Citation Nr: 21003260 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 16-31 923 DATE: January 21, 2021 REMANDED Entitlement to an initial rating in excess of 30 percent for coronary artery disease (CAD) is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU), to include on an extraschedular basis, prior to February 16, 2012 is remanded. PRELIMINARY MATTERS The Veteran, who is the appellant in this case, served on active duty from January 1975 to March 1978. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). Regarding the claim for a rating in excess of 50 percent for posttraumatic stress disorder (PTSD), the Board had remanded the claim in December 2019 in order to allow the AOJ to issue a statement of the case (SOC). Manlicon v. West, 12 Vet. App. 238 (1999). Thereafter, the AOJ issued a SOC in February 2020; however, the Veteran did not file a substantive appeal (VA Form 9). As such, because the Veteran did not file a substantive appeal for the issue for a rating in excess of 50 percent for PTSD, the issue is not before the Board. 38 C.F.R. § 20.200 (an appeal consists of a timely filed notice of disagreement and, after an SOC has been furnished, a timely filed Substantive Appeal). The Veteran testified at an August 2019 Board videoconference hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is associated with the claims file. REASONS FOR REMAND The Board notes that the most recent VA treatment record associated with the claims file is dated in January 2018, over three years ago. Further, following the most recent July 2020 VA heart examination, the Veteran indicated that his VA physician had ordered him to undergo a stress test. See Report of General Information dated in October 2020. As such, updated VA treatment records, to include any recently conducted stress test, should be obtained and associated with the claims file. Additionally, the July 2020 VA examination report indicated that the Veteran had last undergone a stress test in October 2012. However, VA treatment records show that the Veteran presented for a stress test in February 2015. It was noted that the Veteran exercised for 4 minutes and 42 seconds and stopped due to dyspnea. The 2020 VA examiner did not address the results from this test. Moreover, the examiner indicated that the Veteran’s left ventricular ejection fraction was the most objective reflection of the Veteran’s current cardiac status; however, the examiner indicated that the Veteran’s last echocardiogram was conducted in April 2017. As such, the examiner should provide a supplemental medical opinion as to the severity of the Veteran’s CAD disability, after a review of the results from the February 2015 stress test. Additionally, if a recent echocardiogram is not found in updated VA treatment records, the Veteran should be afforded a VA examination, to include an echocardiogram, to assess the current severity of his disability. The remand regarding the claim discussed above could have an outcome regarding the extraschedular TDIU issue; therefore, the issue of entitlement to TDIU (to include on an extraschedular basis) is inextricably intertwined with the issue being remanded. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following actions: 1. Obtain updated VA treatment records from January 2018 to the present, to include any recent stress test results, and associate them with the electronic claims file. 2. Schedule the Veteran for a VA examination to determine the severity of his CAD disability. (a.) The examiner is asked to review the results of the February 2015 stress test conducted at VA. (b.) If recently obtained VA treatment records do not include a LVEF testing results since April 2017, necessary testing, to include an echocardiogram, should be conducted. The examiner should also report at what METs workload the Veteran reports such symptoms as dyspnea, fatigue, angina, dizziness, or syncope, and the Veteran’s LVEF should be noted. 3. Then, readjudicate the claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Casadei, 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.