Citation Nr: 18153392 Decision Date: 11/28/18 Archive Date: 11/27/18 DOCKET NO. 16-51 587 DATE: November 28, 2018 ORDER The Veteran’s 60 percent disability rating for coronary artery disease (CAD) is restored effective September 1, 2014. REMANDED Entitlement to a disability rating exceeding 60 percent for CAD is remanded. FINDING OF FACT The reduction of the Veteran’s disability rating for his service-connected CAD from 60 percent to 30 percent was improper. CONCLUSION OF LAW The criteria for a restoration of the Veteran’s 60 percent disability rating for CAD have been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 3.105(e), 3.321(b)(1), 3.343(a), 4.1, 4.2, 4.7, 4.10, 4.104, Diagnostic Codes (DCs) 7000-7123 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1966 to December 1968. This appeal comes to the Board of Veterans’ Appeals (Board) from a June 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The RO (1) decreased the Veteran’s disability rating for CAD from 60 percent to 30 percent effective September 1, 2014 and (2) decreased the Veteran’s disability rating for prostate cancer and residuals thereof from 100 percent to 10 percent effective September 1, 2014. The reduction of the rating for prostate cancer from 100 percent to 10 percent also resulted in a discontinuation of the Veteran’s special monthly compensation based on housebound effective September 1, 2014. In a September 2016 Statement of the Case, the RO restored the Veteran’s disability rating for CAD to 60 percent for the period from January 25, 2016 through May 14, 2016. The RO assigned a 30 percent rating for CAD from May 15, 2016. The RO increased the Veteran’s rating for prostate cancer and residuals thereof to 20 percent effective May 27, 2015. On his October 2016 substantive appeal form, the Veteran indicated he only wished to appeal the evaluation of his CAD. Therefore, the scope of the appeal and the Board’s consideration of the issues is limited in accordance with the Veteran’s wishes. A Veteran’s disability rating may not be reduced unless the evidence demonstrates that an improvement in the disability has occurred. See 38 U.S.C. § 1155; 38 C.F.R. § 3.951. In addressing whether improvement is shown, the comparison point generally is the last examination on which the rating at issue was assigned or continued. See Hohol v. Derwinski, 2 Vet. App. 169 (1992). In regard to ratings in effect for fewer than five years, reduction is usually warranted if the evidence shows improvement of the condition. See 38 C.F.R. § 3.951. Additional protections apply in cases involving ratings that have continued for long periods of time at the same level (approximately five years or more by guideline but not mandate). See 38 C.F.R. § 3.344(a), (b); Lehman v. Derwinski, 1 Vet. App. 339 (1991). In such cases, rating agencies will handle cases affected by change of medical findings or diagnosis so as to produce the greatest degree of stability of disability evaluations. Not only must it be determined that an improvement in a disability has actually occurred, but also that the improvement actually reflects an improvement in the Veteran’s ability to function under the ordinary conditions of life and work. 38 C.F.R. § 3.344(a); Brown v. Brown, 5 Vet. App. 413, 420-21 (1993); Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). After reviewing the totality of the evidence, the Board finds that the Veteran’s 60 percent rating for CAD should be restored for the entire period at issue because the medical evidence at the time of the reductions was inadequate to support a finding of medical improvement. Under applicable rating criteria for the Veteran’s heart disability, a 30 percent disability rating contemplates: a disability in which a workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. See, e.g., 38 C.F.R. § 4.104, DC 7005. A 60 percent disability rating contemplates: 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. See, e.g., 38 C.F.R. § 4.104, DC 7005. The RO staged the Veteran’s CAD ratings based on three tests. See September 2016 Statement of the Case; June 2014 rating decision. The RO based its initial reduction of the Veteran’s CAD rating to 30 percent on a March 2014 VA examination, which indicated that (1) the Veteran was capable of performing a workload in excess of 5 METs before experiencing relevant symptoms and (2) the Veteran’s left ventricular ejection fraction was 55-60 percent. The opinion regarding METs performance was based on an interview with the Veteran rather than a diagnostic exercise stress test. The Board affords the opinion little probative value because it is conclusory and does not contain adequate discussion of the effects of the Veteran’s CAD on his ability to perform work. Vasodilatory stress testing from O.I., M.D. dated January 25, 2016 shows the Veteran’s left ventricular ejection fraction was calculated as 46 percent, which supports a restoration to a 60 percent disability rating. However, an echocardiogram from St. Bernards Healthcare Center dated May 15, 2016 shows an ejection fraction of 50.3 percent, which the RO cited as a basis for reducing the rating to 30 percent as of the date of the test. The Board finds the evidence shows the severity of the Veteran’s heart disability fluctuates overtime with periods of worsening and improvement as is reflected by the staged ratings in this case. However, the Veteran has indicated that his CAD symptoms have not substantially improved, and the third ejection fraction calculation of 50.3 percent is only very slightly above the 50 percent figure contemplated by the Veteran’s 60 percent disability rating. The RO did not obtain additional VA examinations to assess METs performance and to determine how CAD affects the Veteran’s ability to function under the ordinary conditions of life and work. In consideration of the totality of the evidence, the Board finds the test results noted above do not demonstrate actual improvement in the Veteran’s ability to function under the ordinary conditions of life and work. Accordingly, the Board finds that the reduction was improper, and the Veteran’s 60 percent disability rating is restored effective September 1, 2014. REASONS FOR REMAND The Agency of Original Jurisdiction (AOJ) last rated the Veteran’s heart disability in the September 2016 Statement of the Case. In July 2017, VA received an echocardiogram and a statement from the Veteran indicating he was treated for a myocardial infarction on July 2, 2017. On remand, the AOJ should afford the Veteran a VA examination of the current severity of his service-connected heart disability. The matter is REMANDED for the following action: 1. The AOJ should contact the Veteran and all current representatives and request their assistance in identifying any outstanding relevant records. The AOJ should make reasonable attempts to obtain all identified outstanding records and associate them with the Veteran’s claims file. 2. After associating all identified outstanding relevant records with the Veteran’s claims file, the AOJ should provide the Veteran with a VA examination of the current severity of his service-connected heart disability. The VA examiner should be provided with a complete copy of the claims file to include this remand order. 3. After completing the above action and any other necessary development, the claim must be readjudicated. If a claim remains denied, a Supplemental Statement of the Case must be provided to the Veteran and current representatives. After the Veteran has had adequate opportunity to respond, the appeal must be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Michael Duffy, Associate Counsel