Case A26039662

C.B. IWANOWSKI · 2026 · Case ID: A26039662

MIXED

Summary

The veteran, who served on active duty from November 1968 to August 1970, appeals the denial of service connection for obstructive sleep apnea (OSA) and the denial of earlier effective dates for his granted service connections for coronary artery disease with atrial fibrillation (CAD with AFib), chronic sinusitis, and hypertension. The veteran also appeals the denial of a higher initial rating for CAD with AFib and entitlement to TDIU. The Board found that the granted conditions (CAD with AFib, chronic sinusitis, hypertension) were directly related to service, not due to PACT Act presumptions, thus denying earlier effective dates. The VA examiner opined that the veteran's OSA was less likely than not caused by service exposures, while a private opinion found it at least as likely as not due to service. However, the Board found the private opinion inadequate as it relied on incorrect facts contradicted by service records. The Board remanded the claims for aortic valve disease with endocarditis, the increased rating for CAD with AFib, and TDIU. The remand for cardiovascular conditions was due to an inadequate VA opinion on whether CAD aggravated aortic valve disease, and the TDIU claim was remanded as it was inextricably intertwined with the cardiovascular rating issue.

Rationale

Service connection granted on direct basis.; PACT Act presumption not applicable.; Effective date denied as claim was not based on liberalizing law.

Special Benefit

TDIU

Docket No.

260226-633437

Full Decision Text

Citation Nr: A26039662
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 260226-633437
DATE: April 28, 2026

ORDER

Entitlement to an effective date prior to July 31, 2023, for the grant of service connection for chronic sinusitis is denied.

Entitlement to an effective date prior to July 31, 2023, for the grant of service connection for hypertension is denied.

Entitlement to an effective date prior to July 31, 2023, for the grant of service connection for coronary artery disease with atrial fibrillation is denied.

Entitlement to service connection for obstructive sleep apnea is denied.

REMANDED

Entitlement to service connection for aortic valve disease with endocarditis is remanded.

Entitlement to an initial disability rating higher than 60 percent for service-connected coronary artery disease with atrial fibrillation is remanded.

Entitlement to a total disability rating based on individual unemployability is remanded.

FINDINGS OF FACT

1. The Veteran notified VA of his intent to file a claim for disability compensation on July 31, 2023.

2. The Veteran's claims for service connection for sinusitis, hypertension, and coronary artery disease with atrial fibrillation were granted as directly related to active service; and not as presumptively related to active service based on a liberalizing law.

3. The Veteran's obstructive sleep apnea did not onset in and is not otherwise related to active service.

CONCLUSIONS OF LAW

1. The criteria for an effective date prior to July 31, 2023, for the grant of service connection for chronic sinusitis have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.155, 3.400.

2. The criteria for an effective date prior to July 31, 2023, for the grant of service connection for hypertension have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.155, 3.400.

3. The criteria for an effective date prior to July 31, 2023, for the grant of service connection for coronary artery disease with atrial fibrillation have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.155, 3.400.

4. The criteria for entitlement to service connection for obstructive sleep apnea have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from November 1968 to August 1970, with additional periods of active duty for training and inactive duty for training.

The modernized review system, also known as the Appeals Modernization Act (AMA), applies to this appeal.

In an April 2025 rating decision, the Veteran was awarded service connection for, in relevant part, coronary artery disease (CAD) with atrial fibrillation (AFib), chronic sinusitis, and hypertension. In the same April 2025 rating decision, entitlement to service connection for obstructive sleep apnea (OSA) was denied.

Following receipt of the April 2025 rating decision, in July 2025, the Veteran filed a VA Form 20-0996, Decision Review Request: Higher-Level Review, seeking higher-level review (HLR) of the effective dates of the three now-service-connected conditions, as well as a higher initial disability rating for the service-connected CAD with AFib. On HLR, the Higher-Level Reviewer determined that there had been a duty to assist error and transferred the claim to the Supplemental Claim decision review option for additional development. See October 2025 Rating Decision. Entitlement to the requested relief was later denied in a December 2025 rating decision.

In the February 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, concerning entitlement to service connection for OSA, the Board may only consider the evidence of record at the time of the April 2025 agency of original jurisdiction (AOJ) decision on appeal; and, for the remaining claims concerning entitlement to earlier effective dates and the increased initial rating for the Veteran's CAD with AFib, the Board may only consider the evidence at the time of the December 2025 AOJ decision on appeal. 38 C
2025 Rating Decision. Entitlement to the requested relief was later denied in a December 2025 rating decision.

In the February 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, concerning entitlement to service connection for OSA, the Board may only consider the evidence of record at the time of the April 2025 agency of original jurisdiction (AOJ) decision on appeal; and, for the remaining claims concerning entitlement to earlier effective dates and the increased initial rating for the Veteran's CAD with AFib, the Board may only consider the evidence at the time of the December 2025 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the respective AOJ decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the cardiovascular claims, as well as the associated claim concerning TDIU, any evidence the Board could not consider concerning those issues will be considered by the AOJ on remand. 38 C.F.R. § 3.103(c)(2)(ii).

The Board acknowledges this decision is being issued prior to the expiration of the period in which the Veteran may elect to switch dockets pursuant to the holding in Williams v. McDonough, 37 Vet. App. 305 (2024). However, on February 26, 2026, VA received communication from the Veteran waiving his right to select a different Board review option and requesting his appeal be reviewed as soon as possible. See February 2026 VA Form 21-4138 Due Process Waiver. Therefore, the Board will proceed to decide the appeal.

Finally, the Board observes that the Veteran submitted a VA Form 21-4138 statement with his VA Form 10182. The Court of Appeals for Veterans Claims (CAVC) held in Edwards v. McDonough, 36 Vet. App. 56 (2023), that if a veteran submits evidence with a VA Form 10182 but selects the direct review docket, VA is required to clarify with that veteran that he intended to proceed with direct review by the Board. Here, the statement was offered as argument only. Therefore, the Board concludes that clarification of the Veteran's docket election pursuant to Edwards is not necessary.

Entitlement to an effective date prior to July 31, 2023, for the grant of service connection for chronic sinusitis

Entitlement to an effective date prior to July 31, 2023, for the grant of service connection for hypertension

Entitlement to an effective date prior to July 31, 2023, for the grant of service connection for coronary artery disease with atrial fibrillation

Generally, the effective date of an initial claim for service connection will be the later of the date VA received the claim and the date entitlement arose. See 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. A claimant may indicate the desire to file a claim for benefits by submitting an intent-to-file (ITF) to VA. See 38 C.F.R. § 3.155(b). If, within one year of receiving the ITF, VA receives a complete application for benefits, VA will consider the complete claim to be filed as of the day VA received the ITF. See id. If a complete claim is not filed within 1 year of the receipt of the ITF, VA will not take further action unless a new claim, or a new ITF, is received. See 38 C.F.R. § 3.155(b)(4). Of import here, only one complete claim may be associated with each ITF. In the event multiple claims are filed within a year of the ITF, only the first claim filed will be associated with the ITF. 38 C.F.R. § 3.155(d)(1)(ii).

Additionally, on August 10, 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), Pub. L. No. 117-168, 136 Stat. 175
will not take further action unless a new claim, or a new ITF, is received. See 38 C.F.R. § 3.155(b)(4). Of import here, only one complete claim may be associated with each ITF. In the event multiple claims are filed within a year of the ITF, only the first claim filed will be associated with the ITF. 38 C.F.R. § 3.155(d)(1)(ii).

Additionally, on August 10, 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), Pub. L. No. 117-168, 136 Stat. 1759 (Aug. 10, 2022), was signed into law. This is a liberalizing law which, among other additions, expanded the locations affiliated with presumptive exposure to certain diseases that are associated with toxic exposures. Therefore, service connection claims granted under the liberalizing law of the PACT Act cannot be effective earlier than August 10, 2022 (the Act's date of enactment). In turn, when compensation is awarded pursuant to a liberalizing law, the effective date may be as early as the effective date of the law, if the claim is received within one year of the effective date of the law. See 38 C.F.R. § 3.114.

Moreover, under 38 C.F.R. § 3.2500, if a claim has been continuously pursued, it will be considered filed as of the date the first claim was received in the continuously pursued chain, instead of the date of the most recent request for review. However, an issue is not considered continuously pursued if the most recent request for review is filed greater than one year after notice of the prior decision. See id. For supplemental claims received more than one year after the date on which the AOJ or Board issued notice of a decision, the effective date will be fixed in accordance with the date entitlement arose but will not be earlier than the date of receipt of the supplemental claim. See id.

As noted, the effective date of the PACT Act was August 10, 2022. The Veteran notified VA of his intent to file a claim for compensation on July 31, 2023. See July 2023 VA Form 21-0966: Intent to File (ITF). A completed application for compensation was filed July 30, 2024. See July 2024 VA Form 21-526EZ. In April 2025, the AOJ granted service connection for CAD with AFib, chronic sinusitis, and hypertension and set the effective date of service connection for each of these conditions as July 31, 2023, the date the Veteran filed his ITF.

The Veteran seeks an earlier effective date for the grants of service connection for CAD with AFib, chronic sinusitis, and hypertension. He argues that service connection for these conditions was granted pursuant to the PACT Act, and, as a result, he should be entitled to an effective date of August 10, 2022, the date of the PACT Act, having initiated his claim within a year of the effective date of the liberalizing law. See February 2026 VA Form 21-4138.

The salient question in this appeal is whether service connection was granted based on the liberalizing law (the PACT Act) or whether it was granted on a direct basis. Here, the Board finds that the evidence is persuasive that the Veteran's service-connected CAD with AFib, chronic sinusitis, and hypertension were directly connected to active service, rather than being service connected via the PACT Act.

While the PACT Act codified the concept of toxic exposure risk activities (TERAs), VA has always considered whether direct service connection was warranted based on any exposures a claimant had during his military service. Here, the Veteran sought service connection based on his claimed exposure to herbicide agents. See July 2024 VA Form 21-526EZ (listing "agent orange" as the claimed event when seeking service connection for, in relevant part, CAD and hypertension). However, the AOJ found that the Veteran was not exposed to herbicide agents while in service and, thus, considered whether service connection could be established on another basis. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). Even where the presumption of service connection is inapplicable, service connection for a disability may still be established with proof of direct causation. See Combee; see also Johnson v. Collins, 38 Vet. App. 151 (2025) (finding that a claim based on the liberalizing presumptions in the PACT Act was "se
seeking service connection for, in relevant part, CAD and hypertension). However, the AOJ found that the Veteran was not exposed to herbicide agents while in service and, thus, considered whether service connection could be established on another basis. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). Even where the presumption of service connection is inapplicable, service connection for a disability may still be established with proof of direct causation. See Combee; see also Johnson v. Collins, 38 Vet. App. 151 (2025) (finding that a claim based on the liberalizing presumptions in the PACT Act was "separate and distinct" from a prior claim seeking service connection for the same disability on a direct basis).

The AOJ found that the Veteran was not exposed to herbicide agents, as he initially claimed. See April 2025 Rating Decision; see also February 2025 TERA Memorandum, February 2025 Records Research Memoranda, and Logbooks (associated with the file on February 19, 2025). However, the Veteran was found to have participated in a TERA by virtue of his military occupational specialty (MOS). Specifically, VA found that the Veteran, due to his MOS, would have been exposed to fuel products, industrial solvents, degreasing agents, paint fumes, carbon monoxide, asbestos, and lead. See February 2025 TERA Memorandum. Rather, the AOJ found, based on the medical opinions provided by the VA examiners, that the Veteran's three listed service-connected were due to exposures to fuels and industrial solvents while on active duty. The PACT Act did not make any exposure presumptions that apply to exposure to fuels and/or industrial solvents.

In the March 2025 VA medical opinion which formed the basis for establishing service connection for chronic sinusitis, as granted in the April 2025 rating decision, the VA examiner opined that the Veteran's chronic sinusitis was likely due to exposure to diesel exhaust, cleaning agents, and/or industrial solvents while in service. The PACT Act did not add additional provisions concerning exposure to diesel exhaust, cleaning agents, and/or industrial solvents. Therefore, service connection for chronic sinusitis was granted on a direct basis rather than based on the provisions of the PACT Act.

In the March 2025 VA medical opinion, which formed the basis for establishing service connection for hypertension in the April 2025 rating decision, the VA examiner opined that the Veteran's hypertension was likely due to exposure to lead and/or diesel exhaust while in service. The PACT Act did not add additional provisions concerning exposure to lead and/or diesel exhaust. Therefore, service connection for hypertension was granted on a direct basis rather than based on the PACT Act.

In the March 2025 VA medical opinion concerning CAD, which formed the basis of the April 2025 grant of service connection, the VA examiner opined that the Veteran's CAD was likely due to exposure to diesel exhaust and particulate matter. The PACT Act did not add additional provisions concerning exposure to particulate matter from diesel exhaust. Therefore, service connection for CAD was granted on a direct basis rather than based on the PACT Act.

In summary, service connection for each of the three service-connected conditions on appeal (CAD, hypertension, and chronic sinusitis) was based on a direct theory of service connection, rather than a new presumption added by the PACT Act. Therefore, the earliest possible effective date for service connection for each of these conditions is the date the ITF was filed, which was July 31, 2023. As the evidence weighs persuasively against entitlement to an earlier effective date, the benefit of the doubt rule does not apply and entitlement to an earlier effective date for service connection of each of the listed conditions is denied.

Entitlement to service connection for obstructive sleep apnea

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires: (1) a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

When there is an approximate balance of positive and negative evidence regarding any material issue, the Secretary must give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. The benefit of the
1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires: (1) a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

When there is an approximate balance of positive and negative evidence regarding any material issue, the Secretary must give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. The benefit of the doubt doctrine applies "if the competing evidence is in 'approximate balance.'" Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021) (en banc). However, "the benefit of the doubt rule does not apply [] when the evidence persuasively favors one side or the other" and is not in "approximate balance" or "nearly equal." Lynch at 781-782.

The Veteran contends that he was exposed to herbicide agents, specifically Agent Orange, while in service. See July 2024 Veteran Correspondence. The Veteran stated in his July 2024 correspondence that he was stationed at Subic Bay in the Philippines and routinely interacted with vessels which had been contaminated by virtue of sailing in the "blue waters" of Vietnam. Additionally, he claimed that herbicide agents were stored at Subic Bay, that he handled barrels of agent orange, and that he swam in the bay while the barrels of agent orange were leaking into the bay. See id. Regarding sleep apnea, the Veteran stated that he was diagnosed with the condition in 2010. He stated that he attributed his OSA diagnosis to interrupted sleep and exposure to agent orange while in service. See id. The Veteran described sleep deprivation due to noise and being overworked. See id.

The Veteran submitted additional materials in support of his contentions, to include a "buddy statement." The Veteran's friend, S.B., wrote that he witnessed the extended overtime of the Veteran's crew, as well as the noise exposure and weeks of 24-hour shifts without breaks. See February 2024 Buddy Statement (submitted July 30, 2024). He also wrote that the crew, including the Veteran, unloaded barrels of Agent Orange as part of their duties. See id. He further wrote that the Agent Orange was stored in Subic Bay. See id.

The Veteran has a diagnosed condition. He was diagnosed with OSA in 2010. See Private Treatment Records received July 30, 2024; VA Treatment Records; and March 2025 VA Examination.

The Veteran's service treatment records do not indicate that he had OSA while in service, nor any treatment for symptoms of OSA, such as trouble sleeping. See, generally, Service Treatment Records.

The Veteran was exposed to toxics in service, to include diesel exhaust, industrial solvents, lead, and/or asbestos. See February 2025 TERA Memorandum.

The Veteran claimed exposure to herbicide agents while in service. The Board finds that the Veteran did not have such an exposure in service. First, none of the vessels on which the Veteran served traveled to an area where herbicide agents were used during his tenure. See February 2025 VA Memoranda and Logbooks. Next, Subic Bay is not listed by the Department of Defense as an area in which herbicide agents, such as agent orange, were stored. See 2019 Department of Defense List of Locations Where Tactical Herbicides Were Tested, Used, or Stored Outside of Vietnam, https://www.publichealth.va.gov/PUBLICHEALTH/docs/agentorange/dod_herbicides_outside_vietnam.pdf#.

The Veteran attended a VA examination in March 2025. At this examination, the Veteran stated that he was diagnosed with sleep apnea in 2010 after being a "chronic snorer." See March 2025 VA Examination. Following examination, the VA examiner opined that the Veteran's OSA was less likely than not caused by the TERAs in which the Veteran participated, to include the total potential exposure through all applicable military deployments as well as the synergistic, combined effect of all such activities of the Veteran. As rationale, the VA examiner noted that while there may be correlation between sleep disturbance, generally, and the toxic exposure risk activities of the Veteran, the medical literature does not support the conclusion that such activities cause OSA, a specific diagnosis. See March 2025 VA Medical Opinion.

The Veteran also provided a private nexus opinion in August 2024. In the private opinion, the medical provider stated that, in his "professional opinion
5 VA Examination. Following examination, the VA examiner opined that the Veteran's OSA was less likely than not caused by the TERAs in which the Veteran participated, to include the total potential exposure through all applicable military deployments as well as the synergistic, combined effect of all such activities of the Veteran. As rationale, the VA examiner noted that while there may be correlation between sleep disturbance, generally, and the toxic exposure risk activities of the Veteran, the medical literature does not support the conclusion that such activities cause OSA, a specific diagnosis. See March 2025 VA Medical Opinion.

The Veteran also provided a private nexus opinion in August 2024. In the private opinion, the medical provider stated that, in his "professional opinion, it is at least as likely as not the Veteran's current condition of obstructive sleep apnea (OSA) is due to and caused by active-duty military service." See August 2024 Private Medical Opinion. The private provider noted the Veteran's statements concerning irregular sleep patterns in service due to shift work, overtime, stress, and chronic sleep deprivation; and indicated that such factors are correlated with increased incidence of sleep apnea. As grounds for his opinion, however, the private examiner relied on the Veteran's statements that his symptoms, to include snoring and trouble sleeping, began in service and have continued since that time. The Board notes, however, that the Veteran denied having trouble sleeping during service. See, e.g., July 1970 Separation Examination (no defects noted concerning sleep); June 1972 Report of Medical History (Veteran denied trouble sleeping). Therefore, the private medical opinion is inadequate because it is predicated on incorrect facts, which are contradicted by the other evidence of record. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007); see also Reonal v. Brown, 4 Vet. App. 458 (1993).

The Board acknowledges the Veteran's February 2026 argument that he should be entitled to the benefit of the doubt by virtue of having submitted the August 2024 private nexus opinion; however, as discussed above, the August 2024 private opinion is inadequate because it is predicated on inaccurate facts. As such, the evidence of record persuasively weighs against the Veteran's claim for service connection of OSA. As the evidence of record is persuasive, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (2021).

REASONS FOR REMAND

Entitlement to service connection for aortic valve disease with endocarditis is remanded.

Entitlement to an initial disability rating higher than 60 percent for service-connected coronary artery disease with atrial fibrillation is remanded.

VA is obligated to identify, develop, and adjudicate claims for secondary service connection that are reasonably raised during the processing of a properly initiated claim as to the primary service-connected disability's evaluation level, to include complications of the primary service-connected disability and claims that "logically relate" to the pending claim. See Wilson v. McDonough, 35 Vet. App. 103, 107 (2022). See also Bailey v. Wilkie, 33 Vet. App. 188, 203 (2021) (holding the duty to maximize benefits includes the duty to consider secondary service connection reasonably raised in the context of an increased rating claim).

Concerning entitlement to a higher initial rating for service-connected CAD with AFib, the Veteran has consistently pointed to his heart surgery and endocarditis as factors which should increase his disability rating, to include award of a total disability rating based on individual unemployability (TDIU). The Veteran's heart surgery and subsequent endocarditis were related to his aortic valve disease (AVD), rather than to his CAD and/or AFib. However, the Veteran contended that his AVD was secondary to CAD. In March 2025, a VA examiner considered this relationship and found that the Veteran's CAD did not cause his AVD. However, the same examiner noted that, while CAD did not cause AVD, the presence of CAD worsens symptoms and outcomes of those with AVD. The VA examiner did not offer any opinion as to whether the Veteran's AVD was worsened by his CAD. Thus, the VA medical opinion is inadequate as to secondary service connection because it did not contain an opinion specific to the Veteran regarding the possibility of aggravation. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013); see also Allen v. Brown, 7 Vet. App. 429, 448-449 (1995) (holding that an opinion obtained regarding secondary service connection must address both causation and aggravation of the
examiner noted that, while CAD did not cause AVD, the presence of CAD worsens symptoms and outcomes of those with AVD. The VA examiner did not offer any opinion as to whether the Veteran's AVD was worsened by his CAD. Thus, the VA medical opinion is inadequate as to secondary service connection because it did not contain an opinion specific to the Veteran regarding the possibility of aggravation. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013); see also Allen v. Brown, 7 Vet. App. 429, 448-449 (1995) (holding that an opinion obtained regarding secondary service connection must address both causation and aggravation of the nonservice-connected condition).

The Board finds that, based on the Veteran's contentions, the issue of secondary service connection for AVD and its associated endocarditis was raised in the context of the claim for a higher initial rating for service-connected CAD with AFib. As an award of service connection for AVD with endocarditis has the possibility of increasing the Veteran's entitlement to disability benefits, the AOJ's failure to obtain an adequate VA opinion regarding secondary service connection constitutes a pre-decisional duty to assist error requiring remand.

Moreover, were the secondary condition to be service connected, an award of a higher rating based on this secondary condition may be warranted. Because consideration of secondary service connection is intertwined with consideration of entitlement to a higher rating for the existing service-connected cardiovascular condition (CAD with AFib), the Board must remand the issue of entitlement to a higher initial rating for consideration by the AOJ alongside consideration of secondary service connection for AVD with endocarditis. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (the prohibition against the adjudication of claims that are inextricably intertwined is based upon the recognition that claims related to each other should not be subject to piecemeal decision-making or appellate litigation).

Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded.

In the March 2025 VA examination, the Veteran told the VA examiner that he "had to retire due to [cardiovascular] health issues." See March 2025 VA Examination. Thus, the Veteran's claim of TDIU has been raised by the record and should have been considered by the AOJ in the decision on appeal. See Rice v. Shinseki, 22 Vet. App. 447 (2009).

The Veteran argues that his poor cardiovascular health at least contributed to his unemployability. Therefore, the Veteran's entitlement to TDIU is inextricably intertwined with his entitlement to a higher initial rating for his CAD with AFib, to include consideration of secondary service connection for AVD with endocarditis, as discussed above. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (the prohibition against the adjudication of claims that are inextricably intertwined is based upon the recognition that claims related to each other should not be subject to piecemeal decision-making or appellate litigation). Because the Board is unable to consider the TDIU separately from the remanded cardiovascular rating issue, the Board must remand the issue of TDIU for consideration by the AOJ alongside the increased rating for CAD with AFib, to include secondary service connection for AVD with endocarditis.

The matters are REMANDED for the following action:

1. Request that a VA medical professional review the electronic file and provide the addendum opinions requested below regarding the Veteran's cardiovascular conditions. If the VA examiner determines that an additional examination of the Veteran is necessary to provide adequate opinions, such examination should be scheduled.

(a) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that but for the Veteran's service-connected coronary artery disease with atrial fibrillation he would not have aortic valve disease and/or endocarditis?

(b) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that, but for the Veteran's service-connected coronary artery disease with atrial fibrillation, his aortic valve disease and/or endocarditis would be less severe and result in less functional impairment?

If the aortic valve disease and/or endocarditis would be less severe and result in less functional impairment but for the existing coronary artery disease with atrial fibrillation, the examiner should establish a baseline level of severity, if possible, or explain why a baseline cannot be established.

All opinions must be accompanied by a rationale consistent with the evidence of record.

(Continued on the next page)

2. As the issue of entitlement to a TDIU was raised prior
(likelihood is at least approximately balanced or nearly equal, if not higher) that, but for the Veteran's service-connected coronary artery disease with atrial fibrillation, his aortic valve disease and/or endocarditis would be less severe and result in less functional impairment?

All opinions must be accompanied by a rationale consistent with the evidence of record.

(Continued on the next page)

2. As the issue of entitlement to a TDIU was raised prior to the rating decision on appeal, following any required development, entitlement to a TDIU must be adjudicated alongside the Veteran's claim for an increased rating for his service-connected cardiovascular condition.

C.B. Iwanowski

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board L.C. Reader, 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.

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