Citation Nr: 18146756
Decision Date: 11/01/18	Archive Date: 11/01/18

DOCKET NO. 16-33 717
DATE:	November 1, 2018
REMANDED
A rating in excess of 10 percent for coronary artery disease is remanded.
REASONS FOR REMAND
The Veteran had active service from December 1970 to April 1972.  
He is seeking a rating in excess of 10 percent for his coronary artery disease.  
He stated in his Notice of Disagreement that he could not complete a stress test because of fatigue, shortness of breath, angina, and dizziness.  He indicated that a CTA was ordered showing plaques in two arteries.  He believes that if he had been able to complete a stress test it would have supported a higher rating. 
The Veteran was provided a VA examination in April 2016, at which the examiner confirmed that the Veteran had mild plaque on cardiac CT scan involving the LAD artery and RCA artery. The examiner indicated that a stress test was terminated due to symptoms related to Veteran’s cardiac condition. The examiner referenced a stress test from October 13, 2015 showing METS level of 8 and an echocardiogram dated August 21, 2015 showing left ventricular ejection fraction (LVEF) of 64 percent, and concluded that there was no evidence of cardia hypertrophy and dilatation. 
The Veteran was provided another VA examination in June 2017, at which the examiner indicated that a stress test was terminated due to the Veteran had achieved maximum heart rate.  The examiner again made reference to a stress test dated October 13, 2015 showing METS level of 8 and a multi-gated acquisition scan (MUGA) dated October 13, 2015 showing a LVEF of 58 percent, and concluded that there was no evidence of cardia hypertrophy and dilatation. 
It is unclear from the record whether the assigned METs is currently accurate.  The Veteran has argued that his stress test had to be stopped prematurely because of fatigue, shortness of breath, angina, and dizziness.  VA regulations provide that 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.  Here, it is unclear whether an estimate should have been made by the examiner.
Therefore, the matter is REMANDED for the following action:
Schedule the Veteran for a VA examination to assess the current severity of his cardiac disability. In doing so, the examiner should conduct any testing necessary to determine the Veteran’s METs level and LVEF.  
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If 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, it should be explained why, and the examiner should estimate 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.
 
MATTHEW W. BLACKWELDER
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Q. Wang, Associate Counsel