Citation Nr: 21001151 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 17-38 598 DATE: January 7, 2021 REMANDED Entitlement to service connection for amyloidosis is remanded. Entitlement to a rating in excess of 30 percent for ischemic heart disease, diagnosed as coronary artery disease (CAD), prior to May 17, 2017, and a rating in excess of 60 percent from May 17, 2017 to September 9, 2020, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU), prior to May 17, 2017, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1966 to April 1970, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2019, the Veteran testified at a hearing before the undersigned. This matter was previously remanded by the Board in April 2020. The case has been returned to the Board at this time for further appellate review. The Board notes that, for the reasons stated in the April 2020 Board remand, adjudication of the increased rating claim will encompass the earlier effective date claim raised by the Veteran. 1. Entitlement to service connection for amyloidosis is remanded. The Veteran was afforded a VA examination in September 2020 regarding his claim of entitlement to service connection for amyloidosis which the Board finds inadequate because the September 2020 VA examiner did not sufficiently address whether the Veteran’s service-connected CAD aggravated his amyloidosis. See 38 C.F.R. § 3.310; see also Atencio v. O’Rourke, 30 Vet. App. 74, 91 (2018) (causation and aggravation are independent concepts and should have separate findings and rationale); El-Amin v. Shinseki, 26 Vet. App. 136 (2013) (findings of “not due to,” “not caused by” and “not related to” are insufficient to address the question of aggravation under 38 C.F.R. § 3.310 (b)). Specifically, the September 2020 VA examiner noted that the Veteran’s amyloidosis could not have been aggravated by the Veteran’s service-connected CAD because the amyloidosis was diagnosed after the CAD. To be service connected on a secondary basis under a causation theory, however, the primary disability need not be service connected, or even diagnosed, at the time the secondary condition is incurred. Frost v. Shulkin, 29 Vet. App. 131, 138 (2017) (holding that there was not a temporal requirement inherent in 38 C.F.R. § 3.310 (a) for claims for service connection on a secondary basis). Thus, this rationale is insufficient, therefore, remand is warranted for a new VA opinion. 2. Entitlement to a rating in excess of 30 percent for CAD, prior to May 17, 2017, and a rating in excess of 60 percent from May 17, 2017 to September 9, 2020, is remanded. 3. Entitlement to a total disability rating based on individual unemployability (TDIU), prior to May 17, 2017, is remanded. As stated in the April 2020 Board remand, the issue of an increased rating for CAD is inextricably intertwined with the issue of service connection for amyloidosis, and the issue of entitlement to TDIU prior to May 17, 2017, is inextricably intertwined with the rating assigned for the Veteran’s service-connected CAD. Thus, remand of these issues is also warranted. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a “significant impact” upon another, and that impact in turn could render any appellate review on the other claim meaningless and a waste of judicial resources, the two claims are inextricably intertwined). The matters are REMANDED for the following action: 1. Obtain an opinion from a VA cardiologist who has not previously opined about the Veteran’s claim to determine whether the Veteran’s amyloidosis is related to his military service. The Veteran should only be scheduled for an examination if deemed necessary by the examiner. Following review of the claims file, and examination of the Veteran if deemed necessary, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s amyloidosis began in or is otherwise caused by the Veteran’s active service. The examiner must address the Veteran’s contention that his amyloidosis was caused by his presumed exposure to certain herbicide agents, such as Agent Orange, as well as the August 2017 letter from the Veteran’s private physicians reflecting that the Veteran’s amyloidosis is not hereditary. The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s amyloidosis is (a) caused by; or (b) aggravated (i.e., worsened beyond the normal progression of the disease) by the Veteran’s service-connected CAD. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the amyloidosis prior to aggravation by the service-connected CAD. Please note, causation and aggravation are separate concepts and must be addressed independently. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, he or she must provide a reason for doing so. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 2. Readjudicate the issues on appeal, to include the Veteran’s increased rating claim for CAD and entitlement to TDIU, taking any additional development actions deemed necessary after completing the remand directives above. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Elias, 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.