Citation Nr: 21002894 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 17-19 196 DATE: January 19, 2021 ORDER Entitlement to an evaluation in excess of 30 percent for service-connected coronary artery disease (CAD) is denied. FINDING OF FACT The Veteran’s CAD has not been manifested by 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 which results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent to 50 percent. CONCLUSION OF LAW The criteria for an evaluation in excess of 30 percent for CAD have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.104, Diagnostic Code 7005. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from November 1970 to March 1972. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a December 2019 Board videoconference hearing. A transcript of that hearing has been associated with the claims file. This matter was previously remanded by the Board in February 2020 for development and has been returned for appellate review. 1. Entitlement to an evaluation in excess of 30 percent for service-connected CAD is denied. The Veteran filed an August 2014 claim for increased rating for his heart condition. He contends a higher rating is warranted because of his symptoms of shortness of breath, fatigue, chest pain, and dizzy spells. See December 2019 Board hearing transcript. The Veteran’s coronary artery disease (CAD) is currently assigned a 30 percent evaluation for the period on appeal under 38 C.F.R. § 4.104, Diagnostic Code (DC) 7005. Under DC 7005, status post coronary bypass surgery resulting in workload of greater than 7 METs but not greater than 10 METs that results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication is required, is rated 10 percent disabling. Status post coronary bypass surgery resulting in a workload of greater than 5 METs but not greater than 7 METs that results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray, is rated 30 percent disabling. A 60 percent rating contemplates 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 which results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent to 50 percent. A 100 percent rating is warranted for coronary artery disease resulting in chronic congestive heart failure; or, workload of 3 METS or less results in dyspnea, fatigue, angina, dizziness, or syncope; or, there is left ventricular dysfunction with an ejection fraction of less than 30 percent. Id. One MET (metabolic equivalent) 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). The October 2014 VA heart examination report revealed the Veteran had diagnosed CAD and has not had congestive heart failure. October 201 EKG results showed electronic ventricular pacemaker and echocardiogram in October 2014 showed left ventricular ejection fraction (LVEF) of 55 to 60 percent. Interview based METs testing revealed workload of greater than 5 METs but not greater than 7 METs with fatigue, angina, and dizziness. The September 2019 VA heart examination report indicated that cardiac stress testing is medically contraindicated for VA examination purposes as METS are easily estimated based on the Veteran’s known disease, level of physical activity and reported symptoms. The report noted that the Veteran had workload of between 7 to 10 METs based on objective evidence for his heart condition. The March 2020 VA heart examination report indicated the Veteran had diagnosed CAD and he reported ongoing symptoms that are progressively worse since onset, including sharp, shooting chest pain and weakness and if he picks up anything over 10 pounds, he has shortness of breath. The examiner endorsed the Veteran’s reports and indicated the Veteran’s current symptoms were shortness of breath, dizziness, intermittent swelling, and fatigue. The examiner indicated that exercise stress testing is not required as part of the Veteran’s current treatment plan and this test is not without significant risk. Interview based METs testing was performed and the results revealed workload of greater than 5 METs but not greater than 7 METs with dyspnea, fatigue, and dizziness. The examination report indicated the Veteran has not had congestive heart failure. Based on the evidence of record, the Board finds that the criteria for a rating in excess of 30 percent has not been met or more nearly approximated at any time during the appeal period as the evidence does not support that the Veteran has had 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 which results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent to 50 percent. Accordingly, the preponderance of the evidence is against the claim for a rating in excess of 30 percent for CAD; thus, the claim is denied. 38 U.S.C. § 5107(b). C. TRUEBA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Schick, 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.