Citation Nr: 18154438 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 15-36 327 DATE: November 29, 2018 ORDER A 30 percent rating for mitral valve prolapse (MVP), status post myocardial infarction with coronary artery disease (CAD), is granted from June 1, 2015. FINDING OF FACT The Veteran's MPV disorder results in METs (defined below) greater than 5 but less than 7. CONCLUSION OF LAW The criteria for a 30 percent rating for MPV with CAD have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R §§ 3.102, 3.159, 3.321, 3.326(a), 4.3, 4.7, 4.104, Diagnostic Code 7006. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1975 to June 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision of the Department of Veterans Affairs (VA). The Veteran testified before the undersigned in June 2018. For the Veteran's understanding, VA, in response to your claim in January 2012 and pursuant to 38 C.F.R § 4.30, increased your MVP as 100 percent disabling because of your myocardial infarction, effective November 26, 2011. This rating is, by regulation, temporary. VA has rated your MPV under 38 C.F.R § 4.30, Diagnostic Code 7006 which states that the 100 percent rating is warranted "during and for three months following myocardial infarction." Thus, VA did not follow its own regulations when it construed your case as a permanent reduction. Critically, VA should have ended your temporary rating on February 28, 2012, not May 31, 2015. Thus, you received 39 months of a temporary total rating to which you were not entitled. However, as VA has not attempted to reclaim the benefits paid during this time window, this decision will address the period from June 1, 2015. Issue: Entitlement to a rating greater than 10 percent for MVP from June 1, 2015 Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found in 38 C.F.R. Part 4. 38 U.S.C. § 1155. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, where the question for consideration is the propriety of the initial disability rating assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of a "staged rating" is required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). 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. 38 C.F.R. § 4.7. MPV From June 1, 2015, VA has rated the Veteran's MPV as 10 percent disabling under 38 C.F.R. § 4.104, Diagnostic Code 7006. Under Diagnostic Code 7006, a 10 percent evaluation is warranted for a workload of greater than 7 METs but not greater than 10 METs resulting in fatigue, angina, dizziness or syncope, or; continuous medication is required. A 30 percent evaluation is warranted for 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 dilatation on electrocardiogram, echocardiogram, or x-ray. A 60 percent evaluation 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 resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; for left ventricular dysfunction with an ejection fraction of 30 to 50 percent. The maximum scheduler rating of 100 percent is warranted for chronic congestive heart failure, or; when a workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; for left ventricular dysfunction with an ejection fraction of less than 30 percent. One MET is defined as the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs) and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. 38 C.F.R. § 4.104, Note (2). (Continued on the next page)   VA examined the Veteran in February 2017, and the Veteran has submitted private medical records, to include but not limited to, a July 2018 cardiac Disability Benefits Questionnaire (DBQ). The February 2017 examination reported two METs levels – one factoring in the knee condition requiring replacement and one without. The undersigned finds that the latter - a METs level of greater than 5 but less than 7 – is identical to the level the Veteran's cardiologist reported in the July 2018 DBQ and thus is most reflective of the Veteran's disability level. No medical records support a reduced METs level or left ventricular dysfunction with an ejection fraction of 30 to 50 percent, nor does the Veteran have congestive heart failure. Thus, the Veteran merits a 30 percent rating for his MPV. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Sopko, Counsel