Citation Nr: 18160712 Decision Date: 12/27/18 Archive Date: 12/27/18 DOCKET NO. 14-12 654 DATE: December 27, 2018 REMANDED Entitlement to an initial evaluation for coronary artery disease status post coronary artery bypass surgery (also claimed as ischemic heart disease) in excess of 30 percent prior to December 18, 2013, and in excess of 60 percent thereafter, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1967 to October 1987, with service in Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an February January 2013 rating decision by the Department of Veterans Affairs (VA). A Decision Review Officer (DRO) hearing was conducted in December 2013. In November 2014, the Veteran requested a Board hearing by live videoconference. In October 2018, the Veteran was scheduled for a November 2018 Board hearing. However, the Veteran withdrew his hearing request as noted by an October 2018 written statement. As such, the hearing request is deemed withdrawn. See 38 C.F.R. § 20.704(e). Entitlement to an initial evaluation for coronary artery disease in excess of 30 percent prior to December 18, 2013, and in excess of 60 percent thereafter. The Veteran contends that the December 2012 VA examination for coronary artery disease was inadequate because the examiner did not conduct a laboratory determination of metabolic equivalents (METs) by exercise testing. See February 2013 notice of disagreement (NOD). During the December 2012 examination the VA examiner estimated the Veterans METs level based on his reported symptoms. Pursuant to 38 C.F.R. § 4.104, Note 2, a laboratory determination of METs by exercise testing is required unless there are medical reasons which prevent such testing. Here, the VA examiner did not provide a rationale as to why a laboratory determination of METs by exercise testing was not conducted. As such, remand for a new examination is warranted. Further, while the mere passage of time is not a basis for requiring a new examination, the Board notes that the Veteran’s last VA examination to assess the severity of his coronary artery disease was over six years ago. Palczewski v. Nicholson, 21 Vet. App. 174 (2007). Since his December 2012 VA examination, the Veteran has reported symptoms indicating that his coronary artery disease may have worsened. Notably, at the December 2013 hearing the Veteran reported that he experienced symptoms of frequent dizziness, fatigue, shortness of breath, and chest pain. He indicated that he tires quickly, has difficulty performing physical activities, and can no longer exercise or walk around the block. See December 2013 hearing. The Veteran’s testimony appears to show a worsening of symptomatology and therefore, the Board finds that a remand is necessary to assess the current severity of the Veteran’s service-connected coronary heart disease. See Allday v. Brown, 7 Vet. App. 517, 526 (1995) (where the record does not adequately reveal current state of Veteran’s disability, fulfillment of 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 previous examination). The matter is REMANDED for the following action: 1. The AOJ should obtain copies of VA treatment records for the Veteran’s disabilities from January 2015 to the present. 2. After the above development is completed, the AOJ should arrange for an examination of the Veteran to assess the current severity of his service-connected coronary artery disease. The examiner must review the entire record (including this remand) in conjunction with the examination and note such review was conducted. The examiner should provide a full description of the disability and report all signs and symptoms associated with the Veteran’s disability. The examiner should conduct a laboratory determination of METs by exercise testing. If a laboratory determination of METs by exercise testing cannot be done, the examiner should perform an interview-based METs test based on the Veteran's responses to a cardiac activity questionnaire and provide a full rationale as to why a laboratory determination of METs by exercise testing was not conducted. 3. If upon completion of the above action the issues remain denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Roe, Associate Counsel