Citation Nr: 21063862 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 19-18 988 DATE: October 18, 2021 REMANDED The claim of entitlement to service connection for chronic obstructive pulmonary disease (COPD), including as secondary to service-connected coronary artery disease with coronary artery stent and non-ST-segment elevation myocardial infarction (NSTEMI), is remanded. The claim of entitlement to a total disability rating based on individual unemployability (TDIU) prior to June 22, 2021 is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1961 to July 1981. His claims come before the Board of Veterans' Appeals (Board) on appeal of a May 2018 Department of Veterans Affairs (VA) rating decision. The Board remanded these claims to the Agency of Original Jurisdiction (AOJ) in March 2020 and April 2021. At the time, the claims on appeal included entitlement to service connection for a transient ischemic attack (TIA). In a July 2021 rating decision, however, the AOJ granted service connection for TIA and cerebral vascular accident. This claim is thus no longer before the Board for appellate review. Also, in a September 2021 Decision Review Officer decision, the AOJ increased the rating assigned the Veteran's coronary artery disease with coronary artery stent and NSTEMI to 100 percent and assigned the Veteran special monthly compensation on account of being housebound, effective June 22, 2021. Based on these actions, in a September 2021 supplemental statement of the case, the AOJ found the Veteran's TDIU claim moot from June 22, 2021, and denied entitlement to a TDIU prior to June 22, 2021. The Board has recharacterized the Veteran's TDIU claim to reflect the AOJ's decision. Entitlement to service connection for COPD, including as secondary to service-connected coronary artery disease (CAD) with coronary artery stent and NSTEMI The Board previously remanded this case to the AOJ to obtain a VA opinion on the etiology of the Veteran's COPD, which contemplates all critical evidence of record. Such evidence includes, in part, medical records first noting COPD in 2000 and an April 2012 Abstract titled, "Link between chronic obstructive pulmonary disease and coronary artery disease: implication for clinical practice", which notes that coronary artery disease has a strong effect on the severity and prognosis of COPD. The examiner failed to address either of these documents on Remand. Another opinion is thus needed. In addition, since the Board last remanded this claim, the AOJ has service connected the Veteran for a stroke. The first evidence of a stroke is dated in 1999, the year preceding the COPD diagnosis. Given this fact, the opinion should also address whether there is a relationship between the stroke and COPD. Entitlement to a TDIU prior to June 22, 2021 The Veteran has not worked since 2001, reportedly due to the service-connected stroke. Treatment records and VA examination reports in the Veteran's file include general discussions regarding whether residuals of the stroke and/or other service-connected disabilities, each considered individually, have impacted the Veteran's ability to work. To date, however, VA has not obtained findings addressing whether the service-connected disabilities, considered collectively, rendered the Veteran unable to secure or follow a substantially gainful occupation prior to June 22, 2021. The Board notes that the ultimate question of whether a Veteran is capable of substantially gainful employment is not a medical question, but rather a determination that must be made by an adjudicator. See Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013) (interpreting 38 C.F.R. § 4.16 (a)). However, as medical professionals are responsible for providing a full description of the effects of disability upon the person's ordinary activity, rather than one or more conclusory opinions, the Board points out that retrospective medical comments describing the combined functional effects of the Veteran's service-connected disabilities on his activities of daily living, particularly, employment, prior to June 22, 2021, would be helpful in resolving the claim for a TDIU. See 38 C.F.R. § 4.10; Floore v. Shinseki, 26 Vet. App. 376, 381 (2013)). Therefore, the Board finds that a remand of this matter to obtain medical comments in this regard is warranted. These matters are REMANDED for the following action: Obtain an addendum opinion from the examiner who last reviewed this case. The examiner should then opine: 1. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's diagnosed COPD is etiologically related to his period of service? 2. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's diagnosed COPD was caused by his service-connected CAD and stroke disabilities? 3. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's diagnosed COPD was aggravated by his service-connected CAD and stroke disabilities? 4. The examiner should then describe the combined functional effects of the Veteran's service-connected disabilities on his ability to perform the mental acts and physical acts required for gainful employment prior to June 22, 2021. In providing this description, the examiner should describe what types of employment activities would be limited because of the service-connected disabilities, what types of employment would not be limited (if any), and whether any limitation on employment is likely to be permanent. In providing the above, the examiner should review the Veteran's file, including: (a) an April 2012 Abstract titled, "Link between chronic obstructive pulmonary disease and coronary artery disease: implication for clinical practice", which notes that coronary artery disease has a strong effect on the severity and prognosis of COPD; (b) August 2016, April 2018, May 2019, June 2021 and September VA heart, headache and diabetes examination reports discussing the Veteran's ability to work; (c) the Veteran's spouse's January 2020 written statement; (d) a November 2019 letter from MB, M.D., addressing why the Veteran stopped working; (e) an October 2009 treatment record diagnosing COPD based on pulmonary function tests conducted in January 2000; and (f) an October 2020 VA respiratory examination. The examiner should address the significance of the abstract noted above and the October 2009 treatment record referring to 2000 pulmonary function testing and indicate whether this evidence changes the prior opinion. The examiner should provide a clear rationale for each opinion. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. N. 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.