Citation Nr: 18146406 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 16-39 952 DATE: October 31, 2018 ORDER Entitlement to an increased evaluation in excess of 30 percent for coronary artery disease (Nehmer) with coronary artery bypass graft and implanted cardiac pacemaker is denied. FINDING OF FACT The Veteran’s coronary artery disease with coronary artery bypass graft and implanted cardiac pacemaker manifested with a workload of more than 7 METs but not greater than 10 METs and ejection fraction over 50 percent. CONCLUSION OF LAW The criteria for entitlement to an increased evaluation in excess of 30 percent for coronary artery disease (Nehmer) with coronary artery bypass graft and implanted cardiac pacemaker have not been met. 38 C.F.R. §§ 1154 (a), 1155, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.321, 4.104, Diagnostic Code (DC) 7005 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1969 to May 1976 and May 1976 to March 1988. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2015 rating decision. The Veteran did not request a Board hearing. 1. Entitlement to an increased evaluation in excess of 30 percent for coronary artery disease (Nehmer) with coronary artery bypass graft and implanted cardiac pacemaker The Veteran contends that he rates an evaluation greater than 30 percent for his service connected coronary artery disease. Disability ratings are determined by the application of the VA’s Schedule for Rating Disabilities. Separate diagnostic codes identify the various disabilities. U.S.C. § 1155 (2012); 38 C.F.R. § Part 4 (2017). Ratings for service-connected disabilities are determined by comparing the Veteran’s symptoms with criteria listed in the VA’s Schedule for Rating Disabilities, which is based, as far as can practically be determined, on average impairment in earning capacity. The Veteran’s entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Veteran App. 589 (1995). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe at other times during the course of the claim on appeal. Hart v. Mansfield, 21 Vet. App. 505 (2007). When there is a question as to which of two ratings apply, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating, otherwise the lower rating shall be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2017). The Veteran’s coronary artery disease has been evaluated under 38 C.F.R. § 4.104, Diagnostic Code (DC) 7005. Under DC 7005, 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 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. 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 Board finds that the preponderance of the evidence shows that the Veteran’s CAD does not warrant an evaluation in excess of 30 percent. A July 2015 private disability benefits questionnaire showed the Veteran exhibited symptoms of dyspnea, fatigue, and dizziness with left ventricular ejection fraction of 67 percent. The private examiner did not indicate the Veteran’s METs due to his symptoms. The Veteran was afforded a VA examination in September 2015. The examiner found his METs level due solely to his cardiac condition was more than 7 but no more than 10 METs. His METs level based on other factors including his cardiac condition was more than 3 but no more than five METs. His left ventricular ejection fraction was 55 percent. The Veteran had no hospitalizations for treatment of heart conditions. The Veteran submitted a private disability benefits questionnaire in December 2015 which stated the Veteran’s left ventricular ejection fraction was 50 to 55 percent. The private examiner did not indicate the Veteran’s METs level. In light of the foregoing, the Board finds that a rating in excess of 30 percent is not warranted for the Veteran’s service-connected coronary artery disease. The Veteran did not experience more than one episode of acute congestive heart failure in the past year. His METs level based solely on his cardiac condition was not greater than 3 METs but not greater than 5 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope. The December 2015 results only show a range of ejection fraction from 50 to 55 rather than a specific number. In light of the July 2015 and September 2015 specific 55 or more ejection fraction findings, the Board cannot find that the Veteran’s ejection fraction is consistent with an ejection fraction within the range of 30 to 50 to warrant a 60 percent rating. Rather, the evidence overall more closely reflects a 30 percent rating. The Board acknowledges that the Veteran is competent to report on symptoms and he is sincere in his belief that he is entitled to a higher rating. However, he is not competent to report upon the percentage blockage in his arteries. The issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Thus, his lay evidence is outweighed by competent and credible medical evidence that evaluates the true extent of his coronary artery disease based on objective data coupled with the lay complaints. In this regard, the Board notes that the VA and private examiners have the training and expertise necessary to administer the appropriate tests for a determination of the type and degree of the impairment associated with the Veteran’s complaints. For these reasons, greater evidentiary weight is placed on the examination findings in regard to the type and degree of impairment. Thus, an increased evaluation in excess of 30 percent for coronary artery disease is not warranted. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Alexia E. Palacios-Peters, Associate Counsel