Citation Nr: 18160141 Decision Date: 12/26/18 Archive Date: 12/26/18 DOCKET NO. 17-51 010 DATE: December 26, 2018 ORDER The 60 percent rating for coronary artery disease is restored, effective June 1, 2016. FINDINGS OF FACT 1. In January 2011, the Department of Veterans Affairs (VA) Regional Office (RO) in Portland, Oregon granted service connection and a 60 percent rating for coronary artery disease, effective August 31, 2010; the rating was based on the report of an October 2010 VA examination wherein an examiner estimated that a workload of 3 to 5 metabolic equivalents (METs) resulted in dyspnea, fatigue, angina, dizziness, or syncope. 2. The 60 percent rating for coronary artery disease was in effect for more than five years, until June 1, 2016, when the RO reduced the rating to 30 percent. 3. Resolving all reasonable doubt in the Veteran's favor, the evidence of record at the time of the reduction does not show that the Veteran’s coronary artery disease had improved to the point that he was better able to function under the ordinary conditions of life and work. CONCLUSION OF LAW The reduction in the evaluation for coronary artery disease from 60 to 30 percent was not proper. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.105, 3.344, 4.3, 4.104, Diagnostic Code 7005 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the U.S. Army from July 1965 to January 1993. His decorations include the Combat Infantryman Badge and Purple Heart. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a March 2016 rating decision issued by the RO in Portland, Oregon. Entitlement to restoration of a 60 percent rating for coronary artery disease. In January 2011, the RO in Portland, Oregon granted service connection and a 60 percent rating for coronary artery disease, effective August 31, 2010, under the provisions of 38 C.F.R. § 4.104, Diagnostic Code 7005. 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. The United States Court of Appeals for Veterans Claims (Court) has consistently held that when an RO reduces a Veteran’s disability rating without following the applicable regulations, the reduction is void ab initio. See Greyzck v. West, 12 Vet. App. 288, 292 (1999). Prior to reducing a Veteran’s disability rating, VA is required to comply with several regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect. See 38 C.F.R. §§ 4.1, 4.2, 4.10; see also Brown v. Brown, 5 Vet. App. 413, 420 (1993). These provisions impose a clear requirement that VA rating reductions be based upon review of the entire history of the Veteran’s disability. See Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Such review requires VA to ascertain, based upon the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations. Thus, in any rating-reduction case not only must it be determined that an improvement in a disability has occurred but also that that improvement reflects an improvement in the Veteran’s ability to function under the ordinary conditions of life and work. See Faust v. West, 13 Vet. App. 342, 350 (2000). Additional criteria governing certain rating reductions are found in 38 C.F.R. § 3.344. This regulation applies to ratings that have continued for long periods of time at the same level (five years or more). Brown, 5 Vet. App. at 418-419. The language of 38 C.F.R. § 3.344(a) specifically indicates that ratings for disabilities subject to episodic improvement, including arteriosclerotic heart disease, will not be based on any one examination, except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. In the present case, the Veteran’s 60 percent rating was in effect from August 31, 2010 to June 1, 2016—more than five years. Therefore, the provisions of 38 C.F.R. § 3.344 apply. Under 38 C.F.R. § 3.344(a), the RO must find the following: (1) based on a review of the entire record, the examination forming the basis for the reduction is full and complete, and at least as full and complete as the examination upon which the rating was originally based; (2) the record clearly reflects a finding of material improvement; and (3) it is reasonably certain that the material improvement found will be maintained under the ordinary conditions of life. See Kitchens v. Brown, 7 Vet. App. 320 (1995); Brown, 5 Vet. App. at 420. The burden of proof is on VA to establish that a reduction is warranted by the weight of the evidence. Id. Pursuant to Diagnostic Code 7005, a 10 percent rating is warranted for coronary artery disease when a workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope; or when continuous medication is required. A 30 percent rating is warranted when a workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope; or when there is evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or x-ray. A 60 percent rating is warranted if there has been 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. The highest 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. Id. 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. 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). In the Veteran’s case, the 60 percent rating assigned in January 2011 was based on the report of an October 2010 VA examination, wherein an examiner estimated that a workload of 3 to 5 metabolic equivalents (METs) resulted in dyspnea, fatigue, angina, dizziness, or syncope. The RO based its decision to reduce the Veteran’s rating on the results of a July 2015 VA examination report indicating the Veteran’s METs levels for coronary artery disease were 5 to 7. However, it is clear from the report that those figures, like the figures obtained in October 2010, were based on an estimate, and not exercise testing. Moreover, according to the statement of the case, a private examiner opined in January 2016 that it is not possible to determine to what degree the Veteran’s coronary artery disease is contributing to his limitation of METs due to multiple, non-cardiac factors. For his part, the Veteran has asserted that his condition has not improved. Based on all factors, and taking into account the provisions of 38 C.F.R. § 3.344(a), the Board is not persuaded that the greater weight of the evidence at the time of the reduction established that the Veteran’s coronary artery disease had improved to the point that he was better able to function under the ordinary conditions of life and work. The reduction was improper, and the 60 percent rating is restored, effective June 1, 2016. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD F. Lanton, Associate Counsel