Citation Nr: 18153436 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 16-43 915 DATE: November 27, 2018 ORDER A 60 percent rating for coronary artery disease (CAD) from July 14, 2005, to August 19, 2012, is granted. A 100 percent rating for CAD since August 20, 2012, is granted. FINDINGS OF FACT 1. From July 14, 2005, to August 19, 2012, the Veteran’s CAD caused dyspnea, fatigue, angina, weakness, plaquing, mitral regurgitation, LVEF of greater than 50 percent, heart enlargement, a METs level of 3 to 5, and required continuous medication. 2. Since August 20, 2012, the Veteran had a myocardial infarction and has had a METs level of 1 to 3. CONCLUSIONS OF LAW 1. The criteria for an initial rating of 60 percent from July 14, 2005, to August 19, 2012, for CAD have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.14, 4.104, Diagnostic Code 7005 (2017). 2. The criteria for an initial rating of 100 percent since August 20, 2012, for CAD have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.14, 4.104, Diagnostic Code 7006 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Army from April 1966 to April 1969. He served in the Republic of Vietnam. Entitlement to an initial rating of more than 10 percent from July 14, 2005, to September 18, 2008, and an initial rating of more than 30 percent from September 19, 2008, to July 14, 2016, for coronary artery disease (CAD). Disability evaluations are determined by comparing the Veteran’s current symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155 (2012); 38 C.F.R. Part 4 (2017). Diagnostic code 7005 provides ratings for CAD. A 10 percent rating is warranted for documented CAD resulting in workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required. A 30 percent rating is warranted for 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 electro-cardiogram, echocardiogram, or X-ray. A 60 percent rating is warranted for 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 rating is warranted for chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent. 38 C.F.R. § 4.104, Diagnostic Code 7005 (2017). Diagnostic code 7006 provides ratings for myocardial infarctions. A 100 percent rating is warranted during and for three months following a myocardial infarction documented by laboratory tests. Thereafter, a 100 rating is warranted for chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent. 38 C.F.R. § 4.104, Diagnostic Code 7006 (2017). Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided. Separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Where, as here, the issue involves the assignment of an initial rating for a disability following the award of service connection for that disability, the entire history of the disability must be considered. See Fenderson v. West, 12 Vet. App. 119 (1999). A March 2005 private treatment record indicates that the Veteran had a possible heart attack in the past. He was directed to take aspirin daily. He had an estimated left ventricular ejection fraction (LVEF) of 55 percent. In May 2005, the Veteran underwent left heart catheterization, selective coronary angiography, and left ventriculography. He had plaquing, mitral regurgitation, and an estimated LVEF of 55 to 60 percent. In September 2009, the Veteran was afforded a VA examination. He reported mild shortness of breath on exertion and that he was easily fatigued. On examination, there was evidence of borderline left ventricular hypertrophy and he had an LVEF of 60 percent. In December 2009, the Veteran was afforded another VA examination. His estimated activity level was 3 to 5 METs, his heart was larger than normal, and he had a LVEF of greater than 50 percent. He had dyspnea onset with mild exertion, angina, weakness, and fatigue. There was no evidence of congestive heart failure, dizziness, or syncope. He took continuous medication for his heart disease. Private treatment records indicate that the Veteran was admitted to the hospital with an acute anterior myocardial infarction on August 20, 2012. He underwent coronary angioplasty and stenting. He had an LVEF of 40 percent. On July 15, 2016, the Veteran was afforded a VA examination. The examiner indicated that the Veteran had dyspnea, fatigue, angina, dizziness, and a METs level of 1 to 3. He was granted a 100 percent rating for his CAD effective the date of the examination. From July 14, 2005, to August 19, 2012, the Veteran’s CAD caused dyspnea, fatigue, angina, weakness, plaquing, mitral regurgitation, LVEF of greater than 50 percent, heart enlargement, a METs level of 3 to 5, and required continuous medication. Given these facts, the Board finds that the Veteran’s symptoms most closely approximate a 60 percent rating. 38 C.F.R. §§ 4.7, 4.104, Diagnostic Code 7005. A 100 percent rating is not warranted as the Veteran did not have chronic congestive heart failure, a METs level of 3 or less, or an LVEF of less than 30 percent. (Continued on the next page)   On August 20, 2012, the Veteran had a myocardial infarction which entitles him to a 100 percent rating beginning that date and for three months following. 38 C.F.R. § 4.104, Diagnostic Code 7006. Since November 20, 2012, he has had a METs level of 1 to 3. Given that fact, the Board finds that the Veteran’s symptoms most closely approximate a 100 percent. 38 C.F.R. §§ 4.7, 4.104, Diagnostic Code 7006. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. E. Miller, Associate Counsel