Citation Nr: 18148604 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 15-00 616 DATE: November 7, 2018 ORDER Entitlement to a disability rating greater than 30 percent for hypertensive heart disease is denied. FINDING OF FACT The Veteran’s hypertensive heart disease is manifested by a workload of 4.6 metabolic equivalents (METS) that does not result in dyspnea, fatigue, angina, dizziness, or syncope. He has not exhibited any episodes of congestive heart failure or left ventricular dysfunction with an ejection fraction (LVEF) of 30 to 50 percent. CONCLUSION OF LAW The criteria for a disability rating higher than 30 percent for hypertensive heart disease are not met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. § 4.104, Diagnostic Code (DC) 7007. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service with the United States Army from November 1976 to May 1980. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. In a February 2018 rating decision, the Agency of Original Jurisdiction (AOJ) increased the evaluation for the Veteran’s hypertensive heart disease to 30 percent, for the entire appeal period. As the 30 percent rating is less than the maximum evaluation allowable, the Veteran has not withdrawn his appeal, and this issue remains in appellate status. AB v. Brown, 6 Vet. App. 35 (1993). most recent adjudication of this claim was in a statement of the case (SOC) issued in December 2014, and additional VA outpatient treatment records dated from 2014 to 2018, have been added to the record since then. Although the Veteran has not expressly waived RO review of these records, the Board notes that much of it is duplicative of evidence already of record and contains no new information or cardiovascular findings that would entitle the Veteran to a higher rating for his hypertensive heart disease. Therefore, the provisions of 38 C.F.R. § 20.1304 do not apply, and the issue need not be returned to the RO. Increased Rating The Veteran seeks a higher disability rating for his service-connected hypertensive heart disease. Disability ratings are determined by comparing a veteran’s present symptomatology with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C. § 1155 (2012); 38 C.F.R. Part 4 (2018). When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran’s entire history is considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A review of the recorded history of a disability is necessary to make an accurate rating. 38 C.F.R. §§ 4.2, 4.41. The regulations do not give past medical reports precedence over current findings where such current findings are adequate and relevant to the rating issue. Francisco v. Brown, 7 Vet. App. 55 (1994); Powell v. West, 13 Vet. App. 31 (1999). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s hypertensive heart disease is rated 30 percent rating disabling under DC 7007 for disability manifested by 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 rating of 60 percent is assigned for 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. One MET (metabolic equivalent) 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 decision 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) resulting in dyspnea, fatigue, angina, dizziness, or syncope may be used. Note 2, 38 C.F.R. § 4.104. In this regard, the pertinent evidence in this case consists almost entirely of clinical findings from VA examinations in August 2010 and December 2014. When examined by VA in August 2010, the Veteran was diagnosed with hypertensive heart disease evidenced by cardiomegaly on chest X-ray. Gross inspection of the Veteran’s chest and lungs was within normal limits, and the size of the heart was normal as determined by auscultation. Cardiovascular examination revealed S1 and S2, regular rate and rhythm, and no S3, S4, or heaves, thrills, murmurs, or gallops. There was no evidence of congestive heart failure, cardiomegaly, or cor pulmonale. Although the Veteran required continuous medication for his hypertension, there were no other complaints of specific cardiac symptoms, such as angina, syncope, or dyspnea. However, an electrocardiogram (EKG) showed sinus arrhythmias and 1st degree AV block, left axis deviation. A cardiac stress test showed no symptoms of ischemic heart disease, ectopy, or ST-T wave changes. Although the testing did result in a workload of 4.6 METS, the examining physician noted that the Veteran did not reach target heart rate due to poor exercise tolerance from bilateral knee pain. In addition, his blood pressure response was normal and there were no reports of chest pain, dizziness, syncope arrhythmias, or fatigue. The clinical impression was negative stress test. The Veteran underwent another VA hypertension examination in December 2014. The heart exam revealed regular rhythm and normal auscultation and the point of maximal impact was the fourth intercostal space. Chest X-ray results were within normal limits with no signs of cardiac dilatation, and the EKG showed 1st degree AV block with no signs of cardiac hypertrophy or signs of arrhythmias or ischemia. The Veteran reported that his hypertension causes headaches and that it is still high despite taking medication. He did not report associated chest pain dizziness, fatigue, or syncope. His blood pressure readings were 148/82, 142/84, and 146/84. The remaining evidence consists of outpatient treatment records dated from 2014 to 2018, which show few, if any, entries pertaining to the Veteran’s hypertensive heart disease. In general, the clinical findings from these records are not materially different from those reported on prior VA examinations and show continued evaluation and treatment of the Veteran’s hypertension, but do not otherwise show complaints, findings, or history to suggest congestive heart failure or specific findings of dyspnea, fatigue, angina, dizziness, or syncope. Based upon the preceding evidence, the Board finds no basis to assign a rating greater than 30 percent for the Veteran’s hypertensive heart disease. While, the evidence reflects a workload between 3 and 5 METs (4.6), a 60 percent rating requires that it result in dyspnea, fatigue, angina, dizziness, or syncope. These symptoms have not been shown here. Furthermore, there is no evidence or allegation of even a single episode of congestive heart failure or left ventricular dysfunction with an ejection fraction between 30 and 50 percent. The Board has also considered whether a separate and/or higher rating may be assigned, but there is no evidence that the Veteran’s hypertensive heart disease would be better classified under a different diagnostic code. The remaining cardiovascular codes all have the same criteria as DC 7007, for which the Veteran has already been assigned a 30 percent evaluation. See e.g., DCs 7000-7008, 7011-7020. 38 C.F.R. § 4.104. Accordingly, the Board finds that the Veteran’s impairment due to hypertensive heart disease is more consistent with a 30 percent disability rating and that the level of disability necessary to support the assignment of the next higher evaluation of 60 percent is absent. A preponderance of the evidence is against the claim, and there is no reasonable doubt to be resolved. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J.R. Bryant