Citation Nr: 21063869 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 16-58 536 DATE: October 18, 2021 REMANDED Entitlement to an initial rating in excess of 30 percent for coronary artery disease of the LAD and RCA vessels, status post myocardial infarction, prior to July 29, 2014 and in excess of 60 percent thereafter is remanded. Entitlement to a total disability based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from March 1967 to December 1970. Among his decorations are the Combat Action Ribbon and the Purple Heart Medal with Gold Star. This matter comes before the Board of Veterans' Appeals (Board) on appeal from September 2013 and August 2014 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the claims for further development in August 2019. 1. Entitlement to an initial rating in excess of 30 percent for coronary artery disease of the LAD and RCA vessels, status post myocardial infarction, prior to July 29, 2014 and in excess of 60 percent thereafter is remanded. Pursuant to the prior Board remand, the Veteran was afforded a VA examination in July 2020. However, the examiner did not conduct metabolic equivalents (METs) testing and failed to provide an explanation as to why such testing was not performed. In a September 2020 addendum, a different examiner indicated there was no medical contraindication for not performing METs testing. Therefore, since there is no valid explanation for why the METs test was not completed during the July 2020 VA examination, nor is there any evidence indicating that METs testing was not otherwise possible, a remand is necessary. Furthermore, while the September 2020 VA examiner estimated the Veteran's METs level, noting it was an interview-based test, there is no indication that the examiner interviewed or previously examined the Veteran but rather based his estimation on the evidence of record. Therefore, on remand, the Board finds that the Veteran should be afforded a new in-person VA examination. 2. Entitlement to a TDIU is remanded. The Veteran's entitlement to a TDIU is inextricably intertwined with the issue above and must be remanded as well. Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim). All outstanding treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Schedule the Veteran for an examination with an examiner other than the July 2020 VA examiner, preferably a physician or cardiologist, to determine the current nature and severity of his heart disorder. The entire claims file should be made available to and reviewed by the examiner. All indicated tests should be conducted and all findings reported in detail. (a). METs testing must be conducted, and all associated symptoms must be noted, unless there is a medical contraindication, the left ventricular ejection fraction has been measured and is 50 percent or less, or chronic congestive heart failure is present or there has been more than one episode of congestive heart failure within the past year. If METs testing is not performed, the examiner must provide an explanation for why that is so. (b). The examiner should also opine as to whether it is at least as likely as not (50 percent or greater probability): (1) that diagnosed sinoatrial node dysfunction is proximately due to the Veteran's CAD; (2) that that diagnosed sinoatrial node dysfunction has been aggravated (worsened) by CAD; (3) that the Veteran's need for a cardiac pacemaker is proximately due to CAD and/or sinoatrial node dysfunction if related to CAD in response to (1) and (2) above; or (4) that the Veteran's need for a cardiac pacemaker has been aggravated (worsened) by CAD and/or sinoatrial node dysfunction if related to CAD in response to (1) and (2) above. (c). The examiner should discuss all occupational impairments attributed to the Veteran's service-connected heart disorder(s). A complete rationale should be given for all opinions and conclusions expressed. If unable to opine without resorting to speculation, please provide a basis for reaching this conclusion. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.S. Mahoney 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.