 2014. See July 2014 Medical Treatment Records. In a June 2015 medical note, one physician opined that the Veteran’s symptomatology prevented employment in any capacity. See June 2015 Medical Treatment Record. The Board finds the August 2010 examination is unduly remote, as it is over eight years old, and there appears to be evidence of worsening of the Veteran’s disability. The Board is unable to determine the current severity of the Veteran's service-connected CAD disability, and concludes that a remand is needed to afford the Veteran an opportunity to undergo an updated VA examination to assess the current nature, extent, and severity of this disability and to obtain any outstanding VA treatment records. See Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (noting that an examination too remote for rating purposes cannot be considered “contemporaneous”); see also 38 C.F.R. § 3.159(c)(2). On remand, updated VA treatment records should be obtained and the Veteran should also be offered the opportunity to submit any private treatment records in support of his claim. 2. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. Finally, the Board finds that the issue of TDIU was raised by the record with his claim for increased rating, and thus, the Board has jurisdiction over the claim for TDIU. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Because a decision on the remanded issue of entitlement to an increased rating for a CAD disability could significantly impact a decision on the issue of entitlement to a TDIU, the issues are inextricably intertwined. A remand of the claim for a TDIU is required. The matter is REMANDED for the following actions: 1. Obtain all outstanding VA treatment records. Any attempts to obtain these records and responses received thereafter should be associated with the Veteran's claims file. Ask the Veteran to complete a VA Form 21-8940 for an Application for Increased Compensation Based on Unemployability. Invite the Veteran to submit any other evidence showing that his service-connected disabilities render him unemployable. 2. Schedule the Veteran for a VA examination with an appropriate clinician to determine the current nature and severity of his CAD disability. To the extent possible, the examiner should identify any symptoms and functional impairments due to the CAD disability alone and discuss the effect of the CAD disability on any occupational functioning and activities of daily living. If it is not possible to provide an opinion regarding symptoms or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner does not have the knowledge or training. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Muzzammel, Associate Counsel