Citation Nr: 18151110 Decision Date: 11/19/18 Archive Date: 11/16/18 DOCKET NO. 15-37 276 DATE: November 19, 2018 ORDER The 30 percent rating for valvular heart disease is restored. FINDINGS OF FACT 1. In a January 2014 rating decision, the RO reduced the Veteran’s rating from 30 percent to 10 percent for valvular heart disease. 2. At the time of the April 1, 2014 effective date of the reduction, the 30 percent rating for the Veteran’s valvular heart disease had been in effect for less than five years. 3. After resolving any reasonable doubt in the Veteran’s favor, the VA examination has not demonstrated improvement in the Veteran’s valvular heart disease. CONCLUSION OF LAW The reduction of the rating for a service-connected valvular heart disease was improper and restoration of the 30 percent rating effective April 1, 2014 is warranted. 38 U.S.C. §§ 1155, 5103; 38 C.F.R. §§3.102, 3.105, 3.344, 4.104, Diagnostic Code 7000. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from October 1990 to March 2012. The Veteran contends that the rating reduction of his heart disability was based on an inadequate examination. The United States Court of Appeals for Veterans Claims (Court) has noted that a claim stemming from a rating reduction action is a claim for restoration of the prior rating, not a claim for an increased rating. Peyton v. Derwinski, 1 Vet. App. 292 (1991); Dofflemyer v. Derwinski, 2 Vet. App. 277, 280 (1992). Here, based on the procedural history and contentions, the appeal is limited to the propriety of the reduction. There are required procedures when a rating is reduced. Here, the rating reduction resulted in a decrease in compensation payable to the Veteran, as his combined rating was decreased by 10 percent. Therefore, the provisions of 38 C.F.R. § 3.105(e) apply. In addition, the Veteran’s rating has been in effect for less than five years and therefore the provisions of 38 C.F.R. § 3.344 do not apply as his disability is not deemed to be stabilized. See 38 C.F.R. § 3.344(c). Reexaminations disclosing improvement will warrant a reduction in rating. Id.; see also 38 C.F.R. § 4.1 (disability may require re-ratings over time in accordance with changes in law, medical knowledge, and the Veteran’s condition). For a rating reduction to be sustained, it must be shown by a preponderance of the evidence that the reduction was warranted. Sorakubo v. Principi, 16 Vet. App. 120 (2002). VA has the burden of establishing that the disability has improved. In considering the propriety of a reduction, the Board must focus on the evidence available to the RO at the time the reduction was implemented, although post-reduction medical evidence may be considered in the context of evaluating whether the disability had demonstrated actual improvement. Dofflemyer v. Derwinski, 2 Vet. App. 277, 281-82 (1992). There is “a clear requirement that VA rating reductions, as with all VA rating decisions, be based upon a review of the entire history of the veteran’s disability.” Brown v. Brown, 5 Vet. App. 413, 420 (1993) (referencing 38 C.F.R. §§ 4.1, 4.2, 4.13). A rating reduction requires an inquiry as to “whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations.” Id. at 421. A claim as to whether a rating reduction was proper must be resolved in the veteran’s favor unless the Board concludes that a fair preponderance of evidence weighs against the claim. Id. As pertinent here, under Diagnostic Code 7000, a 10 percent rating is assigned when there is evidence of a workload of greater than 7 METs but not greater than 10 METs that results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of continuous medication required. A 30 percent rating is assigned when symptoms manifest in the following ways: a workload of greater than 5 METs but not greater than 7 METs that results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. 38 C.F.R. § 4.104, Diagnostic Code 7000. The November 2013 rating decision proposing the reduction and the January 2014 rating decision reducing the disability rating assigned to the Veteran’s valvular heart disease was based on an October 2013 VA examination report. The October 2013 VA examination report was based on a normal contemporaneous EKG and a January 2013 echocardiogram showing left ventricle ejection fraction of 60 - 65%. The examiner calculated METs based on the Veteran’s responses to questions. The examiner found the Veteran’s workload was greater than 7 METs but no greater than 10 METs, based on reports of dyspnea, angina, and dizziness. It was reported that the Veteran had not had a syncopal episode in the past year. The Board does not find this examination to be inadequate. The October 2013 VA examination thoroughly detailed the Veteran’s medical history, including precipitating events to his July 2013 hospitalization, and considered objective medical tests and the Veteran’s subjective symptom reporting. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Highly probative to the Board’s decision is the prior January 2013 VA examination, which served as the basis for the initial award of a 30 percent rating for valvular heart disease. The January 2013 VA examination was based on a normal contemporaneous EKG and the same January 2013 echocardiogram considered by the October 2013 examiner. The January 2013 VA examiner interview-based METs test was greater than 5 METs but no greater than 7 METs, based on the Veteran’s reports of dyspnea, angina, and syncope (when pushing a lawnmower in the summer). See Hohol v. Derwinski, 2 Vet. App. 169 (1992) (comparison point whether improvement is shown generally is the last examination on which the rating at issue was assigned or continued). Based on review of the record, historically, the Veteran has had normal EKGs and his echocardiograms have shown left ventricle ejection fraction between 60 - 65 %. These objective tests remain the same since the grant of service-connection for valvular heart disease, even during his hospital admission in July 2013. Moreover, the subjective symptom complaints of the Veteran, namely chest pain, have remained unchanged. Given the consistent objective medical test results and subjective symptom reporting, it cannot be said that the interview-based METs test conducted during the October 2013 VA examination actually demonstrated improvement. Objective medical testing indicates no change in functioning between the January 2013 and October 2013 VA examinations. VA has not met its burden of establishing that the disability has improved. VA has to establish an improvement in a disability has actually occurred, and that such improvement actually reflects an improvement in the Veteran’s ability to function under the ordinary conditions of life and work. See, e.g., Brown v. Brown, 5 Vet. App. 5 Vet. App. 413, 420-22 (1993); Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). If anything, these VA examinations were conducted in close proximity to each other and were based upon the same objective test findings, with the exception of the interview-based METs test. The evidence appears to be in relative equipoise given the disagreement between the examiners on the results of the interview-based METs test. As the evidence is in equipoise, the Board will resolve reasonable doubt in favor of the Veteran. See 38 C.F.R. § 3.102. Based on a review of the clinical findings on the VA examinations, the Board finds that overall, they do not show improvement in the Veteran’s service-connected valvular heart disease. Therefore, without evidence of improvement, the prior 30 percent rating is restored. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Dellarco, Associate Counsel