Citation Nr: 18160302 Decision Date: 12/26/18 Archive Date: 12/26/18 DOCKET NO. 13-03 825 DATE: December 26, 2018 REMANDED Entitlement to an evaluation in excess of 30 percent for coronary artery disease prior to August 15, 2016, and in excess of 60 percent for coronary artery disease status post stent placement from August 15, 2016 to the present, is remanded. Entitlement to an evaluation in excess of 30 percent for anxiety disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1967 to May 1970. In a December 2017 decision, the Board denied a rating in excess of 30 percent for anxiety disorder; granted a 30 percent rating, but no higher, for coronary artery disease prior to August 15, 2016; and denied a rating in excess of 60 percent for coronary artery disease. The Veteran appealed the Board’s decision to the Court of Appeals for Veterans Claims (Court). In August 2018, the Court granted a Joint Motion for Partial Remand (JMPR), vacating the Board’s denials and remanded them for further appellate consideration. The Board’s grant of a 30 percent rating for coronary artery disease prior to August 15, 2016, remained undisturbed. 1. Entitlement to an evaluation in excess of 30 percent for coronary artery disease prior to August 15, 2016 and an evaluation in excess of 60 percent for coronary artery disease status post stent placement from that date. In the August 2018 JMPR, the parties found that Board failed to ensure that the VA satisfied its duty to assist in obtaining outstanding private treatment records, particularly treatment records from Dr. Chen and Huntsville Hospital. See 38 U.S.C. § 5103A (b). A review of the evidence shows that the Veteran receives ongoing treatment from Dr. Chen; however, only treatment records dated through February 2012 have been associated with the claims file. See VA treatment records dated May 8, 2015 and November 15, 2016. Additionally, on August 2012 and 2016 VA examinations, the Veteran reported that he was treated for percutaneous coronary intervention with additional stents and myocardial infarction at Huntsville Hospital in September and October 2011; however, it does not appear that any attempts have been made to associate these records with the Veteran’s claims file. Therefore, the Veteran should be provided the opportunity to identify any private treatment records that are relevant to his claims, and to provide the necessary information in order for the VA to assist him in obtaining these potentially relevant records. See 38 C.F.R. § 3.159 (c). On remand, the AOJ should also obtain any outstanding VA treatment records. Bell v. Derwinski, 2 Vet. App. 611 (1992). In the November 2018 written brief presentation, the Veteran’s representative indicated that the Veteran’s coronary artery disease included current symptoms of dizziness, suggesting an increase in severity since his prior August 2016 VA examination. The Board notes that symptoms of dizziness were not noted during the Veteran’s last VA examination in August 2016 and private medical records reveal that the Veteran repeatedly denied having dizziness. Thus, on remand, the Veteran must be afforded an additional VA examination or examinations to assess the current nature, extent, and severity of his service-connected coronary artery disease. See Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); see also VAOPGCPREC 11-95 (1995), 60 Fed. Reg. 43186 (1995). 2. Entitlement to an evaluation in excess of 30 percent for anxiety disorder is remanded. In the November 2018 written brief presentation, the Veteran’s representative reported that the Veteran’s currently exhibited worrying, hyperarousal, poor concentration, and obsessive-compulsive behavior. Such symptoms were not noted during the Veteran’s last examination in August 2016 and are suggestive of an increase in severity of the Veteran’s service-connected anxiety disorder. Thus, on remand, the Veteran must be afforded an additional VA examination or examinations to assess the current nature, extent, and severity of his service-connected coronary artery disease. See Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); see also VAOPGCPREC 11-95 (1995), 60 Fed. Reg. 43186 (1995). The matters are REMANDED for the following action: 1. Obtain a copy of the Veteran’s VA treatment records since May 2017. 2. The Veteran should also be given an opportunity to identify any additional healthcare providers, including treatment records from Dr. Chen since February 2012 and Huntsville Hospital since September 2011. After securing any necessary authorizations from him, obtain all identified treatment records. All reasonable attempts should be made to obtain any identified records. 3. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records. 4. Schedule the Veteran for a VA examination by a physician with appropriate expertise to determine the current level of severity of the Veteran’s coronary artery disease. The entire claims file must be reviewed by the examiner in conjunction with the examination. All indicated tests and studies should be performed, and all findings should be set forth in detail. The VA examiner should identify all present symptoms and manifestations attributable to the Veteran’s service-connected coronary artery disease. The examiner should provide to the greatest extent possible comprehensive information that addresses all components of the disability, to include an assessment of workload in terms of METs (metabolic equivalent) that results in dyspnea, fatigue, angina, dizziness or syncope; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray; left ventricular function; and commentary on the presence, or lack thereof, of congestive heart failure, and its frequency. If a determination of METs by exercise testing cannot be done for medical reasons, then the examiner should provide an estimate of the level of activity expressed in METs and supported by specific examples (such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness or syncope. All examination findings/testing results, along with a complete, clearly-stated rationale for any opinion offered, must be provided. 5. The Veteran should be scheduled for an appropriate VA examination to determine the current nature and severity of his service-connected anxiety disorder. The entire record must be made available to and be reviewed by the examiner. Any indicated evaluations, studies, and tests should be conducted. The examiner should identify the nature and severity of all current manifestations of his service-connected anxiety disorder, as well as the impact that such has on the Veteran’s social and occupational functioning. All examination findings/testing results, along with a complete, clearly-stated rationale for any opinion offered, must be provided. 6. After completing any additional development deemed necessary, if the benefits requested on appeal are not granted to the Veteran’s satisfaction, the Veteran and his representative should be furnished a Supplemental Statement of the Case (SSOC). V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Crohe, Counsel