Citation Nr: 18145567
Decision Date: 10/29/18	Archive Date: 10/29/18

DOCKET NO. 12-04 841
DATE:	October 29, 2018
ORDER
An initial rating not to exceed 30 percent for coronary artery disease (CAD) for the period prior to November 3, 2011 is granted.
FINDING OF FACT
The Veteran’s METs for the period prior to November 3, 2011 was greater than 
5 but not greater than 7.
CONCLUSION OF LAW
The requirements for an initial evaluation not to exceed 30 percent for CAD for the period prior to November 3, 2011 are met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.10, 4.19, 4.104, Diagnostic Code (DC) 7005.
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veteran served on active duty from August 1953 to August 1974. His service included two tours in Vietnam. This appeal to the Board of Veterans' Appeals (Board) arose from a December 2010 rating decision by a Department of Veterans' Affairs (VA) Regional Office (RO) decision that granted service connection for CAD and assigned an initial 10-percent rating, effective in January 2010. 
The Veteran perfected an appeal of the initial rating. In September 2016, the Veteran appeared at a Board hearing via video teleconference before the undersigned. A transcript of the hearing testimony is associated with the claims file.  
In a decision dated in December 2016, the Board denied an initial rating higher than 10 percent for the period prior to November 3, 2011 and remanded the issue regarding the initial rating since that date. In November 2017, the Board found that the requirements for an initial evaluation higher than 10 percent for CAD for the period since November 3, 2011 were not met. The Board continues its discussion of the history of this issue below.
Entitlement to an initial rating not to exceed 30 percent for CAD for the period prior to November 3, 2011.
Legal Requirements
Rating Criteria
CAD is rated under DC 7005. These criteria provide for a 10 percent rating when the CAD results in a workload of greater than 7 METs, but not greater than 
10 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or when continuous medication is required. A 30 percent rating is warranted where the coronary disease results in 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 dilation on electrocardiogram, echocardiogram, or X-ray. A rating of 60 percent is assigned when a Veteran had more than one episode of congestive heart failure within the past year; or, where a workload of greater than 
3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope; or, where there is left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A rating of 100 percent is assigned for chronic congestive heart failure, or where a workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or where there is left ventricular dysfunction with an ejection fraction of less than 30 percent. 38 C.F.R. § 4.104, DC 7005. 
One MET is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. 38 C.F.R. § 4.104, Note (2).
Discussion
A December 2016 Board decision denied a rating higher than 10 percent because the examiner at the March 2010 examination opined that the Veteran’s METs of 
>5 but not >7 was not due to his CAD but due to his age. The Board closed the prior rating period prior as of November 3, 2011 because the Veteran sustained his second heart attack on that date. The Veteran appealed the December 2016 Board decision to the Court of Appeals for Veterans Claims (Court). In a Memorandum Decision, the Court determined that the Board’s decision was erroneous, as the Veteran’s METs was noted in a March 2010 VA examination, and-per 38 C.F.R. § 4.19, age has no bearing on determining the severity of a service-connected disability. Hence, the Court reversed the December 2016 Board decision and directed that a 30 percent rating be entered for the period prior to November 3, 2011. See 03/28/2018 CAVC, 1st Entry, P. 64-68. Hence, the Board follows the Court’s order and finds that an initial rating of 30 percent for the period prior to November 3, 2011.
The Board acknowledges the Veteran’s representative’s post-Court appellate brief but notes that the Court directed the initial rating to be entered for the period indicated. The Court’s order plainly speaks for itself.  See Memorandum Decision, page 6 (“[T]he December 22, 2016, Board decision denying an evaluation for CAD in excess of 10% prior to November 3, 2011, is REVERSED and the claim is REMANDED with instructions to assign a 30% evaluation for that condition.”). There is no indication in the claims file that the November 2017 Board decision (11/30/2017 BVA) that denied an initial rating higher than 10 percent for the period November 3, 2011 to November 14, 2011, and from March 1, 2012 forward was appealed (a March 2018 rating decision assigned a 100 percent rating from November 15, 2011 to February 28, 2012, and a 10 percent rating from March 1, 2012).
 
Paul Sorisio
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	W.T. Snyder