Citation Nr: 20007072 Decision Date: 01/28/20 Archive Date: 01/28/20 DOCKET NO. 17-28 342 DATE: January 28, 2020 REMANDED A disability rating higher than 60 percent for coronary artery disease (CAD) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1963 to March 1968. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a May 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The May 2016 rating decision continued a 60 percent rating for CAD and denied entitlement to a TDIU. In his substantive appeal (VA Form 9), the Veteran limited his appeal to the issue of a rating higher than 60 percent for CAD. In March 2019, the Board remanded the issue for additional evidentiary development. The Board also notes that the only additional pertinent evidence associated with the claims file since the October 2019 supplemental statement of the case was submitted by the Veteran, through his representative, and does not require a waiver of consideration by the RO, as the substantive appeal was filed in May 2017. Disabled American Veterans v. Secretary of Veterans Affairs, 419 F.3d 1317, 1319-20 (Fed. Cir. 2005); 38 C.F.R. §§ 20.901, 20.903. A disability rating higher than 60 percent for CAD. Although the Board regrets additional delay, another remand is necessary to ensure that there is a complete record upon which to decide the claim so that the Veteran is afforded every possible consideration. A remand by the Board confers on the Veteran, as a matter of law, the right to have compliance with the remand directives, and the Board has a duty to ensure such compliance. Stegall v. West, 11 Vet. App. 268, 271 (1998). In March 2019, due to conflicting MET scores in the record, the Board remanded the claim to obtain a VA heart examination. The examiner was instructed to complete exercise stress testing unless contraindicated. Following the March 2019 remand, the Veteran was afforded a VA examination in August 2019. While the August 2019 VA examiner stated that an exercise stress test had not been performed because it was “not required as part of the Veteran’s current treatment plan and this test is not without significant risk,” clarification of the examiner’s comments is needed. On the August 2019 examination report, the examiner noted that on interview-based METs testing angina was present and the Veteran’s METs level was a workload of 5-7 METs. The Veteran’s functional impairment was noted to be mild to moderate on exertion. However, in January 2020, the Veteran submitted an exercise stress test study from Vidant Cardiology noting that the Veteran had a workload of 2.9 METS and that the test was stopped because of chest pain. The Board also notes that when evaluating disabilities of the cardiovascular system, metabolic equivalent (MET) testing is required in all cases except: (1) when there is a medical contraindication; (2) when the left ventricular ejection fraction has been measured and is 50 percent or less; (3) when chronic congestive heart failure is present or there has been more than one episode of congestive heart failure within the past year; or (4) when a 100 percent evaluation can be assigned on another basis. 38 C.F.R. § 4.100 (b). When the level of METs is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by scientific examples such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. 38 C.F.R. § 4.104, Note (2). Given the contradictory evidence of record, additional development is needed. Additionally, on remand, VA and private treatment records from August 2019 should be associated with the claims file. The matter is REMANDED for the following action: 1. Obtain any outstanding VA and private treatment records. 2. After associating any outstanding treatment records with the file, obtain an addendum opinion from a VA cardiologist to ascertain the current severity of the Veteran’s CAD. If the examiner deems it necessary, schedule the Veteran for an examination. If an examination is needed, all indicated tests should be conducted, and the reports of any such studies should be incorporated into the examination report. A complete copy of the claims file, to include a copy of this remand, must be made available to and be reviewed by the examiner. In the addendum opinion, the examiner should comment on whether the Veteran’s CAD results in congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent. A complete rationale should be given for all opinions and conclusions expressed, to include a discussion of the August 2019 interview-based METs and the January 2020 exercise stress test from Vidant Cardiology. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. B. Smith, Associate 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.