Citation Nr: 18151002 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 16-37 458 DATE: November 16, 2018 ORDER Entitlement to service connection for bilateral hearing loss is denied. A disability rating in excess of 30 percent prior to September 12, 2017 and in excess of 60 percent thereafter for service-connected coronary artery disease, status post coronary artery bypass graft, with residual surgical scars, is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of bilateral hearing loss for VA purposes. 2. Prior to September 12, 2017, the Veteran’s CAD status-post coronary artery bypass graft was manifested by a workload of greater than 5 but less than 7 METs results in dyspnea and fatigue and an ejection fraction of 60 percent with well-healed scars. 3. From September 12, 2017, the Veteran’s CAD status-post coronary artery bypass graft was manifested by a workload of greater than 3 but less than 5 METs with well-healed scars and without evidence of chronic congestive heart failure. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385. 2. The criteria for a rating in excess of 30 percent for coronary artery disease status post coronary artery bypass graft, with residual surgical scars, prior to September 12, 2017 have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.104, Diagnostic Codes 7005-7017. 3. The criteria for a rating in excess of 60 percent for coronary artery disease status post coronary artery bypass graft, with residual surgical scars, from September 12, 2017 have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.104, Diagnostic Code 7005. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Army from January 1969 to September 1970. This case comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before a Decision Review Officer (DRO) in January 2017. 1. Entitlement to service connection for bilateral hearing loss The Veteran contends that he has bilateral hearing loss related to his active service. Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). For purposes of applying the laws administered by VA, impaired hearing will be considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz (Hz) is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Board concludes that the Veteran does not have a current diagnosis of bilateral hearing loss for VA purposes and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. § 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). During the January 2017 DRO hearing, the Veteran stated that he has a problem hearing in situations where there is background music or talking, but additionally noted that in a situation such as the DRO hearing he did not have a problem hearing. The Veteran was afforded a VA audiology examination in July 2015, which reflected the following puretone threshold results: Hz 500 1000 2000 3000 4000 Right 20 10 10 10 15 Left 20 20 20 25 30 Speech discrimination scores using the Maryland CNC word list were 100 percent in the right ear and 96 percent in the left ear. These hearing levels do not constitute hearing loss for VA purposes. The Veteran additionally submitted a March 2016 University of Connecticut audiology examination. The puretone threshold results similarly did not reflect hearing loss of at least 26 decibels at three of the 500, 1000, 2000, 3000, or 4000 frequencies. Although the Board acknowledges that the Veteran does have some elevated hearing thresholds, those thresholds do not meet the definition of a disability under 38 C.F.R. § 3.385. Consideration has been given to his personal statements pertaining to his hearing loss. He is certainly competent to state he experiences some level of lost hearing. However, a finding of hearing loss for VA purposes requires more than a lay opinion. It necessitates a diagnosis utilizing audiometric equipment and interpretation of that data by a trained professional. The Veteran does not possess that expertise. Accordingly, the preponderance of the evidence is against the claim and service connection for bilateral hearing loss must be denied. 2. Entitlement to a rating in excess of 30 percent prior to September 12, 2017 and in excess of 60 percent thereafter for service-connected coronary artery disease, status post coronary artery bypass graft, with residual surgical scars A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as staged ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran was awarded service connection for coronary artery disease in the August 2015 rating decision on appeal. An initial temporary 100 percent disability rating was awarded from May 2014 related to his bypass surgery. From August 2014, a 30 percent disability rating was assigned. Thereafter, in a March 2018 rating decision, the RO increased the disability rating to 60 percent, effective from September 12, 2017. The Veteran asserts that a higher rating is warranted for his service-connected coronary artery disease from August 2014. See A.B. v. Brown, 6 Vet. App. 35, 39 (1993). The Veteran’s coronary artery disease has been evaluated under 38 C.F.R. § 4.104, Diagnostic Codes 7005-7017. Under this code, a 30 percent rating is warranted for coronary artery disease resulting in 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 dilation on electrocardiogram, echocardiogram, or X-ray. A 60 percent rating is warranted when there has been more than one episode of acute congestive heart failure in the past year; or a 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 coronary artery disease resulting in chronic congestive heart failure; or a workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricle dysfunction with an ejection fraction of less than 30 percent. Private treatment records include an April 2014 treadmill exercise stress test showing a maximum workload of 7.1 METs. The left ventricular ejection fraction was 60 percent. The Veteran was afforded a VA examination in August 2015. The Veteran reported intermittent palpitations at night but denied chest pain. He also stated that he had intermittent shortness of breath with anxiety and exertion. An exercised-based METs test again reflected a score of 5 to 7 METs and the examiner noted the April 2014 echocardiogram showing a left ventricular ejection fraction of 60 percent. In his July 2016 notice of disagreement, the Veteran asserted that the symptoms of his coronary artery disease have continued to worsen. During the January 2017 DRO hearing, the Veteran’s representative referenced and submitted into the record an exercise stress test conducted by the Veteran’s cardiologist in November 2016. The representative indicated the report reflected METs of “4.6 and 5.9.” However, upon review of the submitted private treatment records, the cardiologist noted that the Veteran “demonstrated fair exercise tolerance.” He did not have any chest pain and was described as “asymptomatic” 2 years after his bypass surgery. The exercise test reflected a maximum workload of 7.1 METs. The Veteran testified during the January 2017 DRO hearing that his CAD caused him shortness of breath more frequently and prevented him in engaging in activities he was previously able to do, like climb ladders or go fishing on a boat. He said he has had to modify his lifestyle to accommodate his CAD. The Veteran was afforded an additional VA examination in September 2017. At that time, an interview-based METs test indicated a score of 3-5 METs. The examiner stated that the Veteran would have difficulty with certain activities including playing sports and performing heavy manual labor. He further indicated that the heart condition seemed to be stable and that the Veteran had not had cardiac testing since 2014. An opinion was obtained in November 2017 regarding the conflicting medical evidence. The examiner noted the November 2016 private cardiologist treadmill stress test results which did not provide a METs level but stated that his last left ventricular ejection fraction was 60 percent in 2014. The examiner stated that the best predictor for the Veteran’s cardiac function would be the ejection fraction as another exercise-based stress test could potentially be dangerous. Based on the above, the Board finds that a rating in excess of 30 percent prior to September 12, 2017 is not warranted. During that time, his METs score was consistently 5-7. Additionally, his ejection fraction was 60 percent. Accordingly, the evidence shows that the Veteran’s METs score and other symptoms most closely approximated the criterion for a 30 percent rating during that period. Additionally, the Board finds that a preponderance of the evidence is against awarding a rating in excess of 60 percent from September 12, 2017. The September 2017 VA examination report reflected a METs score of 3-5. The Veteran’s METs score has never been indicated to be below 3. Additionally, there is no evidence of an ejection fraction of less than 60 percent during this time or evidence of chronic congestive heart failure. Thus, he does not meet the schedular criteria for a 100 percent rating. Instead, his symptoms during this period are most closely approximated by the criteria for a 60 percent rating. The Board has considered the Veteran’s lay statements regarding his CAD symptomatology and the resulting impairment. The Board is fully aware that the Veteran is competent to report symptoms of fatigue and shortness of breath. There is no indication that the examination reports are not an accurate reflection of the Veteran’s complaints. Additionally, the medical findings discussed directly address the Veteran’s contentions and the criteria under which his CAD is evaluated. The Veteran also claims entitlement to an increased rating based on several scars associated with his bypass surgery. However, despite his contentions during the January 2017 DRO hearing that he had poor healing of a scar, there is no medical evidence showing such. Indeed, during his August 2015 VA examination, the examiner noted that none of the Veteran’s scars were of the face or neck, painful or unstable, and that the total area of all related scars was less than 39 square centimeters. Private treatment records dated in December 2016 reflect that the Veteran complained of a small open area at the lower sternal scar that existed since his coronary artery bypass surgery in 2014. The Veteran reported that there was no draining, but that he could express air through the hole when the skin is wet. The area was not tender and the examiner noted that there is a small area of thickened skin with a less than 1 millimeter opening. There was no erythema or increased warmth in the sternal area over the scar. Treatment records from January 2017 reflect that he underwent surgery to remove 2 painful sternal wires, status-post coronary artery bypass grafting. On the September 2017 examination report, it was again noted that the Veteran had scars related to his bypass graft, but that the scars were not painful or unstable, did not have a total area equal to or greater than 39 square centimeters, and were not located on the head, face, or neck. Indeed, the examiner described the scars as “well-healed.” There is no evidence that the scars caused limitation of motion or caused any limitation of function. These medical findings do not show a compensable impairment caused by the Veteran’s scars. Accordingly, an additional compensable rating for the Veteran’s scars is not warranted. Lindsey M. Connor Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Stuedemann, Associate Counsel