Citation Nr: 18142126 Decision Date: 10/12/18 Archive Date: 10/12/18 DOCKET NO. 13-25 510 DATE: October 12, 2018 ORDER Entitlement to an initial rating in excess of 10 percent for ischemic heart disease (heart disability) is granted. FINDING OF FACT The Veteran has not been found to have congestive heart failure; his workload has not been measured at 3 METs or less during that period; and, he has not had an ejection fraction estimate of 30 percent or less. CONCLUSION OF LAW The criteria for a rating of 60 percent, but no higher, for ischemic heart disease, status post coronary artery surgery have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.104, DC 7005-7017. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1964 to August 1967. This matter comes before the Board of Veterans’ Appeals (Board) from a February 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. The Board remanded this case in July 2017. The Board finds there has been substantial compliance. The Veteran’s heart disability is rated 10 percent disabling under to DC 7005-7017.. Under Diagnostic Code 7005, a 10 percent evaluation is warranted for documented coronary artery disease with workload of greater than 7 METs but not greater than 10 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope; or requiring continuous medication. A 30 percent evaluation is warranted for a workload of greater than 5 METs but not greater than 7 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope; or evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or x-ray. A 60 percent evaluation is warranted for more than one episode of acute congestive heart failure in the past year, or a workload of greater than 3 METs but not greater than 5 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent rating is warranted for chronic congestive heart failure, or when a workload of 3 METs or less results 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, DC 7005. DC 7017 provides rating for heart disease following coronary bypass surgery. A 10 percent rating is assigned in cases where a workload of greater than 7 metabolic equivalents (METs) but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope; or where continuous medication is required. A 30 percent rating is warranted if workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or evidence of cardiac hypertrophy or dilation on electrocardiogram, echocardiogram, or x-ray. A higher 60 percent rating is warranted if the same symptoms occur after workload of greater than 3 METs but not greater than 5 METs, more than one episodes of acute congestive heart failure in the past year, or left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent disability rating is provided for chronic congestive heart failure or; workload of 3 METs or less results 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. On December 2011 VA examination, the examiner noted the Veteran took continuous medication for his ischemic heart disease. The examiner did not perform an exercise test but the Veteran’s responses indicated a 3-5 METs workload with dyspnea and fatigue. An April 2011 test result showed left ventricular ejection fraction of 55 percent. The examiner reported the Veteran’s MET level restriction was not due to his heart disability but instead due to his severe COPD. However, there was no rationale provided for this opinion. A March 2012 ischemic heart disease DBQ showed the Veteran took medication for his ischemic heart disease. Dr. T.F. determined the Veteran’s responses indicated a 1-3 METs workload with dyspnea and fatigue. On May 2012 VA examination, the examiner did not perform an exercise test but the Veteran’s responses indicated a 3-5 METs workload with dyspnea. Treatment records showed left ventricular ejection fraction of 55 percent. The examiner included treatment records reflecting that the Veteran’s MET level restriction was due his severe COPD and not his heart disability. The Board notes these records were provided with no opinion from the examiner. On September 2017 VA examination, the examiner noted the Veteran took continuous medication for his ischemic heart disease. He did not have congestive heart failure. The examiner did not perform an exercise test because the Veteran could not exercise. The Veteran’s responses indicated a 3-5 METs workload with dyspnea. The doctor did not clarify the affect, if any, of the dyspnea. A September 2017 test result showed left ventricular ejection fraction of 55-60 percent. The examiner reported the Veteran’s MET level restriction was due to multiple medical conditions and it was not possible to accurately estimate the percent of METs limitation attributable to each condition. On review of the record, the Board finds that the disability picture presented by the Veteran’s heart disability warrants a 60 percent rating for the entire appellate period. There is no evidence to support a finding that the Veteran had chronic congestive heart failure, or workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular ejection fraction of less than 30 percent. In this regard, the Board notes that in the September 2017 examination the examiner indicated that the range was 3-5 METS - the Board finds that this is not a finding of 3 or less, as the range is above 3 and the other evidence of record regarding this functionality, to include the 2017 opinion regarding his abilities, indicates greater functionality than contemplated by the 100 percent rating. In making this determination, the Board has reviewed all the evidence of record, both medical and lay evidence, regarding the frequency, duration, and severity of the Veteran’s symptoms. The Board notes that the rating criteria for a 100 percent rating under Diagnostic Code 7017 and 7005 are the same; the preponderance of the evidence weighs against a finding that these criteria for a total rating are met. The Veteran has COPD, which is non service-connected. The Board notes it is precluded from differentiating between symptomatology attributed to a non service-connected disability and a service-connected disability in the absence of medical evidence which does so. Mittleider v. West, 11 Vet. App. 181, 182 (1998). Here, the evidence does not separate out the symptomatology.   For these reasons, the Board finds that the preponderance of the evidence supports a 60 percent rating, but no higher, the Veteran’s heart disability throughout the appeal period. 38 U.S.C. § 5107; 38 C.F.R. § 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Kass, Associate Counsel