Citation Nr: 20021432 Decision Date: 03/25/20 Archive Date: 03/25/20 DOCKET NO. 18-42 756A DATE: March 25, 2020 ORDER Entitlement to a rating in excess of 30 percent for coronary heart disease is denied. FINDING OF FACT The Veteran’s coronary heart disease did not lead to a METs score of 3-5 solely because of his heart disease, and his ejection fraction score was never below 50 percent. CONCLUSION OF LAW The criteria for entitlement to a rating in excess of 30 percent for coronary heart disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.104, Diagnostic Code 7005. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the United States Army from September 1965 to August 1968. This case comes before the Board of Veterans Appeals (Board) from a January 2019 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Unfortunately, the Veteran passed away in May 2018 during the pendency of the appeal. His widow was successfully substituted as the claimant for purposes of this appeal. 1. Entitlement to a rating in excess of 30 percent for coronary heart disease Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Ischemic heart disease is rated using the General Rating Formula for Diseases of the Heart found in 38 C.F.R. § 4.104, Diagnostic Code 7005. Under the General Rating Formula, a 30 percent rating is warranted for a workload of greater than 5 METs but not greater than 7 METs results 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 warranted when there has been more than one episode of acute congestive heart failure in the past year; or a workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricle dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent rating is warranted when there is evidence of chronic congestive heart failure; or a workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricle dysfunction with an ejection fraction of less than 30 percent. The Veteran’s post-service treatment records are associated with the claims file. Pursuant to this claim, he underwent a VA examination in August 2017. He was noted to have no congestive heart failure. His METs score was noted as 1-3. He underwent an interview-based test but was unable to undergo an exercise stress test due to his advanced rheumatoid arthritis and peripheral neuropathy. The examiner noted this METs score was solely attributable to his heart condition. In a September 2017 addendum opinion, that same examiner determined that the Veteran’s METs restriction was comorbid and noted he was unable to undergo exercise testing due to these comorbid conditions. The examiner determined it was not possible to accurately separate the impact of these other conditions from those of pure cardiac etiology. The examiner stated that the ejection fraction, rather than the estimated METs score, would most objectively quantify the ventricular function of the Veteran’s cardiac condition related to his ischemic heart disease for rating purposes. The Board determines that the evidence does not support a rating in excess of 30 percent at any point during the period on appeal. While the Board acknowledges the August 2017 VA examination found a METs score of 1-3, the examiner ultimately noted that this METs score could not be solely attributed to his cardiac conditions, and that it was impossible to separate the percentage that was attributable to his cardiac conditions rather than his comorbid conditions of rheumatoid arthritis and peripheral neuropathy. Additionally, the VA examiner, in his addendum opinion clarifying this point, specifically noted that the Veteran’s ejection fraction would provide a more accurate representation of his cardiac condition for rating purposes. With that noted, the Veteran’s ejection fraction was never shown to be below 50 percent such to warrant a rating of 60 percent or under 30 to warrant a 100 percent rating. Additionally, prior to his death, he was not shown to have either a single episode of acute congestive heart failure within the past year required for a 60 percent rating or chronic congestive heart failure to support a 100 percent rating. In arriving at the foregoing decisions, the Board has considered the doctrine of reasonable doubt. However, that doctrine is only invoked where there is an approximate balance of evidence which neither proves nor disproves a claim. In this case, the preponderance of the evidence is against the Veteran’s claims. Therefore, the doctrine of reasonable doubt is not applicable. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Caroline B. Fleming Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Stuedemann, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.