Citation Nr: 18157160 Decision Date: 12/13/18 Archive Date: 12/11/18 DOCKET NO. 16-56 948 DATE: December 13, 2018 ORDER Entitlement to an initial rating in excess of 60 percent for coronary artery disease, claimed as a heart condition, is denied. FINDING OF FACT Throughout the course of the appeal, the Veteran’s coronary artery disease was characterized by left ventricular dysfunction with an ejection fraction of 39 percent or greater, and a workload greater than 3 METs but not greater than 5 METs, resulting in dyspnea, dizziness, and fatigue. CONCLUSION OF LAW The criteria for a rating in excess of 60 percent for coronary artery disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.104, Diagnostic Code (DC) 7005. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army from March 1969 to March 1971, including a tour of duty in the Republic of Vietnam. Under 38 C.F.R. § 19.9 (b), the Board shall refer to the Agency of Original Jurisdiction (AOJ) for appropriate consideration and handling in the first instance all claims reasonably raised by the record that have not been initially adjudicated by the AOJ, except for claims over which the Board had original jurisdiction. The issue of entitlement to service connection for peripheral vascular disease has been raised, specifically in the Notice of Disagreement submitted in June 2016 and the VA Form 9 submitted in November 2016, but has not been adjudicated by the AOJ. Therefore, the Board does not have jurisdiction and refers the matter to the AOJ for appropriate action. Increased Rating Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. While the Board typically considers only those factors contained wholly in the rating criteria, it is appropriate to consider factors outside the specific rating criteria when appropriate in order to best determine the level of occupational and social impairment. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Where evidence indicates that the degree of disability increased or decreased during appeal period following the assignment of the initial rating, “staged” ratings may be assigned for separate periods of time based on facts found. Fenderson v. West, 12 Vet. App. 119, 126 (1999). The analysis in the following decision is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, where the evidence contains factual findings that show a change in the severity of symptoms during the course of the rating period on appeal, assignment of staged ratings would be permissible. Hart v. Mansfield, 21 Vet. App. 505 (2007). Coronary Artery Disease In a September 2015 rating decision, the Veteran was granted service connection for coronary artery disease with a 60 percent rating. However, in July 2016, he submitted a Notice of Disagreement indicating that he sought an increase in his rating. The Veteran currently receives a 60 percent disability rating for his coronary artery disease. Under Diagnostic Code 7005, a 60 percent rating is assigned for: • more than one episode of acute congestive heart failure in the past year, or; • workload of greater than 3 Metabolic Equivalent of Task (METs) but not greater than 5 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; • left ventricular dysfunction with an ejection fraction of 30 to 50 percent. 38 C.F.R. § 4.104, DC 7005. Metabolic Equivalent of Task, or MET, represents a physiological measure used to determine what activity is appropriate for a person. An activity level of greater than 3 METs but not greater than 5 METs is consistent with light yard work such as weeding, mowing the lawn using a power mower, and brisk walking. In order to warrant the next higher 100 percent disability rating, the evidence must show: • 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, DC 7005. An activity level of 3 METs or less is consistent with activities such as eating, dressing, taking a shower, and slow walking. Based on the evidence of record, a rating in excess of 60 percent is not warranted for the Veteran’s coronary artery disease. In an August 2015 VA examination, the examiner found the Veteran’s ejection fraction to be 40 percent and found evidence of cardiac hypertrophy on an echocardiogram. The examiner also found that the Veteran did not have a history of congestive heart failure. The examiner opined that that the Veteran functioned between 3 and 5 METs activity levels. The examiner noted that the Veteran experienced moderate functional impairment, but maintained semi-retired work as a golf course ranger, for which he uses a golf cart. Therefore, based on the assessment of the VA examiner, the Veteran’s symptoms do not warrant a rating in excess of 60 percent. Similarly, in a review of the Veteran’s medical treatment records throughout the period on appeal, the Veteran’s coronary artery disease symptoms remain consistent with a 60 percent disability rating. In the VA treatment records from December 2014, the Veteran reported that he experienced no dyspnea, angina, lightheadedness, or dizziness. In the November 2015 records, the Veteran reported some chest tightness but not pain, and there was no evidence of dyspnea, lightheadedness, or dizziness. The March 2016 records show an ejection fraction of 45 percent and 39 percent at stress and rest respectively. In the May 2016 records, the Veteran’s ejection fraction was between 40 to 45 percent. He reported some dyspnea when cold outside, and denied angina and syncope. Additionally, in the August and September 2016 records, the Veteran reported no dyspnea, angina, lightheadedness, or dizziness. Thus, none of the reported symptoms in these treatment records support a rating in excess of 60 percent. There is no evidence in the record that the Veteran’s symptoms of coronary artery disease meet the rating criteria required for a rating of 100 percent. The Board finds that the VA examination and VA treatment records show that the Veteran does not have chronic congestive heart failure, he has never functioned at a workload of 3 METs or less, and that his ejection fraction was never less than 30 percent. In considering the appropriate disability rating, the Board has also considered the Veteran's statements that his coronary artery disease is worse than the rating he currently receives. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. While the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his heart disorder according to the appropriate diagnostic codes. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify"). On the other hand, such competent evidence concerning the nature and extent of the Veteran's coronary artery disease has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports) directly address the criteria under which these disabilities are evaluated.   Therefore, a rating in excess of 60 percent for coronary artery disease, claimed as a heart condition, is denied. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Page-Nelson, Associate Counsel