Citation Nr: A21020301 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 210423-155715 DATE: December 21, 2021 REMANDED Entitlement to a rating in excess of 10 percent for service-connected coronary artery disease status post coronary artery bypass (CAD) is remanded. Entitlement to a compensable rating for service-connected scar, status post coronary artery bypass graft is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from September 1960 to September 1990. For his meritorious service, the Veteran was awarded (among other decorations) the Vietnam Campaign Medal. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a March 2021 rating decision from a Department of Veterans Affairs (VA) Regional Office. Given the date of the rating decision, the Veteran's appeal is governed by the modernized review system (known by the Board as the AMA). 38 C.F.R. § 19.2. On his April 2021 notice of disagreement (NOD), the Veteran selected the evidence submission docket, which limits the Board's review to the evidence of record at the time of the Agency of Original Jurisdiction (AOJ) decision and evidence submitted by the Veteran or his representative within 90 days following receipt of the NOD. 38 C.F.R. § 20.303. As will be explained, a remand is necessary in order to correct duty to assist errors that occurred prior to March 2021 rating decision on appeal. See 38 C.F.R. § 20.802(a) (2020). 1. Entitlement to a rating in excess of 10 percent for service-connected CAD is remanded. The Veteran asserts that he is entitled to higher ratings for his CAD as his symptoms are worse than those contemplated by the currently assigned ratings. The Veteran was afforded a VA examination in March 2021 to assess the severity of his heart disability. The Veteran reported dyspnea, fatigue, angina, dizziness, and syncope with a METs level of 1-3. However, the examiner did not indicate whether the reported level of METs was due solely to the Veteran's service-connected CAD. In this regard, the Board notes that the Veteran also suffers from chronic obstructive pulmonary disease (COPD). A June 2021 VA addendum opinion was requested to address whether non-cardiac conditions contributed to his reported METs level. The examiner noted the Veteran's diagnosis of COPD and concluded that his left ventricular ejection fraction (LVEF) was the most accurate and objective reflection of his cardiac status, as his METs level is based on a subjective interview and that he has other non-cardiac medical conditions with similar symptoms that contribute to his METs level. While the Board finds the June 2021 VA addendum opinion to be probative, the Board notes that the VA examiner did not provide the Veteran's estimated METs level due solely to the cardiac condition. As such, further medical guidance is necessary to address the level of METs solely based on his cardiac condition. 2. Entitlement to a compensable rating for service-connected scar, status post coronary artery bypass graft is remanded. The Veteran is seeking a compensable disability rating for a scar related to his service-connected CAD. The Board notes, however, that the March 2021 VA examination contains conflicting information as to the exact nature of the Veteran's scar. While the VA examiner indicated the absence of any scars related to his heart disability or to the treatment of his heart disability, the examiner also noted the presence of a scar from coronary artery bypass graft. Despite this observation, the examiner did not document the current nature and severity of the scar. As such, a VA examination determining the exact severity of the Veteran's scar is needed upon remand. The matters are REMANDED for the following actions: 1. After obtaining all outstanding records, the Veteran should be scheduled for an appropriate VA examination to determine the current nature and severity of his service-connected CAD. The entire record, to include a copy of this Remand, must be made available to and be reviewed by the examiner, and the examination report should note that review. Any indicated evaluations, studies, and tests should be conducted. The examiner should describe all symptoms associated with the Veteran's service-connected CAD, to include his LVEF, as well as the severity of each symptom. The examiner should assess the Veteran's workload of METs and indicate his level of METs due solely to his service-connected CAD (as opposed to any other disabilities). The examiner should also address the functional effects, to include any limitations, that the Veteran's CAD has on his activities of daily living. In addressing such inquiries, the examiner should take into consideration all of the evidence of record, to include medical records as well as the Veteran's lay statements, accepted medical principles and objective medical findings. All examination findings/testing results, along with a complete, clearly-stated rationale for any opinion offered, must be provided. 2. After obtaining all outstanding records, the Veteran should be scheduled for an appropriate VA examination to determine the current nature and severity of his service-connected scar, status post coronary artery bypass graft. The entire record, to include a copy of this Remand, must be made available to and be reviewed by the examiner, and the examination report should note that review. Any indicated evaluations, studies, and tests should be conducted. The examiner should describe all symptoms associated with the Veteran's service-connected scar, status post coronary artery bypass graft, to include to include pain and underlying muscle/tissue damage. The examiner should also address the functional effects, to include any limitations, that the Veteran's scar, status post coronary artery bypass graft has on his activities of daily living. In addressing such inquiries, the examiner should take into consideration all of the evidence of record, to include medical records as well as the Veteran's lay statements, accepted medical principles and objective medical findings. (CONTINUED ON NEXT PAGE) All examination findings/testing results, along with a complete, clearly-stated rationale for any opinion offered, must be provided. James Springer Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Higgins, J.R. 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.