Citation Nr: 25003574 Decision Date: 03/14/25 Archive Date: 03/14/25 DOCKET NO. 16-41 783 DATE: March 14, 2025 REMANDED Entitlement to an initial rating in excess of 30 percent for myocardial infarction is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1966 to October 1968, including service in the Republic of Vietnam from February to October 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). When this matter was initially before the Board in March 2020 it was remanded for further development. This matter was previously before the Board in March 2021, March 2022, January 2023, and December 2023. In the March 2021 decision, the Board denied a rating in excess of 30 percent for myocardial infarction residuals. The Veteran subsequently appealed to the Untied States Court of Appeals for Veterans Claims (Court). Thus, in December 2021, the Court granted the Parties' Joint Motion for Partial Remand and vacated part of the March 2021 decision which denied a rating in excess of 30 percent for myocardial infarction. In the March 2022, January 2023, and December 2023 decisions, the Board Entitlement to an initial rating in excess of 30 percent for myocardial infarction is remanded. Most recently, in December 2023 the Board noted that in the November 2023 Appellate Brief, the Veteran's representative requested a new examination and the transcript of the interview based METs testing. The Veteran's representative also noted the Veteran is unlikely to encounter stairs and yard work as he lives between an RV park in Arizona and a one story home in Washington. In pursuant to that, the Board remanded the claim for a new VA examination. Specifically, the Board requested that if an interview-based testing was performed, the examiner's questions and the Veteran's responses must be included with the examination report. In the October 2024 VA examination, the examiner determined that an exercise stress testing was not provided due to the Veteran's current treatment plan. Thus, the examiner determined the Veteran's METs level using an interview-based METs test. However, the examiner failed to provide a report of the examiner's questions and the Veteran's responses in the examination, as requested in the December 2023 Board remand directives. After a review of the examination and opinions, the Board finds that the December 2023 remand directives have not been fulfilled, and this matter must be remanded for compliance with the previous remand instructions. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. Obtain updated records of the Veteran's treatment with the claims file. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of the nature, extent and severity of his heart symptoms, to include all physical and mental manifestations. The Veteran is also invited to discuss the impact of his heart condition on his ability to work. The Veteran should be provided an appropriate amount of time to submit this lay evidence. Schedule the Veteran for a VA examination to determine the current severity of his myocardial infarction. All necessary tests should be performed. All findings should be reported in detail. Specifically, the examiner should opine as to: (a.) What are the current diagnoses related to myocardial infarction? (b.) Has the Veteran ever had CHF that is related to myocardial infarction? If so, when did it begin? Is the CHF acute or chronic? Cite to the supporting medical evidence for this conclusion. (c.) The examiner should perform exercise stress testing or clearly indicate that exercise stress testing is medically contraindicated and why. (d.) If interview-based testing is performed, the examiner's questions and the Veteran's responses must be included with the examination report. (e.) If both exercise stress and interview-based testing are performed, the examiner must provide a rationale as to why one test is more representative of the current severity of the Veteran's myocardial infarction than the other test if the results of the two tests are not the same. (f.) The examiner must determine at what METs level the Veteran experiences dyspnea with exertion. A complete rationale should be provided for any opinion rendered. Please consider the Veteran's report that his medical records document a general lethargy and whether this lethargy is present and due to his myocardial infarction. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Nettles, 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.