Citation Nr: 21001906 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 13-32 315 DATE: January 12, 2021 REMANDED Entitlement to a disability evaluation in excess of 30 percent for CAD prior to April 24, 2019 is remanded. Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1950 to August 1970. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board on several occasions, most recently in August 2019, at which time the claims herein on appeal were denied. The Veteran appealed the Board’s August 2019 decision to the Court of Appeals for Veterans’ Claims (Court), which, pursuant to a Joint Motion for Partial Remand (JMPR), vacated the Board’s decision with respect to the above-enumerated issues and returned the matter to the Board. The Board notes that the Veteran has never explicitly raised the issue of entitlement to Special Monthly Compensation (SMC) under 38 C.F.R. § 1114(s), but that because he is in receipt of a total disability evaluation due to individual unemployability (TDIU), with an individual disability rated as 70 percent disabling, the issue is deemed to be on appeal as part and parcel of his claims for disability benefits. As explained in this remand, because the question of entitlement to SMC is inextricably intertwined with the other issues on appeal, remanded below, it too must be remanded. 1. Entitlement to an initial disability evaluation in excess of 30 percent for CAD prior to April 24, 2019 Additional development must be completed before the Veteran’s claim for increase can be adjudicated. Records associated with the Veteran’s April 2019 VA heart examination show he underwent surgery in August 2018 involving the placement of multiple arterial stents, with ensuing complications. These records also indicate the Veteran endorsed significant worsening of heart-related symptoms in the year prior to that surgery. However, records associated with the August 2018 surgery, as well as private medical treatment records from that period and the year prior, are as yet unassociated with the medical file. These records are central to the question of if and when the Veteran’s CAD may have warranted a higher evaluation than the initially-assigned 30 percent rating, and the Board finds it necessary that adequate efforts be made to secure them. 2. Entitlement to service connection for sleep apnea is remanded. Additional development must be completed before the Veteran’s service connection claim can be finally adjudicated. The Board’s July 2018 remand charged the AOJ with schedule a VA examination with “an appropriate sleep specialist,” to evaluate the presence and etiology of the claimed sleep disorder. It is not clear that the April 2019 VA examination satisfied that directive, insofar as it was not conducted by a sleep specialist. On remand, a new VA examination must be conducted with an appropriate sleep specialist in order to ensure substantial compliance with the July 2018 remand directives, and that specialist must furnish an expert medical opinion as to the presence and etiology of the Veteran’s claimed sleep disorder. Because a decision on the increase and service connection issues could significantly impact a decision on the issue of entitlement to SMC under 38 U.S.C. § 1114(s), the issues are inextricably intertwined. A remand of the SMC issue is required. The matters are REMANDED for the following action: 1. The Veteran must be afforded the opportunity to submit or identify private medical records associated with his August 2018 heart surgery, as well as any as yet unsecured private medical records relevant to his claim for increase, and the AOJ must make adequate efforts to secure any identified and as yet unobtained records. 2. Schedule the Veteran for a VA examination with an appropriate sleep specialist to explore the presence and etiology of his claimed sleep disorder. All indicated tests and studies should be conducted and all clinical findings reported in detail. The entire claims file should be made available to and be reviewed by the examiner in conjunction with this request.   Please identify whether the Veteran has a current sleep-related disability. If so, the examiner should state whether it is at least as likely as not (e.g. at least a 50 percent probability or greater) that the condition began in service or is otherwise related to service. In addressing the above opinion, the examiner should consider the Veteran’s lay statements regarding onset of symptomatology and any continuity of symptomatology since onset and/or since discharge from service. The examiner should also consider any other pertinent evidence of record, as appropriate. All findings should be reported in detail and all opinions must be accompanied by a clear rationale 3. Thereafter, the RO should readjudicate the claims remaining on appeal, including the issue of entitlement to special monthly compensation under 38 U.S.C. § 1114(s). GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Z. Sahraie, 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.