Citation Nr: 20005986 Decision Date: 01/24/20 Archive Date: 01/23/20 DOCKET NO. 15-14 915 DATE: January 24, 2020 ORDER Entitlement to an effective date prior to January 14, 2013 for service connection for painful, unstable scars of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7804, is denied. Entitlement to an effective date prior to January 14, 2013 for service connection for a scar of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7801, is denied. Entitlement to an effective date prior to January 14, 2013 for service connection for scars, status post vein harvest of the left lower extremity, rated under Diagnostic Code 7801, is denied. Entitlement to an effective date prior to January 14, 2013 for the grant of a 100 percent schedular rating for coronary artery disease, status post coronary artery bypass graft surgery, is denied. Entitlement to service connection for diabetes mellitus, type II, is denied. REMANDED Entitlement to an evaluation in excess of 60 percent for coronary artery disease, status post coronary artery bypass graft, (excluding the period from January 14, 2013, through April 30, 2013 during which a 100 percent schedular rating was in effect), is remanded. Entitlement to an evaluation in excess of 20 percent for degenerative joint disease of the left ankle, status post left ankle fracture with retained hardware, is remanded. Entitlement to an evaluation in excess of 10 percent for hypertension is remanded. Entitlement to an evaluation in excess of 10 percent for residual scars, status post left ankle surgery, is remanded. Entitlement to an initial evaluation in excess of 10 percent for painful, unstable scars of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7804, is remanded. Entitlement to a compensable initial evaluation for service connected scar of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7801, is remanded. Entitlement to a compensable initial evaluation for service connection for scars, status post vein harvest of the left lower extremity, rated under Diagnostic Code 7801, is remanded. Entitlement to a TDIU due to a single service-connected disability other than coronary artery disease from January 14, 2013, to April 30, 2013 for the purpose of special monthly compensation pursuant to 38 U.S.C. § 1114 (s) is remanded. Entitlement to a TDIU due to service-connected disabilities, including coronary artery disease, prior to January 14, 2013 and from May 1, 2013, is remanded. Entitlement to special monthly compensation based on the need for aid and attendance is remanded. Entitlement to special monthly compensation based on housebound criteria is remanded. FINDINGS OF FACT 1. The Veteran’s painful, unstable scars of the chest, status post coronary artery bypass graft surgery, rated under Diagnostic Code 7804, are secondary to his January 14, 2013 coronary bypass surgery, and service connection was awarded based on the date the entitlement arose. 2. The Veteran’s scar of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7801, is secondary to his January 14, 2013 coronary bypass surgery, and service connection was awarded based on the date the entitlement arose. 3. The Veteran’s scars, status post vein harvest of the left lower extremity, rated under Diagnostic Code 7801, are secondary to his January 14, 2013 coronary bypass surgery, and service connection was awarded based on the date the entitlement arose. 4. The Veteran was admitted and underwent coronary artery bypass graft surgery on January 14, 2013, and was appropriately assigned a 100 percent schedular rating beginning on this date. 5. The Veteran’s diabetes mellitus, type II, was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to an effective date prior to January 14, 2013, for the grant of service connection for painful, unstable scars of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7804, have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.155, 3.157, 3.400. 2. The criteria for entitlement to an effective date prior to January 14, 2013, for the grant of service connection for a scar of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7801, have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.155, 3.157, 3.400. 3. The criteria for entitlement to an effective date prior to January 14, 2013, for the grant of service connection for scars, status post vein harvest of the left lower extremity, rated under Diagnostic Code 7801, have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.155, 3.157, 3.400. 4. The criteria for entitlement to an effective date prior to January 14, 2013 for the grant of a 100 percent schedular rating for coronary artery disease, status post coronary artery bypass graft surgery, have not been met. 38 U.S.C. §§ 5110; 38 C.F.R. §§ 3.155, 3.157, 3.400, 4.104, Diagnostic Code 7017. 5. The criteria for service connection for diabetes mellitus, type II, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from January 1980 to May 1992. These matters come before the Board of Veterans’ Appeals (Board) on appeal from October 2012 and May 2013 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. The Veteran’s representative submitted a June 2013 general notice of disagreement as to all denials and effective dates as determined by the October 2012 and May 2013 rating decisions. The October 2012 rating decision, in part, granted a 20 percent evaluation for mild degenerative joint disease of the left ankle, effective August 1, 2012, the date of the claim for increase. The Agency of Original Jurisdiction (AOJ), in part, characterized an issue on appeal related to this determination as entitlement to an earlier effective date for mild degenerative joint disease of the left ankle, rated as 20 percent disabling prior to August 1, 2012. However, under 38 U.S.C. § 5110 (a), the effective date of an increase in a veteran’s disability compensation shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application therefor. However, an increased rating may be awarded up to one year prior to receipt of the claim if the evidence shows an increase in disability was factually ascertainable during that period. Thus, the disagreement as to an earlier effective date for the grant of a 20 percent evaluation for a left ankle disability is in reality simply a continued claim for an increased rating prior to the grant of this increased evaluation, as the rating period for the left ankle disability is from one year prior to August 1, 2012, as this was the date of the receipt of the claim for increase. Therefore, this claim is encompassed within the increased rating claim for the left ankle disability which was separately addressed as an appeal issue by the AOJ. However, to the extent the Veteran’s representative raised entitlement to an earlier effective date for grant of service connection itself for the left ankle disability, such is not on appeal as it would be an impermissible freestanding claim. See Rudd v. Nicholson, 20 Vet. App. 296 (2006). In September 2019, the Veteran presented testimony as to the issue of entitlement to a TDIU at a Travel Board hearing before the undersigned Veterans Law Judge. The hearing transcript is associated with the claims file and reflects the record was held open for 30 days from the date of the hearing to allow the Veteran and his representative to submit additional evidence. Subsequently in September 2019, the Veteran, in conjunction with his representative, submitted an application for TDIU and waived review of such by the AOJ. However, since the issuance of the most recent January 2016 Supplemental Statement of the Case (SSOC), issued for the appeal herein, additional evidence consisting of disability benefits questionnaires, VA treatment records and the Veteran’s Vocational Rehabilitation and Employment file, have been associated with the record. The Veteran did not waive AOJ review of this new evidence. In this regard, if new evidence is submitted with or after a substantive appeal received on or after February 2, 2013, then it is subject to initial review by the Board unless the Veteran explicitly requests consideration by the AOJ. Here, although the Veteran’s substantive appeal for the relevant issues was filed after February 2, 2013, the Board interprets such exception as applying only to evidence submitted by the Veteran. As described above, the record does not reflect that this additional evidence was submitted by the Veteran. However, this evidence is only relevant to the claims for increased ratings for coronary artery disease, the left ankle disability, hypertension, scars of the left ankle, scars of the chest, scars of the left lower extremity, entitlement to a TDIU due to a single service-connected disability other than coronary artery disease from January 14, 2013, through April 30, 2013 for the purpose of special monthly compensation pursuant to 38 U.S.C. § 1114 (s), and entitlement to a TDIU due to service-connected disabilities, including coronary artery disease, prior to January 14, 2013 and from May 1, 2013, and thus, is addressed in the remand below as to these issues. Further, as to the Veteran’s claim for service connection for diabetes mellitus, type II, decided herein, this evidence is either not relevant, or duplicative of prior evidence, as it reflects that the Veteran has been diagnosed with diabetes mellitus type, II, which was previously established of record. Additionally, with respect to the claims for an earlier effective date decided herein, these claims turn on the evidence already of record, to include when a claim was received, the date the entitlement arose, and when the level of disability was factually ascertainable. Thus, there is no prejudice to the Veteran by the Board’s adjudication of these issues at this time. Effective Date Claims Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. Additionally, as applicable for increased rating claims, the effective date is the earliest date which it is factually ascertainable, based on all evidence of record, that an increase in disability had occurred if a complete claim or intent to file a claim is received within one year from such date, otherwise, date of receipt of claim. 38 C.F.R. § 3.400 (o)(2). Effective March 24, 2015, VA amended its regulations to require that all claims governed by VA’s adjudication regulations be filed on a standard form. The amendments also, inter alia, eliminated the constructive receipt of VA reports of hospitalization or examination and other medical records as informal claims to reopen. See 79 Fed. Reg. 57,660 (Sept. 25, 2014), codified as amended at 38 C.F.R. §§ 3.151, 3.155, 3.157. However, the amended regulations do not apply to these appeals as they were initiated prior to March 24, 2015. In this regard, a pre-amendment “claim” is defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. See 38 C.F.R. § 3.1 (p); see also Brannon v. West, 12 Vet. App. 32, 34-35 (1998); Servello v. Derwinski, 3 Vet. App. 196, 199 (1992). 1. Entitlement to an effective date prior to January 14, 2013 for service connection for painful, unstable scars of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7804, entitlement to an effective date prior to January 14, 2013 for service connection for a scar of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7801, and entitlement to an effective date prior to January 14, 2013 for service connection for scars, status post vein harvest of the left lower extremity, rated under Diagnostic Code 7801 The Veteran contends that he is entitled to an earlier effective date of service connection for painful, unstable scars of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7804, for service connection for a scar of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7801, and for service connection for scars, status post vein harvest of the left lower extremity, rated under Diagnostic Code 7801. A September 2004 rating decision granted service connection for coronary artery disease effective June 15, 2004. On December 27, 2012, VA received an informal claim from the Veteran for an increased evaluation for coronary artery disease. On January 23, 2013, VA received an informal claim for scars as secondary to coronary artery disease as the Veteran had bypass surgery on January 14, 2013. Thereafter, a May 2013 rating decision, in part, granted service connection for painful, unstable scars of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7804, service connection for a scar of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7801, and service connection for scars, status post vein harvest of the left lower extremity, rated under Diagnostic Code 7801, each effective January 14, 2013. In this case, the record does not establish that an effective date earlier than January 14, 2013 is warranted for the Veteran’s scars associated with his coronary artery disease. As described above, on December 27, 2012, VA received an informal claim from the Veteran for an increased evaluation for coronary artery disease with a subsequent claim for associated scars which was received on January 23, 2013. The record is entirely negative for evidence of an increased rating claim for coronary artery disease with a derivate claim of scars, either formal or informal, prior to December 27, 2012. Moreover, and most probative, the record demonstrates that the Veteran underwent coronary artery bypass surgery on January 14, 2013 and received the scars for which service connection has been granted secondary to this surgery. As discussed above, the Veteran was already service-connected for coronary artery disease prior to the date of the January 14, 2013 surgery. However, an effective date prior to January 14, 2013 is not warranted as the painful, unstable scars of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7804, a scar of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7801, and scars, status post vein harvest of the left lower extremity, rated under Diagnostic Code 7801, were not present prior to the date of the surgery. Specifically, a February 2013 VA examiner documented that the Veteran had a coronary artery bypass graft on January 14, 2013 resulting in central chest and left lower extremity (saphenous vein harvest site) scars. The February 2013 VA examiner found the claimed condition was at least as likely as not proximately due to or the result of the Veteran’s service-connected condition as this Veteran had a coronary artery bypass graft on January 14, 2013 and had scars of the sternum, as well as left lower extremity from saphenous vein harvest site due to the coronary artery bypass graft. Similarly, a June 2013 VA examiner noted the Veteran had cardiac surgery on January 14, 2013, and in particular, noted discomfort in the median sternotomy scar particularly of the upper third of the scar. Additionally, the medical evidence prior to the Veteran’s January 14, 2013 coronary artery bypass graft does not reflect the existence of any scars associated with coronary artery disease. In particular, a September 2012 VA examiner found the Veteran did not have any scars (surgical or otherwise) related to any conditions or to the treatment of coronary artery disease. Thus, the Veteran was awarded service connection for painful, unstable scars of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7804, a scar of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7801, and scars, status post vein harvest of the left lower extremity, all as secondary to the coronary artery bypass surgery on the date the entitlement arose, specifically on January 14, 2013. Accordingly, entitlement to an effective date prior to January 14, 2013 for these scars is not warranted. In reaching the above decisions, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the claims, the doctrine is inapplicable. Gilbert v. Derwinski, 1 Vet. App. 45 (1990); 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102. Accordingly, the claims are denied. 2. Entitlement to an effective date prior to January 14, 2013 for the grant of a 100 percent schedular rating for coronary artery disease, status post coronary artery bypass graft surgery The Veteran was admitted to the Memphis VA Medical Center (VAMC) and underwent a coronary artery bypass graft on January 14, 2013. A May 2013 rating decision granted a 100 percent schedular evaluation, pursuant to 38 C.F.R. § 4.104, Diagnostic Code 7017, for coronary artery bypass graft surgery, from January 14, 2013, through April 30, 2013, for the three months following hospital admission for the January 14, 2013 coronary bypass surgery. Thus, the Veteran was granted a 100 percent schedular rating effective from the date of this hospital admission, pursuant to Diagnostic Code 7017. He is seeking an effective date earlier than January 14, 2013. Under Diagnostic Code 7017, a 100 percent evaluation is warranted for 3 months following hospital admission for coronary bypass surgery. Thus, the provisions of Diagnostic Code 7017 make clear that a 100 percent rating could not begin prior to the date of hospital admission for the coronary bypass surgery. The evidence reflects that January 14, 2013, was the date of hospital admission. In sum, there is no legal basis for the grant of an effective date earlier than January 14, 2013, for a 100 percent schedular rating based on coronary bypass surgery. Accordingly, this claim must be denied. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Service Connection Generally, service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. To establish service connection on a direct incurrence basis, the Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 3. Entitlement to service connection for diabetes mellitus, type II The Veteran contends that service connection for diabetes mellitus, type II, is warranted. However, neither he nor his representative have advanced a specific argument for the Board to consider. In this regard, in a June 2013 notice of disagreement and April 2015 substantive appeal, the Veteran’s representative argued generally, as to all claims, that VA did not properly assess the military and medical records. Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of diabetes mellitus type II, as evidenced by VA treatment records dated during the pendency of the claim. Diabetes is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. In this regard, the Veteran has not reported his diabetes mellitus, type II, or symptoms of such, onset during service and continued after service, or that it onset within one year after separation from service. Consistent with such, VA treatment records show the Veteran was not diagnosed with diabetes mellitus, type II, until July 2012, decades after his separation from service and decades outside of the applicable presumptive period. In this regard, although an October 2000 VA treatment record documented a glucose reading of 113 mg/dL which was slightly outside the expected range 70 to 110, a diagnosis of diabetes mellitus, type II, was not endorsed. Moreover, a May 2001 VA treatment record documented, in part, there was no history of diabetes. A November 2005 VA treatment record documented a glucose reading of 111 mg/dL; however, again a diagnosis related to this finding was not endorsed. Similarly, although a May 2007 VA treatment record documented, in part, impaired glucose tolerance was suspected and that the section on diabetes was flagged for the Veteran’s review, diabetes was not diagnosed until July 2012. In this regard, a July 2012 VA treatment record documented, in part, diabetes mellitus, type II, of a new onset, and that the Veteran was started on Metformin, that a new glucometer and supplies were ordered, and that diabetic education was consulted. Thus, the evidence reflects the Veteran’s diabetes mellitus, type II, began many years after his separation from service and many years outside of the applicable presumptive period. Service connection for diabetes mellitus, type II, may still be granted on a nonpresumptive direct incurrence basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s diabetes mellitus, type II and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. As discussed above, the first element of service connection on a direct incurrence basis, the existence of a present disability, has been established by VA treatment record which reflect a diagnosis of diabetes mellitus, type II. However, the second element of a claim for service connection is medical evidence, or in certain circumstances lay testimony, of in-service incurrence or aggravation of an injury or disease. The Veteran has not identified a specific incident or event during service as a link as to his claim for service connection for diabetes mellitus, type II. In this regard, review of the Veteran’s service treatment records reveals no diagnosis of diabetes mellitus, type II, or symptoms thereof. Specifically, an April 1990 service treatment record documented the Veteran’s glucose was measured as 102 mg/dL, which was within the expected range of 70 to 110. An April 1990 in-service examination, also found, in pertinent part, the Veteran’s endocrine system, as relevant to diabetes mellitus, type II, was clinically normal upon examination. Additionally, in an April 1990, Report of Medical History, the Veteran checked “no” to the existence of sugar or albumin in urine. Similarly, an April 1992 in-service examination, conducted in conjunction with separation from service, found in pertinent part, the Veteran’s endocrine system, as relevant to diabetes mellitus, type II, was clinically normal upon examination, which also weighs against a finding of an in-service injury or event for this claim. The April 1992 examination report also documented, in part, there was no family history of diabetes, urinalysis for sugar and albumin was negative, and glucose was measured as 83 mg/dL which was within the expected range of 70 to 110. Moreover, in an April 1992, Report of Medical History, also completed in conjunction with separation from service, the Veteran checked “no” to the existence of sugar or albumin in urine. Thus, the April 1992 Report of Medical History also weighs against a finding of an in-service injury or event for this claim. Although the Veteran’s service treatment records generally reflect issues with his weight during service, there is no indication that the Veteran suffered from diabetes as a complication of obesity during service. For instance, although a January 1982 service treatment record documented the Veteran’s weight was 214.5 lbs. and that an ideal weight was 178 lbs., a subsequent August 1982 service treatment record documented that according to the Veteran’s body structure and muscle development, an appropriate weight for the Veteran was the current weight of 223 lbs. Similarly, a November 1985 service treatment record noted that the Veteran’s weight was 249 lbs. and his body fat was 24 percent which was in compliance with Army standards. On separation, the Veteran weighed 233 lbs. However, a December 2011 VA treatment record, dated proximate to the Veteran’s July 2012 diagnosis of diabetes mellitus, type II, documented that the Veteran’s weight was 324 lbs. A July 2012 VA treatment record documented the Veteran’s body mass index (BMI) was 41.7. In this regard, in adults, a BMI greater than 30 kg/m2 indicates obesity and a BMI greater than 40 kg/m2 indicates morbid obesity. Farlex Partner Medical Dictionary. S.v. “body mass index.” Retrieved December 6, 2019 from https://medical-dictionary.thefreedictionary.com/body+mass+index. Thus, as discussed, there is no evidence to link the Veteran’s diabetes mellitus, type II, to his active service, to include as a complication of obesity during service. In reviewing the Veteran’s claim for service connection for diabetes mellitus, type II, the Board has reviewed the statements of the Veteran. The Veteran is certainly competent to describe the extent of symptoms in service, and his current symptomatology for diabetes mellitus, type II; however, the Veteran has not provided any statement regarding such symptomology nor has he identified a basis for service connection for this disability for the Board to consider. See Layno v. Brown, 6 Vet. App. 465 (1994). Nonetheless, the Board recognizes that by virtue of the Veteran filing a claim for service connection for diabetes mellitus, type II, he believes such is connected to his active service. The Board notes, however, that there is no evidence that the Veteran possesses the requisite medical training or expertise necessary to render him competent to offer evidence on the causal question of whether his diabetes mellitus, type II, can be attributed to a specific injury or event during active service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Lay persons may be competent to provide opinions as to some medical issues. However, the specific questions in this case pertaining to the actual diagnosis, etiology, time of onset, and degree of severity at time of onset of diabetes mellitus, type II, fall outside the realm of common knowledge of a lay person. The Veteran has not been shown to have the requisite knowledge and/or expertise to be deemed competent to provide a probative medical opinion as to the existence of diabetes mellitus, type II, during his military service, or etiologically linking diabetes mellitus, type II to his military service. Id. Thus, for the reasons discussed above, the element of in-service disease or injury is not met for the claim for service connection for diabetes mellitus, type II. As the second element for the claim for service connection for diabetes mellitus, type II, is not met, the third requirement for service connection, competent evidence of a nexus between diabetes mellitus, type II, and an in-service disease or injury, need not be further discussed. Additionally, while VA has not provided a medical examination to the Veteran for his claim of service connection for diabetes mellitus, type II, the standard for VA to provide an examination for this claim was not satisfied. In this instance, as discussed above, there is no evidence that diabetes mellitus, type II, is related to service, nor has the Veteran articulated a specific incident or injury during service or link to service for this disability. Indeed, the record is devoid of any assertion from the Veteran or his representative identifying a basis for linking any diabetes mellitus, type II, to the Veteran’s active service. Thus, a VA examination or a medical opinion for this claim is not warranted. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006). Based on the foregoing, the Board finds that the preponderance of the evidence is against a grant of service connection for diabetes mellitus, type II. In reaching the above conclusion, the Board has considered the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim for service connection for diabetes mellitus, type II, that doctrine is not applicable, and service connection must be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). REASONS FOR REMAND 1. Entitlement to an evaluation in excess of 60 percent for coronary artery disease, status post coronary artery bypass graft, (excluding the period from January 14, 2013, through April 30, 2013 during which a 100 percent schedular rating under 38 C.F.R. § 4.104, Diagnostic Code 7017 was in effect) is remanded. As discussed above, additional relevant evidence developed by VA consisting of an October 2019 artery and vein conditions disability benefits questionnaire, which tangentially addressed the Veteran’s coronary artery disease, was associated with the record subsequent to the most recent, January 2016 SSOC issued, in part, for this claim. The Veteran did not waive AOJ review of this additional evidence. Specifically, the October 2019 examiner noted, in part, the Veteran reported tiring easily after performing minimal walking at a regular pace as well as having shortness of breath with exertion, dizziness, and fatigue all related to his heart condition. However, the October 2019 examiner also noted that a cardiovascular disability benefits questionnaire would be more appropriate to assess Veteran’s heart condition. In this regard, a heart conditions disability benefits questionnaire was last obtained in June 2013. Thus, a remand for AOJ consideration of this evidence as well as a new examination to ascertain the current severity and manifestations of the Veteran’s coronary artery disease is warranted. 2. Entitlement to an evaluation in excess of 20 percent for degenerative joint disease of the left ankle, status post left ankle fracture with retained hardware, is remanded. As discussed above, additional relevant evidence developed by VA consisting of an October 2019 ankle conditions disability benefits questionnaire, which addressed the Veteran’s left ankle disability, was associated with the record subsequent to the most recent, January 2016 SSOC issued, in part, for this claim. The Veteran did not waive AOJ review of this additional evidence. Thus, a remand for AOJ consideration of this evidence is warranted. Additionally, the most recent October 2019 ankle conditions disability benefits questionnaire noted there was no objective evidence of pain on passive range of motion testing or when the joint was used in non-weight bearing; however, the report does not contain range of motion measurements in degrees as to these findings. See Correia v. McDonald, 28 Vet. App. 158 (2016). Further, while the October 2019 examiner documented the Veteran did not report flare-ups, an August 2012 examiner documented the Veteran reported flare-ups, specifically that he had severe pain with weather changes and activity. However, the August 2012 examiner did not provide additional functional loss in degrees during flare-ups or range of motion testing regarding passive motion or with weight bearing. Thereafter, a February 2015 examiner, in review of the August 2012 examination, was unable to say without mere speculation whether pain, weakness, fatigability or incoordination significantly limited functional ability with flare-ups as the Veteran was not experiencing a flare-up during the August 2012 examination. Sharp v. Shulkin, 29 Vet. App. 26 (2017). Thus, due to these deficiencies, a retrospective and current medical opinion as to the severity of the disability in terms of any additional functional loss during passive motion, with weight-bearing, and during flare-ups, are warranted. 3. Entitlement to an evaluation in excess of 10 percent for hypertension is remanded. As discussed above, additional relevant evidence developed by VA consisting of an October 2019 hypertension disability benefits questionnaire, which addressed the Veteran’s hypertension, was associated with the record subsequent to the most recent, January 2016 SSOC issued, in part, for this claim. The Veteran did not waive AOJ review of this additional evidence. Thus, a remand for AOJ consideration of this evidence is warranted. 4. Entitlement to an evaluation in excess of 10 percent for residual scars, status post left ankle surgery, entitlement to an initial evaluation in excess of 10 percent for painful, unstable scars of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7804, entitlement to a compensable initial evaluation for service-connected scar of the chest, status post coronary artery bypass surgery, rated under Diagnostic Code 7801, and entitlement to a compensable initial evaluation for service-connected scars, status post vein harvest of the left lower extremity, rated under Diagnostic Code 7801, are remanded. As discussed above, additional relevant evidence developed by VA consisting of an October 2019 scars/disfigurement disability benefits questionnaire, which addressed the Veteran’s scars related to his coronary artery disease and left ankle disability, was associated with the record subsequent to the most recent, January 2016 SSOC issued, in part, for these claims. The Veteran did not waive AOJ review of this additional evidence. Thus, a remand for AOJ consideration of this evidence is warranted. 5. Entitlement to a TDIU due to service-connected disabilities, including coronary artery disease, prior to January 14, 2013 and from May 1, 2013, and entitlement to a TDIU due to a single service-connected disability other than coronary artery disease from January 14, 2013 through April 30, 2013, are remanded. Entitlement to a TDIU has been raised as part and parcel of the Veteran’s increased rating claims for his left ankle disability, hypertension and coronary artery disease. Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran’s increased rating claims for coronary artery disease and hypertension, were each received by VA on August 1, 2012 and his informal increased rating claim for coronary artery disease was received on December 27, 2012. Rice v. Shinseki, 22 Vet. App. 447 (2009). As such, the rating period for consideration, as most favorable to the Veteran, for entitlement to a TDIU is from August 1, 2011, one year prior to the August 1, 2012 date of receipt of the claim for increase, if it is factually ascertainable that an increase warranting a TDIU occurred during that period. During the pendency of the claim, a May 2013 rating decision granted a 100 percent schedular evaluation for coronary artery bypass graft from January 14, 2013 through April 30, 2013 pursuant to 38 C.F.R. § 4.104, Diagnostic Code 7017. The AOJ initially characterized the issue of entitlement to a TDIU as entitlement to a TDIU for the dates of August 1, 2012 to January 14, 2013 in a May 2013 rating decision, as entitlement to a TDIU from May 1, 2013 in a January 2016 rating decision, and as entitlement to a TDIU prior to January 14, 2013 and from May 1, 2013 in a January 2015 SSOC. However, as discussed above, the period for consideration for entitlement to a TDIU is from August 1, 2011. Further, a separate TDIU rating predicated on one (single) disability may be awarded if that disorder is not already rated at the schedular 100 percent level. Bradley v. Peake, 22 Vet. App. 280 (2008). Thus, pursuant to Bradley, such an award does not automatically moot the pending appeal for a TDIU. Nonetheless, a separate TDIU rating cannot be awarded based on one service-connected disability if the Veteran is already receiving a 100 percent schedular rating for that disorder. Buie v. Shinseki, 24 Vet. App. 242 (2010). As discussed above, additional relevant evidence developed by VA consisting of October 2019 opinions addressing the Veteran’s TDIU claims were associated with the record subsequent to the most recent, January 2016 SSOC issued, in part, for these claims. The Veteran did not waive AOJ review of this additional evidence. Thus, a remand for AOJ consideration of this evidence is warranted. The Veteran’s claims for TDIU must also be remanded as they are inextricably intertwined with the above issues being remanded herein. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Additionally, in a September 2019 application for TDIU, the Veteran reported in part, that he last worked full-time and became too disabled to work in 2010. However, an August 2012 VA treatment record noted, in part, that that the Veteran was currently unemployed and that he used to work as a physical education teacher/coach in middle school, but had to stop working last year due to an inability to function/stay on his feet too long on a regular basis. However, a December 2012 VA treatment record noted, in part, the Veteran was a physical education teacher and a coach, so he was very active all day, and a January 2013 VA treatment record noted, in part, the Veteran was concerned regarding how long to keep sternal precautions as he has an active job as a physical education teacher/coach. Another January 2013 VA treatment record noted the Veteran had decided that he likely would not return to his previous line of employment (teaching/coaching teens) as he saw the work as being too physically strenuous. Thus, as described, the date of the Veteran’s last employment as a physical education teacher and coach is unclear from the evidence of record as it reflects dates in 2010, 2011 and 2013. Further, in September 2019 testimony, the Veteran reported he was currently employed, but that this was marginal employment. The record reflects that, in November 2019, the AOJ sent a VA Form 21-4192, Request for Employment Information, to the Veteran’s current employer requesting information which has not yet been provided; however, all steps should be taken to ensure this information is obtained. Also, a VA Form 21-4192, Request for Employment Information, should be obtained from the Veteran’s prior employer related to his position as a physical education teacher and coach. Additionally, in September 2019 testimony, the Veteran reported he applied for disability benefits from the Social Security Administration when he stopped working full-time but was denied. The Veteran’s Social Security Administration records are not associated with the record nor does the record reflect an attempt has been made to obtain any such records with regard to disability benefits. There is a reasonable possibility that any existing Social Security Administration records may be relevant to the Veteran’s TDIU claims. Thus, upon remand, an attempt should be made to obtain any Social Security Administration disability benefits records. 6. Entitlement to special monthly compensation based on the need for aid and attendance and entitlement to special monthly compensation based on housebound criteria are remanded. The Veteran’s claims for special monthly compensation based on based on the need for aid and attendance or housebound status, must be remanded as they are inextricably intertwined with the above issues being remanded herein. Id. The matters are REMANDED for the following actions: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected coronary artery disease, status post coronary artery bypass graft. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. 2. Obtain addendum opinions from an appropriate clinician as to the current and retrospective severity of the Veteran’s service-connected left ankle disability in terms of any additional functional loss during passive motion, with weight-bearing, and during flare-ups. The examiner, to the extent possible, should provide retrospective findings in regard to an estimation of functional loss in degrees as to passive motion and as to weight-bearing at the time of the VA examinations conducted August 2012 and October 2019, and well as currently. The examiner, to the extent possible, should also provide retrospective findings in regard to an estimation of functional loss in degrees due to flare-ups experienced by the Veteran at the time of VA examination conducted in August 2012, and currently. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment for the period prior to the current examination, or currently, 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). 3. Obtain a completed VA Form 21-4192, Request for Employment Information In Connection With Claim for Disability Benefits, for the Veteran’s prior employer related to his employment as a physical education teacher and coach, and continue efforts to obtain a completed VA Form 21-4192, Request for Employment Information In Connection With Claim for Disability Benefits, from the Veteran’s current employer. 4. Obtain and associate with the record all records pertaining to the Veteran concerning a claim for disability benefits from the Social Security Administration, to include all evidence and copies of any disability determination. Document all requests for information as well as all responses in the claims file. 5. After undertaking any other development deemed appropriate, readjudicate the issues on appeal, with consideration of all additional evidence received subsequent to the most recent SSOC. If any benefit sought is not granted, furnish the Veteran and his representative with a SSOC and afford them the   appropriate opportunity to respond before the record is returned to the Board for further review. U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Espinoza, 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.