Citation Nr: 21071058 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 17-10 851A DATE: November 29, 2021 REMANDED Entitlement to an increased disability rating greater than 30 percent for coronary artery disease (CAD) from May 22, 2014 to August 5, 2015 is remanded. Entitlement to an increased disability rating greater than 60 percent for CAD from August 6, 2015 to August 1, 2016 and from November 1, 2016 is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1970 to December 1978. Unfortunately, the Veteran died in February 2020 and the Appellant is his surviving spouse, who was recognized as the substitute appellant for the Veteran's pending claim. See July 2020 VA correspondence. The Veteran initially appealed a February 2015 rating decision by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) denying a rating greater than 30 percent for CAD. During the appeal period, his rating increased to 60 percent, effective August 6, 2015. See August 2017 rating decision. Additionally, the Veteran received a temporary total disability rating, or 100 percent, based on hospital admission for heart surgery from August 2, 2016 to October 31, 2016. Id. This temporary total rating is considered a full grant of the benefit sought and, therefore, this period is no longer on appeal. AB v. Brown, 6 Vet. App. 35 (1993). Also before the Board of Veterans' Appeals (Board) is entitlement to TDIU. Most recently, the Board remanded these issues in July 2021 so the AOJ could properly issue a supplemental statement of the case (SSOC) Regrettably, an additional remand is required to obtain clarification of a pertinent medical issue regarding the Veteran's CAD. In January 2019, the Board remanded the issues, in part, to have a medical examiner review the Veteran's medical history and "specifically address whether he had chronic congestive heart failure (CHF)" and "if so, from what date was the condition diagnosable." The Board remand also requested a retrospective opinion regarding ejection fraction percentages in October 2013 versus December 2015. A January 2020 VA examiner noted the Veteran had chronic CHF, but did not discuss the date this condition was diagnosable. Instead, the VA examiner stated she was "asked to indicate onset dates of CHF" and answered the other questions put forth in the January 2019 Board remand. It is unclear if her medical opinion implies the Veteran had chronic CHF as early as January 2015 due to his December 2015 ejection fraction estimate and continued hospitalization for his heart condition, or if she was merely answering a different Board remand question. As the Veteran's VA treatment records do not specifically note a date his chronic CHF began, and the Board cannot make independent medical determinations, a remand is required to obtain a clarifying medical opinion. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Since the decision on an increased rating for CAD impacts a decision on entitlement to TDIU, these issues are inextricably intertwined, and the Board will defer decision on the matter. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriately qualified clinician, preferably from the clinician who provided the January 2020 VA cardiology examination, to determine the severity of the Veteran's CAD prior to his death in February 2020. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the reviewing clinician. After a thorough review of the record, the reviewing clinician should provide an opinion of when the Veteran's heart conditions progressed to chronic CHF. The reviewing clinician is directed to the January 2020 VA examination report noting the Veteran had chronic CHF, and the corresponding medical opinion discussing some of the Veteran's symptoms, including "hospitalization in 2016 on numerous occasions for CHF with elevated BNPS and CXR's showing pulmonary edema." A full and complete rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the reviewing clinician cannot provide a requested opinion without resorting to mere speculation, it must be stated, and the reviewing clinician must provide the reasons why an opinion would require speculation. As such, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. (Continued on the next page) 2. After the above has been completed to the extent possible, readjudicate the claim. If any benefit sought remains denied, provide the Appellant and her representative with an SSOC and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bona, 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.