Citation Nr: 18150570 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 18-33 235 DATE: November 15, 2018 ORDER Entitlement to an evaluation in excess of 60 percent for status-post myocardial infarction associated with hypertension (for substitution purposes) is denied. Entitlement to an evaluation in excess of 30 percent for dermatophytosis pedis, tinea pedis, ungium (for substitution purposes) is denied. FINDINGS OF FACT 1. During the period on appeal, status-post myocardial infarction manifested in a workload of greater than 3 METs but not greater than 5 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, and left ventricular dysfunction with an ejection fraction of 30 to 50 percent. 2. During the period on appeal, dermatophytosis pedis, tinea pedis, ungium manifested in symptoms consistent with a 30 percent evaluation under the relevant Diagnostic Criteria prior to 2002. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 60 percent evaluation for status-post myocardial infarction associated with hypertension have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.104, Diagnostic Code 7006 (2017). 2. The criteria for an evaluation in excess of 30 percent for dermatophytosis pedis, tinea pedis, ungium have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.118, Diagnostic Code 7806 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1976 to January 1978. The Veteran died in February 2013 and the Appellant is the surviving spouse. The matter of entitlement to a TDIU was denied by the Board in an April 2012 decision. This was affirmed by an October 2013 Memorandum Decision by the United States Court of Appeals for Veterans Claims. Increased Rating 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 that uniform evaluations are warranted for both issues on appeal. 1. Entitlement to an evaluation in excess of 60 percent for status-post myocardial infarction associated with hypertension Prior to the Veteran’s death, he submitted a notice of disagreement with a June 2011 rating decision denying entitlement to an evaluation in excess of 10 percent for status-post myocardial infarction. Subsequent to the Veteran’s death, a May 2018 rating decision awarded a 60 percent evaluation under Diagnostic Code 7006, effective December 9, 2005. Under Diagnostic Code 7006, a 60 percent evaluation requires 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 evaluation is assigned for chronic congestive heart failure; or workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricular dysfunction with an ejection fraction of less than 30 percent. A review of the record, including a May 2007 VA examination and VA treatment records, does not reveal chronic congestive heart failure, workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular dysfunction with an ejection fraction of less than 30 percent. The Board does note that VA treatment records indicate that the Veteran was hospitalized in June 2011 due to his heart disorder. However, there is no indication that this hospitalization or any other manifestations documented in treatment records amounted to chronic congestive heart failure. As a result, a uniform evaluation of 60 percent is most appropriate for the entire period on appeal. The evidence weighs against a rating in excess of 60 percent at any point. 2. Entitlement to an evaluation in excess of 30 percent for dermatophytosis pedis, tinea pedis, ungium The Veteran’s dermatophytosis pedis, tinea pedis, ungium was evaluated as 30 percent disabling under Diagnostic Code 7806. The Veteran filed an increased rating claim on September 22, 2010. At the time of the Veteran’s increased rating claim, under Diagnostic Code 7806, a 30 percent disability rating is warranted when 20 to 40 percent of the entire body is affected; 20 to 40 percent of exposed areas are affected; or intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs are required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A 60 percent disability rating is warranted when more than 40 percent of the entire body or more than 40 percent of exposed areas are affected; or constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs are required during the past 12-month period. 38 C.F.R. § 4.118. After a review of the medical evidence of record, the Board has determined that the current 30 percent evaluation during the period on appeal is appropriate. This medical evidence includes a January 2011 VA examination, which documents that the Veteran’s disorder affects less than 5 percent of the total body area and that constant topical medication was used, but that it was neither a corticosteroid or an immunosuppressive. Thus, after a review of the medical and lay evidence, the Board finds that the current 30 percent evaluation is appropriate. Simply put, there is no evidence that more than 40 percent of the entire body or exposed areas was affected, or of constant or near constant systemic therapy such as the use of corticosteroids or other immunosuppressive drugs during the period on appeal. Johnson v. Shulkin, 862 F.3d 1351 (2017). The Board notes that the current 30 percent evaluation was awarded effective March 26, 1992, prior to the enactment of new disability criteria for relevant skin disorders in 2002. In addition, the Board notes the implementation of revised   Diagnostic Criteria for skin disorders by VA in July 2018, effective August 13, 2018. To the extent that such criteria would be applicable here, they would not warrant an increased evaluation either. In short, the competent medical and lay evidence of record reflects that the 30 percent evaluation during the period on appeal is appropriate. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD W. R. Stephens, Counsel