Citation Nr: 21031576 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 14-35 564A DATE: May 24, 2021 REMANDED Entitlement to an initial disability rating in excess of 10 for coronary artery disease with angina pectoris is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Navy from November 1965 to July 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Buffalo, New York. The Veteran testified before the Board at a January 2021 virtual hearing. A transcript has been associated with the claims file. 1. Entitlement to an initial disability rating in excess of 10 percent for coronary artery disease with angina pectoris is remanded. By way of background, the Veteran was granted service connection for coronary artery disease with angina pectoris, with an evaluation of 10 percent assigned, effective April 2, 2012. The Veteran timely disagreed with the initial rating assigned in June 2014 and perfected his appeal to the Board. In his June 2014 Notice of Disagreement, the Veteran contended that VA did not adequately consider all of his medical records. He contends that his heart disease merits the highest rating percentage allowed. Recently, in the Veteran's January 2021 Board hearing, the Veteran contended that his disability has worsened in severity during the appeal period. The Veteran noted that he received private treatment through Dr. T.P., and has not received treatment through VA. Although some of these records have been associated with the Veteran's claims file, it is not clear to the Board that the most recent private treatment records from Dr. T.P. have been associated with the Veteran's claims file. The Board notes that the Veteran testified that, at this time, he does not feel that his disability has limited his ability to do simple things like shoveling snow, going up and down stairs, or getting around his house. The Veteran clarified that he struggles, instead, with more strenuous activities. Nevertheless, the Board points out that the Veteran's medical records refer to reproducible chest pain at very low workloads, with unstable angina. See March 2013 Private Treatment Records. Additionally, the Veteran's private treatment records specifically reference episodes of angina after shoveling snow, as well as after walking a short distance to his neighbor's house to care for their dog. These episodes were noted to have increased in duration. See March 2014 Private Treatment Records. Based upon the Veteran's testimony and private treatment records, the Board finds that a remand is necessary in order to obtain another VA examination of his coronary artery disease with angina pectoris, which adequately addresses the current severity of his disability. On remand, any outstanding private treatment records should also be obtained. See 38 U.S.C. § 5103A(b), (c); 38 C.F.R. § 3.159(b). 2. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. In the Veteran's October 2014 VA Form 9, the Veteran asserted that he "left work 2 years early due to having stents [sp.] put in." When entitlement to TDIU is raised during the adjudicatory process of the underlying disability or during the administrative appeal of the initial rating assigned for that disability, it is part of the claim for benefits for the underlying disability. Rice v. Shinseki, 22 Vet. App. 447, 448 (2009). This issue is inextricably intertwined with the issue of an increased rating for coronary artery disease with angina pectoris; thus, it must be remanded concurrently for additional development. Harris v. Derwinski, 1 Vet. App. 180, 183 (issues are "inextricably intertwined" when a decision on one issue would have a "significant impact" on a veteran's claim for the second issue). The matters are REMANDED for the following action: 1. Send the Veteran a letter requesting that he submit, or authorize VA to obtain on his behalf, any relevant outstanding private treatment records from Dr. T.P. Take all appropriate steps to obtain identified private treatment records. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected coronary artery disease with angina pectoris. 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. In particular, the examiner is asked to consider: (a.) The private treatment record from March 2013 referencing reproducible chest pain at very low workloads, with unstable angina. (b.) The private treatment record from March 2014 referencing episodes of angina (noted to have increased in duration), which the Veteran experienced after shoveling snow and walking a short distance to his neighbor's house to care for their dog. 3. Thereafter, and after any additional development deemed necessary, readjudicate the appeal, to include entitlement to a TDIU. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Hennessy, 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.