Citation Nr: 18157525 Decision Date: 12/13/18 Archive Date: 12/12/18 DOCKET NO. 16-53 307 DATE: December 13, 2018 ORDER The reduction in the rating for coronary artery disease from 100 percent to 60 percent was not proper, and the 100 percent disability rating is restored. FINDING OF FACT The evidence of record at the time of the December 2015 reduction in rating of coronary artery disease from 100 percent to 60 percent fails to show actual improvement in the disability. CONCLUSION OF LAW The December 2015 rating decision reducing the rating of coronary artery disease from 100 percent to 60 percent was improper, and the 100 percent disability evaluation is restored. 38 U.S.C. §§ 1155, 5112; 38 C.F.R. §§ 3.105(e), 3.344. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1965 to July 1967. This matter is before the Board of Veterans’ Appeals (Board) on appeal from December 2015 and April 2016 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). Coronary Artery Disease Rating The Veteran contends that he continues to meet the criteria for a 100 percent rating for coronary artery disease. In an August 2014 rating decision, the RO awarded service connection for coronary artery disease, and assigned a 100 percent evaluation, effective September 30, 2013. In a November 2014 rating decision, the RO continued the 100 percent evaluation and stated that there was a “likelihood of improvement” and that “the assigned evaluation [was] not considered permanent and is subject to further review.” In a July 2015 rating decision, the RO proposed to decrease the evaluation from 100 percent to 60 percent. In December 2015, the RO lowered the Veteran’s evaluation from 100 percent to 60 percent. In April 2016, the RO continued the evaluation at 60 percent. Where a reduction in an evaluation of a service-connected disability is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance must be prepared setting forth all material facts and reasons, and the RO must notify the veteran that he has 60 days to present additional evidence showing that compensation should be continued at the present level. The Veteran must also be informed that he may request a predetermination hearing, provided that the request is received by VA within 30 days from the date of the notice. If no additional evidence is received within the 60-day period and no hearing is requested, final rating action will be taken and the award will be reduced or discontinued effective the last day of the month in which a 60-day period from the date of notice to the veteran expires. 38 C.F.R. § 3.105(e). The record reflects that the RO satisfied these procedural requirements before issuing its final rating decision reducing the rating for coronary artery disease in December 2015. Generally, a veteran’s disability rating shall not be reduced unless an improvement in the disability is shown to have occurred. 38 U.S.C. § 1155, Greyzck v. West, 12 Vet. App. 288, 292 (1999). According to 38 C.F.R. § 3.344(c), where a rating or ratings have been in effect for less than five years, as here, reexaminations disclosing improvement, physical or mental, in the disability will warrant reduction in rating. 38 C.F.R. § 3.344(c); see also Brown v. Brown, 5 Vet. App. 413, 417 (1993). Additionally, in any rating reduction case, not only must it be determined that an improvement in a disability has actually occurred, but that such improvement reflects improvement in ability to function under ordinary conditions of life and work. Brown, 5 Vet. App. at 420-21; see 38 C.F.R. §§ 4.2, 4.10. In this case, the Veteran’s service-connected coronary artery disease is rated under Diagnostic Code (DC) 7005. Under DC 7005, a 10 percent rating is warranted when ischemic heart disease results in a workload of greater than 7 METs, but not greater than 10 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; when continuous medication is required. A 30 percent rating is warranted where ischemic heart disease results in 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 rating is assigned when a Veteran had more than one episode of congestive heart failure within the past year, or; where a workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; where there is left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A rating of 100 percent is assigned for 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, Diagnostic Code 7005. The Veteran’s coronary artery disease has been evaluated based on METs testing, which assesses 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 of METs by exercise testing 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). The record reflects that the Veteran has not shown actual improvement in METs testing during the period under consideration. In an October 2013 VA 21-0960A-1 Form, Ischemic Heart Disease Disability Benefits Questionnaire, the Veteran’s physician noted that the METs level was consistent with 1 to 3 METs before experiencing dyspnea. Based upon these results, the RO assigned the original 100 percent rating for the Veteran’s coronary artery disease. The Veteran’s METs testing results thereafter show mixed results. VA examinations from September 2014 and June 2015 show that the Veteran experienced dyspnea between 3 to 5 METs. However, a private medical examination in September 2015 reflected dyspnea from 1 to 3 METs. The Board assigns equal probative value to all three results, as each appears to adequately assess the Veteran’s coronary artery disease at the time each test was administered. This evidence reflects fluctuating METs test results during this time period. Such fluctuating results do not reflect that there was an actual improvement in the condition, particularly regarding whether it reflects an improvement in the Veteran’s ability to function under the ordinary conditions of life and work. In fact, the most recent September 2015 METs test results show that the Veteran’s METs results had declined to 1 to 3 METs. In reaching this decision, the Board acknowledges that the Veteran has undergone additional METs testing since the reduction, and pertinent post-reduction evidence must also be considered. See Dofflemeyer v. Derwinski, 2 Vet. App. 277 (1992). Specifically, a May 2017 VA examination showed that the Veteran experienced dyspnea and fatigue between 3 to 5 METs. A single test result may be indicative of an actual improvement in some circumstances; however, the Veteran reported in his VA Form 21-0958, Notice of Disagreement, that his “condition has not improved in any way” since the original 100 percent assignment. While the Veteran is not competent to identify the precise number of METs that proper medical testing would provide, he is competent to report the extent of his symptomology. In this case, the Veteran is competent to state that he is still experiencing the same level of symptoms after engaging in the same activities. The preponderance of the post-reduction evidence, therefore, does not establish an actual improvement in the Veteran’s condition under the ordinary conditions of life and work. Based on the above, the Board cannot conclude that the weight of the evidence shows improvement that is reasonably certain to be maintained under the ordinary conditions of life and work. 38 C.F.R. § 3.344; Brown, 5 Vet. App. at 413. Therefore, the Board finds that the reduction from 100 percent to 60 percent for coronary artery disease was improper. Accordingly, the 100 percent rating for coronary artery disease is restored. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. H. White, Associate Counsel