Citation Nr: 22017447
Decision Date: 03/25/22	Archive Date: 03/25/22

DOCKET NO. 15-46 914
DATE: March 25, 2022

REMANDED

Entitlement to a rating in excess of 10 percent for coronary artery disease status post coronary artery bypass graft with aortic valve (root) replacement (hereinafter CAD) prior to June 1, 2021, is remanded.

Entitlement to a compensable rating for aortic aneurysm from October 4, 2014, is remanded.

REASONS FOR REMAND

The Veteran served on active duty from February 1971 to November 1972.  These matters come before the Board of Veterans' Appeals (Board) on appeal from November 2013 and April 2018 rating decisions of the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ).

The Board issued a decision on these matters in June 2019.  The Veteran subsequently appealed to the United States Court of Appeals for Veterans Claims (Court).  Pursuant to a May 2020 Joint Motion for Partial Remand (JMPR), the Court remanded both matters to the Board in May 2020.  The Board then remanded them to the AOJ in October 2020.

In a September 2021 rating decision, the AOJ granted a 100 percent rating for CAD, effective June 1, 2021.  Because that rating decision represents a grant of the maximum possible benefit as of June 1, 2021, the appeal is satisfied from that date forward.

Remand is necessary to obtain an additional VA medical opinion.  The October 2020 Board Remand directed the AOJ to obtain a VA opinion that addressed whether the Veteran experienced any symptoms or disabilities proximately due to or the result of his service-connected CAD or aortic aneurysm.  The Board Remand left this analysis open to "any . . . indicated disabilities" but specifically requested that the VA medical opinion address anemia, left leg pain, and hip pain. 

A June 2021 VA medical opinion failed to address the etiology of anemia.  Moreover, it provided conflicting opinions regarding the etiology of lower extremity pain.  The VA medical opinion determined that the Veteran's leg and hip pain were "more likely than not related to a soft tissue issue (IT Band) than to his SC [service-connected] heart disabilities."  In the next paragraph, however, the VA medical opinion indicated that the Veteran's coronary artery bypass graft surgery "required harvesting of a LLE [left lower extremity] leg vein . . . [which] left [the V]eteran with a disproportionate LLE pain as compared with his RLE."  The VA medical opinion also noted "objective evidence of circulation discrepancies as the LLE has diminished DP/PT pulsed and increase[d] pitting edema compared with his RLE."  This conflict must be addressed in a new VA medical opinion.

For these reasons, the Board finds that an additional VA medical opinion is required on remand.  See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that the Board errs as a matter of law when it fails to ensure compliance with its remand orders).

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from the same clinician who provided the June 2021 VA examination and medical opinion.  If that clinician is unavailable, another qualified clinician may be consulted.  The clinician must state whether the Veteran experiences any symptoms or disabilities that are proximately due to or the result of his service-connected CAD and aortic aneurysm.  The clinician must specifically address anemia, left leg pain, and hip pain.  The clinician must also discuss the conflicting findings in the June 2021 VA medical opinion that leg pain was both due to "soft tissue issue (IT Band)" and a residual of the coronary artery bypass graft surgery.

2. Then, readjudicate the claims. If the benefits sought remain denied, issue a supplemental statement of the case and return the matter to the Board if otherwise in order.

 

 

WILLIAM H. DONNELLY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	W. Ripplinger, 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.