Citation Nr: 18154305 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 16-39 723 DATE: November 29, 2018 ORDER Entitlement to an initial rating in excess of 10 percent for the period of October 20, 2013, to October 15, 2014, for service-connected ischemic heart disease is not warranted. Entitlement to an initial rating of 100 percent, the highest schedular rating, for the period of October 16, 2014, to July 29, 2015, for service-connected ischemic heart disease is granted. FINDINGS OF FACT 1. From October 20, 2013, to October 15, 2014 the evidence reflects that the Veteran’s ischemic heart disease has not been manifested beyond dyspnea at a workload of greater than seven METs but not greater than ten METs and by requiring continuous medication. 2. As of October 16, 2014, to July 29, 2015, the evidence reflects that the Veteran’s ischemic heart disease has been manifested by dyspnea, fatigue, and angina resulting at a workload of three METs or less. CONCLUSIONS OF LAW 1. From October 20, 2013, to October 15, 2014, the criteria for a disability rating in excess of 10 percent have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7017. 2. From October 16, 2014, to July 29, 2015, the criteria for a disability rating of 100 percent, the highest schedular rating, for ischemic heart disease have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7017. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1966 to May 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), granting the Veteran’s claim for service connection for ischemic heart disease (IHD) status post coronary artery bypass graft (CABG) and awarding a 10-percent rating from October 20, 2013. In July 2016, the RO issued a rating decision increasing the evaluation to 100 percent effective July 30, 2015, the date of a stress test administered by the Veteran’s cardiologist that showed symptoms satisfying the schedular criteria for a 100-percent evaluation. The Veteran contends that the severity of his disability reflected in the July 30, 2015 stress test was also the severity of his disability dating back to October 16, 2014, the date on which the Veteran prepared and signed his claim. Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. Separate ratings can be assigned for separate periods of time based on the facts found, a practice known as “staged” ratings. See Fenderson v. West, 12 Vet. App. 119 (1999); see also Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s disability rating for IHD status post-CABG is assigned under 38 C.F.R. § 4.104, Diagnostic Code (DC) 7017. A 10-percent rating is warranted where a workload greater than 7 metabolic equivalents (METs) but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope; or, where continuous medication is required. 38 C.F.R. § 4.104, DC 7017. One MET is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. 38 C.F.R. § 4.104. A 30-percent rating is warranted where a workload greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope; or, where there is evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. 38 C.F.R. § 4.104, DC 7017. A 100-percent rating is warranted where there is chronic congestive heart failure; or, where a workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope; or, where there is left ventricular dysfunction with an ejection fraction of less than 30 percent. 38 C.F.R. § 4.104, DC 7017. For the period before October 16, 2014, the Board concludes that the evidence does not establish that a schedular evaluation higher than the initial 10-percent evaluation is warranted. A 10-percent evaluation is supported by a May 1, 2015 VA examination that reported that continuous medication is required and found dyspnea upon a workload of greater than 7 but not greater than 10 METs. As to a rating in excess, the examiner opined that a 55-percent left ventricular ejection fraction found in a 2013 echocardiogram is just as likely as not to have not changed since then. Additionally, the cardiologist’s September 2016 letter does not support a higher rating for this period, because it stated that the Veteran’s disability was of the same severity only during the time period from October 16, 2014, to July 30, 2015. Thus, there is not sufficient evidence of record to show symptoms warranting a rating in excess of 10 percent during this period, even resolving any reasonable doubt in the Veteran’s favor. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.104, Diagnostic Code (DC) 7017. Concerning the period on and after October 16, 2014, the Board notes that a letter from the Veteran’s private cardiologist was submitted showing that on July 30, 2015, during an exercise stress test with a workload of less than 3 METs the Veteran experienced dyspnea, fatigue, and chest discomfort. A September 2016 letter from the same cardiologist stated that the Veteran’s disability was unchanged from October 16, 2014. The cardiologist is the Veteran’s treating physician and indicated knowledge of the Veteran’s history of heart disability. Additionally, the severity of the Veteran’s disability during this earlier period is corroborated by the July 30, 2015 exercise stress test administered a year later. The Veteran, too, offered that the reason there was not a stress test before July 30, 2015, was because at that time his condition was so severe that his doctor did not want him to participate in a physical stress test. The Board finds the cardiologist’s September 2016 letter competent and credible to opine on, and therefore probative of, the severity of the Veteran’s in the period at issue. 38 C.F.R. § 3.159(a)(1); Caluza v. Brown, 7 Vet. App. 498, 511 (1995).   The Board concludes that the evidence is sufficient to establish that the severity of the Veteran’s disability reported on July 30, 2015, extends back to October 16, 2014. Thus, the Board concludes that the severity of the Veteran’s symptoms from October 16, 2014, to July 29, 2015, meet the criteria for a 100-percent schedular rating, which is the highest schedular evaluation. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.104, DC 7017. K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Davis, Associate Counsel