Citation Nr: 18148923 Decision Date: 11/09/18 Archive Date: 11/08/18 DOCKET NO. 16-38 864 DATE: November 9, 2018 ORDER Entitlement to a rating in excess of 10 percent for paroxysmal atrial tachycardia (heart disability) is denied. FINDING OF FACT The Veteran’s paroxysmal atrial tachycardia or other supraventricular tachycardia has not been manifested by more than four episodes per year that were documented by ECG or Holter monitor. CONCLUSION OF LAW The criteria for entitlement to a rating in excess of 10 percent for paroxysmal atrial tachycardia have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.104, Diagnostic Code 7010. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Army from January 1984 to July 1989. Increased Rating Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. See 38 U.S.C. § 1155; 38 C.F.R. Part 4. The percentage ratings in VA’s Schedule for Rating Disabilities (Rating Schedule) represent as far as can practicably be determined the average impairment in earning capacity resulting from such disabilities and their residual conditions in civil occupations. See 38 C.F.R. § 4.1. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 4.3. Where entitlement to compensation has already been established and increase in disability is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, “staged” ratings are appropriate where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). Separate compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as “staged” ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). The Board observes that the words “slight,” “moderate,” and “severe” are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. It should also be noted that use of descriptive terminology such as “mild” by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 U.S.C. § 7104 (a); 38 C.F.R. §§ 4.2, 4.6. Once the evidence has been assembled, it is the Board’s responsibility to evaluate the evidence. 38 U.S.C. § 7104 (a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Entitlement to a rating in excess of 10 percent for paroxysmal atrial tachycardia The Veteran asserts that the severity of his heart disability, currently evaluated under Diagnostic Code 7010, warrants a rating in excess of 10 percent. Pursuant to Diagnostic Code 7010, a 10 percent rating is warranted for permanent atrial fibrillation (lone atrial fibrillation), or one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor. A 30 percent rating is warranted for paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by ECG or Holter monitor. 38 C.F.R. § 4.104. The Veteran was diagnosed with supraventricular arrhythmia in 1989 and underwent an ablation surgery in 1991. Following the ablation surgery, the Veteran did not experience complications until September 2012, when he began to suffer from chest pain and heart palpitations. In September 2012, the Veteran was diagnosed with atrial fibrillation and given a prescription for continuous medication to treat his symptoms. See, post-service VA treatment records dated September 2012. Following the prescription of Metoprolol, the Veteran’s symptoms were well controlled and the Veteran was continually noted to be doing well with no palpitations or other heart rate or rhythm irregularities. See, post-service treatment records dated February 2013, August 2013, March 2015, October 2015, December 2015, February 2016, March 2016. The Veteran was afforded a VA examination in connection with his claim in June 2013. During this examination, the Veteran’s diagnoses of supraventricular arrhythmia and atrial fibrillation were confirmed. With respect to the Veteran’s supraventricular tachycardia, the VA examiner noted that the frequency was intermittent (paroxysmal) with no episodes in the past 12 months as confirmed by EKGs and Holter monitor. Turning to the Veteran’s atrial fibrillation, the VA examiner that the frequency was intermittent (paroxysmal) with 1-4 episodes in the past 12 months as confirmed by EKGs and a March 2013 Holter monitor reading. See, June 2013 VA examination. The June 2013 VA examination also included an interview-based METs test, during which the Veteran endorsed symptoms such as dyspnea, fatigue, angina, and was diaphoretic. The VA examiner indicated that the Veteran’s workload was between 5-7 METs. During the examination, the Veteran’s heart rate and rhythm were noted to be regular. Id. As the June 2013 VA examination was completed following a review of the Veteran’s record, included an in-person examination, and is consistent with the Veteran’s post-service treatment records, the Board has assigned the findings in the June 2013 VA examination with significant probative value. The Board acknowledges the Veteran’s lay statements that he experiences heart palpitations, abnormal rhythm and episodes that require him to rest. See, September 2013 Notice of Disagreement. Additionally, the Board notes that the Veteran emphasizes that he has to take daily medication to control to his symptoms. See, August 2016 VA Form 9 Substantive Appeal to the Board. However, the Board finds that the preponderance of the evidence is against a finding that the Veteran is entitled to a rating in excess of 10 percent for his paroxysmal atrial tachycardia. As outlined above, there is evidence of 1-4 episodes of atrial fibrillation documented by a Holter monitor in March 2013 and confirmed during the Veteran’s June 2013 VA examination. The Veteran’s subsequent post-service treatment records do not indicate further episodes of atrial fibrillation or supraventricular arrhythmias, as required for a 30 percent rating. 38 C.F.R. § 4.104, Diagnostic Code 7010. In April 2015, he informed a VA examiner that he had not experienced any arrhythmias since he began using prescription Metoprolol. The Veteran’s documented medical evidence indicating less than 4 episodes of atrial fibrillation which requires daily medication is contemplated by his currently assigned rating of 10 percent. The Board has considered whether the Veteran would be entitled to a higher rating under a different Diagnostic Code. However, in this regard, the Board notes that Diagnostic Codes 7000-7008 are not for application because the evidence does not demonstrate that the Veteran has a diagnosis of valvular heart disease, endocarditis, pericarditis, pericardial adhesions, syphilitic heart disease, arteriosclerotic heart disease, myocardial infarction, hypertensive heart disease, or hyperthyroid disease. 38 C.F.R. § 4.104, Diagnostic Coded 7000-7008. (Continued on the next page)   With respect to Diagnostic Code 7011, the Board notes that while the Veteran’s June 2013 VA examination indicated a workload of greater than 5 METs but not greater than 7 METs which results in dyspnea, fatigue and angina, there is no indication that the Veteran’s atrial fibrillation is sustained in nature. Moreover, he has been diagnosed with supraventricular, not ventricular, arrhythmia. His June 2013 VA examination results also specify that his atrial fibrillation is intermittent and therefore, Diagnostic Code 7011 is not for application. 38 C.F.R. § 4.104, Diagnostic Code 7011. Furthermore, the medical evidence of record does not reflect that the Veteran’s arrhythmia involves an atrioventricular block such that application of Diagnostic Code 7015 would be appropriate. Accordingly, based on the above, the Board finds that the preponderance of the evidence is against a finding that the Veteran is entitled to a rating in excess of 10 percent for his paroxysmal atrial tachycardia and therefore, the claim for an increased rating is denied. JEBBY RASPUTNIS Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Daugherty, Associate Counsel