Citation Nr: 19190891 Decision Date: 12/03/19 Archive Date: 12/03/19 DOCKET NO. 15-20 988 DATE: December 3, 2019 REMANDED An initial disability rating higher than 30 percent for posttraumatic stress disorder (PTSD) is remanded. An initial disability rating higher than 30 percent for ischemic heart disease/coronary artery disease is remanded. A total disability rating for compensation based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1970 to November 1974. The case is on appeal from a rating decision issued in June 2013, and on appeal from two rating decisions issued on September 8, 2014. The June 2013 rating decision granted service connection for ischemic heart disease with a rating of 10 percent effective April 30, 2012. The Veteran appealed the assigned rating. In a rating decision dated in February 2014, the RO increased the rating for service-connected ischemic heart disease from 10 percent to 30 percent effective April 30, 2012; and in a rating decision dated in April 2017, the RO granted an earlier effective date of April 30, 2011 for the grant of service connection for ischemic heart disease. In a rating decision dated September 8, 2014, the RO granted service connection for PTSD with a rating of 30 percent effective August 6, 2013; and in a separate rating decision dated September 8, 2014, the RO denied entitlement to TDIU. The Veteran promptly appealed the initially assigned rating for his service-connected PTSD, and the RO’s September 2014denial of TDIU. In September 2018, the Veteran and his spouse testified at a Board hearing regarding the issues of a higher disability rating for service-connected ischemic heart disease and PTSD, and entitlement to TDIU. In March 2019, the Board remanded the issues of a higher disability rating for service-connected ischemic heart disease and PTSD, and entitlement to TDIU, for further development. While on remand, the Veteran perfected a Legacy appeal for service connection for sleep apnea and requested a Board Hearing regarding that matter. A decision on the appeal for service connection sleep apnea will be issued after the requested Board Hearing. 1. An initial disability rating higher than 30 percent for PTSD is remanded. In March 2019, the Board remanded the matter for a VA examination in order ascertain the severity of the Veteran’s service-connected PTSD; and in May 2019 an examination was done. However, in correspondence dated in September 2019, the Veteran indicated that his PTSD had worsened since his last VA examination, and that his PTSD medications had been changed/increased. He also advised that there were extant VA PTSD and relevant primary care treatment records since the May 2019 VA examination, and requested that those records be obtained. REMAND for the extant VA medical records is warranted. The Veteran should then be afforded a new examination. 2. An initial disability rating higher than 30 percent for ischemic heart/coronary artery disease is remanded. In March 2019, the Board remanded the matter for a VA examination in order ascertain the severity of the Veteran’s service-connected ischemic heart disease; and in May 2019 an examination was done. However, exercise stress testing was not done, and the interview-based METs estimate of “ >5-7 METs” was, according to the examiner, from a May 2015 assessment. See May 2019 VA Heart Conditions examination report, p. 5. While this may simply be a typographical error, the Board cannot presume that this is the case, particularly since the examiner’s assertion that the Veteran has a METs level “consistent with activities such as walking 1 flight of stairs, golfing (without cart), mowing lawn (push mower), [and] heavy yard work (digging)” is contrary to the Veteran’s assertions that he is winded with climbing a flight of stairs; unable to mow the lawn with a power push mower or dig; and has to be very careful about being aggressive with activity. See March 2017 VA general medical examination report. See also TDIU application submitted by the Veteran in June 2019, wherein the Veteran stated that his heart disease caused “winded-ness and lack of physical stamina.” The Board further notes that in his examination report the May 2019 examiner averred that a May 23, 2019 echocardiogram found “normal” left ventricular ejection fraction of “[>55%]”; however, the Board observes that the May 23, 2019 echocardiogram report reads: “Due to the poor quality of the echocardiogram, an assessment of left ventricular ejection fraction cannot be made.” See May 23, 2019 Adult Transthoracic Echocardiogram Study Report. REMAND for reexamination is warranted. See 38 C.F.R. § 4.100(b). 3. TDIU is remanded. The issue of TDIU is inextricably intertwined with the appeals for increased rating. See Harris v. Derwinski, 1 Vet. App. 180, 183 (providing that two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless both issues have been considered). Thus, the adjudication of this matter is deferred. The matters are REMANDED for the following action: 1. Associate all of the Veteran’s VA PTSD treatment records and primary care records dating from June 1, 2019 with the claims file. 2. Transfer the claims file to the 2019 VA examiner to obtain an addendum report, assessing or reaffirming the severity of the Veteran’s PTSD. If the examiner deems it appropriate, schedule the Veteran for a new VA examination. If a new examination is deemed necessary, the examiner should discuss the Veteran’s current complaints and experiences with the Veteran and document these in the examination report. The examiner must then: (a.) identify all current symptoms of the Veteran’s PTSD. (b.) opine, after the required consultation with the Veteran and review of the evidence of record (including the statements from the Veteran, his spouse, and his friend), as to the severity/impact of the Veteran’s PTSD on his activities of daily living, including his occupational and social functioning. 3. Schedule the Veteran for a VA heart examination to ascertain the current severity of his service-connected coronary artery disease. The claims file should be reviewed by the examiner, and the Veteran must be physically examined. The examiner must also (a.) discuss the Veteran’s current complaints and symptoms with the Veteran and document such in the examination report. (b.) conduct cardiovascular testing, including exercise stress testing, if viable. The Veteran’s current METs and LVEF must be assessed and reported. If exercise stress testing is not done, explain why. Simply stating that exercise stress testing is not part of the Veteran’s current treatment plan is not sufficient. (c.) Additionally, after the required consultation with the Veteran and physical and clinical examinations, opine as to the severity/impact of the Veteran’s coronary heart disease on his activities of daily living, including his occupational and social functioning. 4. After completion of all of the above and any other development deemed warranted (such as verification of the Veteran’s income history for TDIU purposes), issue a Supplemental Statement of the Case that addresses the three remanded issues, including the appeal for TDIU; unless the benefit sought is granted. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Childers, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.