Citation Nr: 18161121 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 13-23 850 DATE: December 28, 2018 REMANDED Entitlement to an initial evaluation in excess of 10 percent for coronary artery disease (CAD) is remanded. REASONS FOR REMAND The Veteran had active service from January 1966 to October 1969, including service in Vietnam. This appeal to the Board of Veterans’ Appeals (Board) arose from an August 2011 rating decision in which the Department of Veterans Affairs (VA) Regional Office (RO), which awarded service connection for CAD and assigned a 10 percent rating effective September 3, 2004. The Veteran timely appealed the assigned initial evaluation for that disability. This case was initially before the Board in May 2016, at which time the Board denied the earlier effective date claim for the award of service connection for CAD, and remanded the increased evaluation claim for additional development. The case was returned to the Board in August 2017, at which time the Board denied an evaluation in excess of 10 percent for CAD. The Veteran timely appealed that decision to the United States Court of Appeals for Veterans Claims (Court). During the pendency of that appeal, the parties jointly agreed to vacate the August 2017 Board decision and remand it for further clarification and development. The case has been returned to the Board at this time in compliance with the May 2018 Joint Motion for Remand and Court order. The May 2018 Joint Motion has directed the Board to remand the claim for a VA cardiology examination to perform an exercise stress test, or provide an explanation as to why one cannot be performed. In May 2016, the Board remanded the initial increased rating claim to ascertain the current severity of the Veteran’s coronary artery disease. The remand directives instructed the examiner to provide the level of METs, and if that was not ascertainable, to provide an estimate with examples. Pursuant to the Board’s remand, the Veteran underwent a VA examination in August 2016. However, the examiner noted that an exercise test was done in February 2006, and also noted that the test was terminated due to symptoms that were related to the cardiac condition. The examiner indicated that an interview-based METs test was performed August 2016, but did not respond to a question asking that, if an exercise stress test was performed, to provide a reason. It is not clear whether the August 2016 examiner performed a stress test, therefore, the examination does not substantially comply with the May 2016 remand. Accordingly, on remand, the AOJ should arrange for the Veteran to undergo a VA cardiology examination that complies with the May 2016 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). On remand, the Board also finds that any outstanding VA or private treatment records should also be obtained. See 38 U.S.C. § 5103A(b), (c); 38 C.F.R. § 3.159(b); see also Sullivan v. McDonald, 815 F.3d 786 (Fed. Cir. 2016) (where the Veteran “sufficiently identifies” other VA medical records that he or she desires to be obtained, VA must also seek those records even if they do not appear potentially relevant based upon the available information); Bell v. Derwinski, 2 Vet. App. 611 (1992). The matter is REMANDED for the following action: 1. Obtain any and all VA treatment records not already associated with the claims file from the Detroit and Chicago VA Medical Centers, or any other VA medical facility that may have treated the Veteran and associate those documents with the claims file. 2. Ask the Veteran to identify any private treatment that he may have had for his CAD, which is not already of record. After securing the necessary releases, attempt to obtain and associate those identified treatment records with the claims file. If any identified records cannot be obtained and further attempts would be futile, such should be noted in the claims file and the Veteran should be notified so that he can make an attempt to obtain those records on his own behalf. 3. Arrange for the Veteran to undergo a VA cardiology examination to ascertain the current severity of coronary artery disease. All indicated tests and studies should be accomplished if deemed necessary by the examiner for rating the Veteran under the pertinent rating criteria. The examiner should indicate whether a stress test was being performed at that time, and if not, explain the reason why. The examiner should identify all symptoms and impairments associated with the Veteran’s CAD, noting their frequency and severity. The examiner should provide the level of METs which results in dyspnea, fatigue, angina, dizziness, or syncope. If that number cannot be determined by testing, an estimate, supported by specific examples of activities that cause that result, should be provided. The examiner should state whether or not there is evidence of cardiac hypertrophy or dilation on echocardiogram, electrocardiogram, or X-ray. The examiner should state whether there have been any episodes of congestive heart failure, and frequency. The contents of the entire, electronic claims file, to include a complete copy of this REMAND, must be made available to the designated clinician, and the examination report should reflect consideration of the Veteran’s documented medical history and lay assertions. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD W. Wells, Associate Counsel