Citation Nr: 21003255 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 16-33 994 DATE: January 21, 2021 ORDER Entitlement to a disability rating in excess of 30 percent from November 29, 2018 for ischemic heart disease, also claimed as coronary atherosclerosis, is denied. FINDING OF FACT 1. From November 29, 2018, the Veteran’s ischemic heart disease, also claimed as coronary atherosclerosis, manifested by a workload of greater than 5 METs but not greater than 7 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope. 2. From November 29, 2018, the Veteran’s ischemic heart disease, also claimed as coronary atherosclerosis, manifested by left ventricular dysfunction with an ejection fraction (LVEF) of 55 to 60 percent. CONCLUSION OF LAW From November 29, 2018, the criteria for a disability evaluation in excess of 30 percent for ischemic heart disease, also claimed as coronary atherosclerosis, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.104, Diagnostic Code 7005. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from January 1962 until his honorable retirement in September 1987. This appeal has been advanced on the Board’s docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.900(c). These matters come before the Board of Veterans’ Appeals (Board) on appeal from a December 2013 rating decision by the Decatur, Georgia Regional Office (RO) of the United States Department of Veterans Affairs (VA). In September 2019, the Veteran testified at a videoconference Board hearing before the undersigned Veterans Law Judge (VLJ), sitting at the RO in Atlanta, Georgia. A transcript of the hearing has been associated with the record on appeal. In November 2019, the Board remanded the case to the RO for further development. Specifically, the Board directed the RO to send the Veteran and his representative a Statement of the Case (SOC) that addresses the issue of entitlement to a disability rating in excess of 30 percent for ischemic heart disease also claimed as coronary atherosclerosis, from November 29, 2018 and that if the Veteran perfects an appeal by submitting a timely VA Form 9, the issue should be returned to the Board for further appellate consideration. In response, in July 2020, the RO issued a Supplemental Statement of the Case (SSOC). The Board finds that there has been substantial compliance with the Board’s previous remand directives regarding the issue(s) on appeal. Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 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 military 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. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where an appeal is based on an initial rating for a disability, however, evidence contemporaneous with the claim and the initial rating decision are most probative of the degree of disability existing when the initial rating was assigned and should be the evidence “used to decide whether an original rating on appeal was erroneous.” Fenderson v. West, 12 Vet. App. 119, 126 (1999). In either case, if later evidence indicates that the degree of disability increased or decreased following the assignment of the initial rating, staged ratings may be assigned for separate periods of time. Fenderson, 12 Vet. App. at 126; Hart v. Mansfield, 21 Vet. App. 505 (2007) (noting that staged ratings are appropriate whenever the factual findings show distinct time periods in which a disability exhibits symptoms that warrant different ratings). When adjudicating an increased rating claim, the relevant time period for consideration is the time period one year before the claim was filed. Hart, 21 Vet. App. at 509. 1. Entitlement to a disability rating in excess of 30 percent from November 29, 2018 for ischemic heart disease, also claimed as coronary atherosclerosis The Veteran asserts that he is entitled to a disability rating in excess of 30 percent for ischemic heart disease, also claimed as coronary atherosclerosis. Under Diagnostic Code 7005 (arteriosclerotic heart disease/coronary atherosclerosis), a 10 percent rating is assigned for a workload of greater than 7 METs but not greater than 10 METs which results in dyspnea, fatigue, angina, dizziness, or syncope, or continuous medication required. A 30 percent rating is assigned 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. Id. 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; LVEF of less than 30 percent to 50 percent. Id. A 100 percent rating is warranted for coronary atherosclerosis resulting in chronic congestive heart failure; or, workload of 3 METs or less which results in dyspnea, fatigue, angina, dizziness, or syncope; or, there is LVEF 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). Thus, for the higher, 60 percent disability rating, the evidence must show the severity of his disability approximates: 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; LVEF of less than 30 percent to 50 percent. The Board finds none of these are present or approximated. A November 2018 VA examination revealed that the Veteran has not had congestive heart failure; but does have cardiac arrhythmia, specifically more than four episodes of atrial fibrillation in the prior 12 months; interview-based METs of greater than 5 to 7; and LVEF of 55 to 60 percent. As no criteria for a higher evaluation is met, one is not warranted. Furthermore, the November 2018 VA examiner noted that the Veteran’s atrial fibrillation is less likely than not (less than 50 percent probability) incurred in or caused by the Veteran’s ischemic heart disease, also claimed as coronary atherosclerosis because although there is an association between the two, there is no causative relationship. The Board notes that the Veteran submitted private treatment records from SouthCoastHealth dated March 2016. However, the Veteran’s private treatment records do not reflect an increase in severity to the Veteran’s disabilities. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Deemer, 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.