Citation Nr: 21069863 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 15-02 026 DATE: November 22, 2021 REMANDED Prior to April 9, 2019, a rating higher than 10 percent for the service-connected coronary artery disease (CAD) is remanded. Prior to April 9. 2019, entitlement to a total disability rating due to individual unemployability (TDIU), to include entitlement to special monthly compensation (SMC), is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1971 to September 1973. This matter comes on appeal before the Board of Veterans' Appeals (Board) from an April 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). By way of procedural background, this matter was previously before the Board in February 2019 and November 2020. The Board awarded a 10 percent rating for the scar disability in the February 2019 decision. While on remand, the RO awarded a 100 percent rating for the CAD disability effective January 2020. In November 2020, the Board granted an earlier effective date of February 9, 2019 for the 100 percent rating for the CAD disability. In addition, the November 2020 Board decision remanded the claim for a rating higher than 10 percent for the CAD disability and entitlement to a TDIU prior to April 9, 2019 for further development. These claims have now been returned to the Board for further appellate consideration. The Veteran testified before the Board in April 2018. The transcript is of record and has been reviewed. 1. Prior to April 9, 2019, a rating higher than 10 percent for the service-connected coronary artery disease is remanded. In November 2020, the Board remanded the claim for a rating higher than 10 percent for the CAD disability to obtain a retrospective medical opinion from a cardiologist as to the severity of the Veteran's CAD disability prior to April 9, 2019 and to obtain additional private treatment records. On further review of the record, it is unclear if all VA community care records have been associated with the claims file. A June 2021 VA treatment record noted that the Veteran was previously followed by Dr. G. and Dr. A. through community care a few years earlier. After a 2000 coronary artery bypass graft surgery, the Veteran underwent cardiac catheterizations in 2010, 2014, and April 2019. While February 2015 VA treatment records reference and summarize a July 2014 cardiac catheterization, the original treatment records are not associated with the claims file. There are also notations in January 2020 and July 2020 of cardiac treatment records stored on VistA Imaging, a document and image storage database to which the Board does not have access. On remand, the RO should ensure that all community care private treatment records are associated with the claims file. Furthermore, a Board remand confers on the Veteran the right to substantial compliance with remand directives. Stegall v. West, 11 Vet. App. 268 (1998). The November 2020 Board decision specifically directed the RO to obtain a retrospective opinion from a cardiologist as to the nature and severity of the CAD disability from September 2012 to April 2019. Although the RO obtained a June 2021 retrospective opinion, it was provided by an advanced registered nurse practitioner and not a cardiologist. Thus, the claim must be remanded for an additional VA retrospective opinion from a VA cardiologist. 2. Prior to April 9, 2019, entitlement to a TDIU, to include SMC, is remanded. Entitlement to a TDIU and SMC prior to April 9, 2019 are inextricably intertwined with the increased rating claim for the CAD disability being remanded herein, as the outcome may impact the TDIU and SMC claims. See Harris v. Derwinski, 1 Vet. App.180, 183 (1991). Thus, adjudication of these claims is deferred. The matters are REMANDED for the following action: 1. Obtain any outstanding pertinent VA treatment records and associate them with the claims file, to include any outstanding pertinent community care records or pertinent community care records stored on VistA imaging. 2. Obtain a retrospective opinion from a VA cardiologist for a retrospective opinion regarding the severity of the service-connected CAD disability from September 2012 to April 8, 2019. 3. Then readjudicate the claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Harper, 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.