Citation Nr: 21070345 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 19-08 744 DATE: November 23, 2021 REMANDED A rating higher than 30 percent for coronary artery disease (CAD) is remanded. A compensable rating for chest scar associated with CAD is remanded. A compensable rating for leg scar associated with CAD is remanded. Service connection for erectile dysfunction is remanded. Service connection for hypertension is remanded. Service connection for a lung disability is remanded. Service connection for neuropathy is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1967 to July 1969 in the U.S. Army, including service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) from a February 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. This case has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). The Veteran and his wife testified before the undersigned Veterans Law Judge at a Board hearing in August 2019. A copy of the proceeding is associated with the record. This case was previously before the Board in October 2020, at which time the issues on appeal were remanded for additional development. Although further delay is regrettable, the Board finds that remand is necessary for further development. The Board notes that the record indicates that there may be outstanding relevant Social Security Administration records. See October 2021 SSA Profile and Benefit Data. Therefore, remand is required to allow VA to request these records. Increased Rating for CAD The Veteran contends that a higher rating is warranted for his service-connected CAD. He was afforded a VA examination in February 2021. However, the examiner did not complete the section that refers to METs (metabolic equivalents) testing. Because METs workload measurements are the primary rating criterion for CAD, this examination is inadequate for rating purposes. 38 C.F.R. § 4.104, Diagnostic Code 7005. Moreover, the examiner noted that the Veteran has not had congestive heart failure (CHF); however, the Veteran's private treatment records note that he has a past medical history of CHF. See Medical Treatment Record Non-Government Facility received November 2020. Therefore, remand is warranted to afford the Veteran a new VA examination. Increased Rating for Chest and Leg Scars The Veteran contends that a compensable rating is warranted for his service-connected chest and leg scars. He was afforded a VA examination in February 2021. However, the examination inaccurately indicates that the claim was not initiated prior to August 12, 2018. As a result, the examiner proceeded to not complete the section of the examination report that relates to the historical criteria for rating scars. Therefore, the Board finds that remand is warranted to afford the Veteran a new scar examination in which the examiner completes all relevant sections of the examination report. Service Connection for Erectile Dysfunction The Veteran contends that his erectile dysfunction is related to in-service exposure to herbicide agents. See April 2015 Correspondence. Alternatively, he contends that his erectile dysfunction is related to his service-connected CAD. The Veteran was afforded a VA examination in February 2021. However, the Board finds the opinion is inadequate for adjudication purposes because it is conclusory, it does not address whether the Veteran's erectile dysfunction was caused or aggravated by medications prescribed for the Veteran's CAD, and it does not address aggravation. Additionally, the Board cannot make a fully informed decision on the issue of service connection for erectile dysfunction because no VA examiner has opined whether the Veteran's erectile dysfunction directly related to service. Accordingly, remand is warranted to obtain an addendum VA opinion. Service Connection for Hypertension, Lung Disability, and Neuropathy The Veteran reported that he began taking medication for blood pressure due to his service-connected CAD. See March 2019 Correspondence. Additionally, the Veteran contends that he has a lung disability and neuropathy that is related to his service-connected CAD. See July 2019 Form 9; see also September 2019 Form 9. The issues of secondary service connection for hypertension, a lung disability, and neuropathy, have therefore been reasonably raised by the record. The Board is required to address any claims explicitly raised by the Veteran or reasonably raised by the record, to include secondary service connection claims in the context of a claim seeking an increased rating. Bailey v. Wilkie, 33 Vet. App. 188 (2021). The Veteran has not been afforded VA examinations regarding these disabilities. Therefore, remand is necessary to afford the Veteran VA examinations to determine the nature and etiology of his hypertension, a lung disability, and neuropathy. The matters are REMANDED for the following action: 1. Associate with the record any relevant, outstanding VA or private medical records regarding treatment of the Veteran. 2. Contact the Social Security Administration and obtain all records associated with any claim for disability benefits. 3. Schedule the Veteran for a VA examination by an appropriate physician to determine the current severity of his service-connected coronary artery disease (CAD) and associated scars, to include chest and leg. The claims file, including a copy of this Remand, must be made available to the examiner and review should be noted. All necessary tests and studies should be accomplished. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. As to the Veteran's CAD, the examiner should provide to the greatest extent possible comprehensive information that addresses all components of the disability, to include an assessment of workload in terms of METs (metabolic equivalent) that results in dyspnea, fatigue, angina, dizziness or syncope; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray; left ventricular function; and commentary on the presence of congestive heart failure, and its frequency. If a determination of METs by exercise testing cannot be done for medical reasons, then the examiner should provide an estimate of the level of activity expressed in METs and supported by specific examples (such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope. If any of these findings cannot be provided, the examiner should provide reasons why. As to the Veteran's scars, the appropriate DBQ should be filled out for this purpose, if possible. Such findings should include, but not limited to, the measurements of the scars associated and indicate whether the scars are linear, superficial, deep, painful, unstable, and/or exhibit any other disabling effects. The examiner should attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the service-connected scars and discuss the effect of the Veteran's scars on any occupational functioning and activities of daily living. If it is not possible to provide an opinion regarding flare-ups, symptoms, or functional impairment without speculation the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The scar examiner is advised that he or she must complete the section of the scar examination report related to the historical rating criteria because the rating period for consideration begins April 29, 2013. The examiner must consider the lay statements of record, including the October 2019 Board hearing testimony. 4. Obtain an addendum opinion to determine the nature and etiology of the Veteran's erectile dysfunction. After complete review of the record, the physician is asked to provide an opinion as to the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's erectile dysfunction is related to any in-service injury, event, or disease, to include herbicide agent exposure. (b.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's erectile dysfunction is (1) proximately due to or (2) aggravated by his service-connected coronary artery disease (CAD), to include any medications prescribed to the Veteran for his service-connected CAD. The physician must address the Veteran's contentions that his circulation issues related to his CAD affects his erectile dysfunction and carvedilol is known to cause erectile dysfunction. The examiner must include a rationale with all opinions, citing to supporting clinical data/medical literature as appropriate. 5. Schedule the Veteran for VA examinations by appropriate physicians to determine the nature and etiology of his hypertension, lung disability other than lung cancer, and neuropathy. The examiner should identify all diagnoses related to the Veteran's claimed disabilities throughout the appeal period. After review of the file, for each diagnosis, the examiner is asked to opine, with rationale, as to the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's disability (1) had its onset in service, (2) had its onset within one year of separation from service, or (3) is otherwise related to his active service, to include the Veteran's presumed exposure to herbicide agents. (b.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's disability was (1) caused or (2) aggravated by his service-connected coronary artery disease. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Kernen, 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.