Citation Nr: 22018448 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 14-18 467 DATE: March 29, 2022 ORDER Entitlement to a rating in excess of 60 percent, prior to June 19, 2013, for hypertensive heart disease, status post coronary artery bypass graft (CABG), is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected disease or injury, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDING OF FACT Prior to June 19, 2013, the Veteran's hypertensive heart disease has not more nearly approximated chronic congestive heart failure, or; a workload of 3 METs or less, resulting in in dyspnea, fatigue, angina, dizziness, and syncope; or; left ventricular dysfunction with an ejection fraction of less than 30 percent. CONCLUSION OF LAW Prior to June 19, 2013, the criteria for a disability rating in excess of 60 percent for hypertensive heart disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, §§ 4.1, 4.2, 4.3, 4.7, 4.15, 4.104, Diagnostic Code 7017. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1970 to April 1972. Unfortunately, he died in February 2017. In May 2020, the Veteran's surviving spouse was notified she had been substituted as the appellant in these matters. These matters come before the Board of Veterans' Appeals (Board) from a March 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Most recently, in June 2021, this case was remanded for additional development. In a January 2022 rating decision, the RO restored entitlement to a 100 percent evaluation for the Veteran's service-connected hypertensive heart disease, status post CABG, effective September 1, 2013, the date the condition was previously reduced to 60 percent disabling. The RO noted that a 100 percent evaluation was previously assigned effective June 19, 2013, the date the Veteran was admitted for surgery. As this does not constitute a grant in full, the Veteran's claim for an increased rating, prior to June 19, 2013, remains pending. See AB v. Brown, 6 Vet. App. 35, 38 (1993). Entitlement to a rating in excess of 60 percent, prior to June 19, 2013, for hypertensive heart disease, status post CABG, is denied. The Veteran's hypertensive heart disease disability is rated as 60 percent disabling, prior to June 19, 2013, under Diagnostic Code 7017. Under Diagnostic Code 7017, a 60 percent disability rating is warranted if there is more than one episode of acute congestive heart failure in the past year; a workload of greater than 3 METs but not greater than 5 METs, resulting in dyspnea, fatigue, angina, dizziness, or syncope; or there is evidence of left ventricular dysfunction with an ejection fraction of 30 to 50 percent. 38 C.F.R. § 4.104, Diagnostic Code 7017. A 100 percent disability rating is warranted if there is chronic congestive heart failure; a workload of 3 METs or less, resulting in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricular dysfunction with an ejection fraction of less than 30 percent. 38 C.F.R. § 4.104, Diagnostic Code 7017. An October 2012 VA treatment record reflects a low normal LV function with post-stress LVEF of 50 percent, compared with 45 percent at rest. There were regional wall motion abnormalities in the inferior and mid to basal lateral/inferolateral walls. The Veteran was afforded a VA hypertension examination in May 2013. The Veteran's treatment plan included taking continuous medication for hypertension or isolated systolic hypertension. The examiner noted the Veteran's EKG showed arrythmias (multiple PACs). The EKG showed "frequent premature atrial complexes noted (4), right axis and right bundle branch block: consider right ventricular hypertrophy or pulmonary disease, inferior infarct, age undetermined." The EKG showed no signs of cardiac dilatation. The EKG showed no signs of cardiac hypertrophy or ischemia. For period prior to June 19, 2013, the Board finds that a disability rating in excess of 60 percent for the Veteran's hypertensive heart disease is not warranted. The above evidence shows that at no point was the Veteran noted to have chronic congestive heart failure, an ejection fraction of less than 30 percent, or demonstrate a workload of 3 METs or less that resulted in dyspnea, fatigue, angina, dizziness, or syncope. The Board notes that the May 2013 VA examination did not address whether the Veteran had chronic congestive heart failure, but treatment records did not indicate chronic congestive heart failure or any episodes of congestive heart failure. In view of the above, the Board finds that prior to June 19, 2013, the most probative evidence of record persuasively weighs against a disability rating in excess of 60 percent under Diagnostic Code 7017. There is no objective indication that during the period on appeal, the Veteran's service-connected hypertensive heart disease, demonstrated chronic congestive heart failure, a workload of 3 METs or less, or left ventricular dysfunction with an ejection fraction of less than 30 percent. Accordingly, the Board finds that the Veteran is adequately compensated by the assigned 60 percent evaluation for the entire period on appeal, and a higher rating is not warranted. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected disease or injury, is remanded. In February 2022 correspondence, the appellant asserted that VA doctors knowingly misdiagnosed the Veteran and that he in fact suffered from posttraumatic stress disorder (PTSD) after serving in Vietnam and not generalized anxiety disorder (GAD) as diagnosed. See February 2022 Correspondence. She also asserted that she was misquoted during her husband's VA treatment and attached a VA progress note as an example. Id. In June 2021, the Board remand this matter to determine, in part, whether the criteria for a diagnosis of a mental disorder were met. Most recently, in December 2021, a VA addendum opinion was obtained. The VA examiner determined that the Veteran had a diagnosis of GAD from 2001 to 2006. However, the examiner found that it could not be established that the Veteran met the criteria for any other mental health disorder at any other time. The examiner did not mention PTSD. Considering the appellant's February 2022 lay statements, the Board finds remand is necessary to obtain an addendum opinion regarding whether the Veteran displayed any symptoms during the period on appeal that met the criteria for PTSD. Entitlement to a TDIU is remanded. As to the TDIU claim, the Board finds that the claim of entitlement to TDIU is inextricably intertwined with the service connection claim on appeal, and the Board will defer adjudication of the TDIU claim until the development directed on the other claim has been completed. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to remand the claim on appeal pending the adjudication of the inextricably intertwined claim. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following actions: 1. Return the claims file to the December 2021 VA examiner for an addendum retrospective opinion to determine the nature and etiology of any acquired psychiatric disorder, specifically PTSD. The examiner is asked to review the claims file and provide the following information: (a) With respect to PTSD, specifically, the examiner should offer a retrospective opinion as to whether the Veteran, at any point during the pendency of this claim, met the DSM-IV or V criteria. *In forming this opinion, the VA examiner should specifically address the appellant's February 2022 correspondence.* (b) If PTSD is diagnosed, opine whether it is at least as likely as not (approximately 50 percent probability or greater) that such was incurred in or otherwise related to the Veteran's service. (c) If PTSD is diagnosed, opine whether it is at least as likely as not (approximately 50 percent probability or greater) that such was caused or aggravated by any of the Veteran's service-connected disabilities, to include his hypertensive heart disease. Aggravation under 38 C.F.R. § 3.310 (b) does not require that there be "permanent" worsening of the nonservice connected disability. The VA examiner must provide separate findings and rationales relating to causation and aggravation. The examiner should set forth all examination findings, with a clear, detailed, and fact-based rationale for the conclusions reached. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Griffith, Shari 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.