Citation Nr: 18145878 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 15-11 605 DATE: October 30, 2018 ORDER Entitlement to an initial 30 percent evaluation for coronary artery disease, status post myocardial infarction is granted. FINDING OF FACT Coronary artery disease, status post myocardial infarction has manifested in evidence of cardiac hypertrophy or dilatation on electrocardiogram and echocardiogram. CONCLUSION OF LAW The criteria for a 30 percent evaluation for coronary artery disease, status post myocardial infarction, but not higher, have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.104, Diagnostic Code 7005 (2017).   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1968 to November 1969. Service connection for coronary artery disease, status post myocardial infarction was granted in a December 2013 rating decision, effective July 25, 2013. A 30 percent evaluation was assigned. The Veteran appealed the effective date of service connection, requesting an effective date of February 26, 2008. Subsequent to his Notice of Disagreement, a February 2015 rating decision granted an effective date for service connection of February 26, 2008. A 10 percent evaluation was awarded effective February 26, 2008, and a 30 percent evaluation was awarded effective April 16, 2013. A simultaneous Statement of the Case was issued addressing entitlement to an earlier effective date for the 30 percent evaluation. In the Veteran’s March 2015 Form 9 Substantive Appeal, the Veteran made clear that he was specifically challenging the initial 10 percent evaluation, in effect from February 26, 2008 to April 15, 2013. As a result, the Board will only address this time period. However, it has considered whether an evaluation in excess of 30 percent from April 16, 2013 is warranted as well. 1. Evaluation of coronary artery disease, status post myocardial infarction Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of a veteran. 38 C.F.R. § 4.3. Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be staged. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). As explained below, the Board has determined a uniform 30 percent evaluation is warranted from the initial effective date of service connection. The Veteran’s coronary artery disease (CAD) has an initial 10 percent evaluation under Diagnostic Code 7005, effective February 26, 2008. A 30 percent evaluation is assigned effective April 16, 2013. As noted, the Veteran has specifically challenged the initial evaluation of 10 percent. Diagnostic Code 7005 provides for a 10 percent evaluation for a workload greater than 7 METs but not greater than 10 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required. 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 workload of greater than 3 METs but not greater than 5 METs results 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, Diagnostic Code 7005. A note prior to the Diagnostic Code explains that 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). The Veteran’s representative submitted a September 2015 statement with attached private medical records for the relevant time period. As noted by the representative, these medical records document cardiac hypertrophy and dilation on an echocardiogram as early as April 2008. As a result, the Board has determined that a 30 percent evaluation is warranted beginning February 26, 2008. A review of the relevant medical records during this period, and from April 16, 2013, does not indicate multiple episodes of acute congestive heart failure, a workload of greater than 3 METs and not greater than 5 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular dysfunction with an ejection fraction below 50 percent.   As a result, a uniform evaluation of 30 percent is most appropriate for the entire period on appeal, beginning February 26, 2008. The evidence weighs against a rating in excess of 30 percent at any point. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD W. R. Stephens, Counsel