Citation Nr: 21008902 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 14-35 372A DATE: February 18, 2021 REMANDED For the appeal period prior to December 3, 2019, entitlement to a rating in excess of 60 percent for ischemic heart disease (IHD) is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1968 to May 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from the September 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).  This matter was previously before the Board in November 2018, at which time it was remanded for further development. Following a December 2019 VA examination, in an April 2020 rating decision, the Agency of Original Jurisdiction (AOJ) awarded the Veteran a 100 percent evaluation for his IHD, effective December 3, 2019 – the date of the echocardiogram which first showed evidence of chronic congestive heart failure. As the grant was only a partial grant of the relief sought, the claim came back before the Board. See A.B. v. Brown, 6 Vet. App. 35, 38 (1993). In August 2020, the Board remanded the claim again due to noncompliance with the November 2018 remand directives; specifically, to obtain outstanding VA treatment records. The Veteran contends that his IHD warrants a higher rating. However, the Board requires clarification of the January 2020 VA medical opinion, specifically the history of the Veteran’s congestive heart failure (CHF). Therefore, the Board must remand the claim to obtain an addendum medical opinion. In the January 2020 VA compensation examination, the examiner found the December 2019 echocardiogram revealed signs of congestive heart failure, and indicated the Veteran had chronic congestive heart failure, stating “CHF etiology is IHD. Chronic IHD of 10 years in this Veteran’s case is a known cause of weakening heart muscle, CHF.” It is unclear if examiner found the December 3, 2019 echocardiogram was the first evidence to reveal CHF, or if it had been ongoing. The VA treatment records do not provide any further clarity, as some records indicate he has heart failure while others do not. See e.g. April 2014 VA Cardiology Consultation; cf. February 2016 VA Ambulatory Care Note. Additionally, echocardiogram results from February 2014, July 2016, and July 2017 were associated with the file after the January 2020 VA examination. As such, the Board requires clarification as to the history of the Veteran’s CHF associated with his IHD. The matters are REMANDED for the following action: 1. Obtain a medical opinion from the January 2020 VA examiner to clarify the history of the Veteran’s IHD disability, specifically the onset of CHF, if ascertainable. After reviewing the claims file in its entirety, the examiner is asked to respond to the following:  (a) Clarify the history of the Veteran’s CHF associated with his IHD disability. (b) If possible, provide a reasonable estimate of the onset date of the Veteran’s CHF. If the examiner cannot provide the requested opinions without resorting to speculation, he should expressly indicate the same and provide supporting rationale as to why the opinions cannot be made without resorting to speculation. *In doing so, (i) address the April 2014 VA cardiology consultation, March 2016 anesthesia preoperative evaluation, and September 2019 VA Cardiology Consultation which note heart failure or CHF; (ii) address the January 2015 VA Ambulatory Care Note, February 2015 History and Physical Preoperative evaluation, and the February 2016 Ambulatory Care Note which state no heart failure or CHF; and (iii) address the diagnostic tests performed on the Veteran, including multigated acquisition (MUGA) scans, electrocardiograms, and echocardiograms, including the February 2014, July 2016, and July 2017. 2. Thereafter, readjudicate the claim on appeal. Romina A. Casadei Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Moldawer, 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.