Citation Nr: 21004563 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 18-07 625 DATE: January 27, 2021 ORDER Entitlement to an initial evaluation of 30 percent for atrial fibrillation is granted. FINDING OF FACT The service-connected atrial fibrillation results in more than 4 episodes of arrhythmia per year verified by electrocardiogram and Holter monitor. CONCLUSION OF LAW The criteria for an initial 30 percent evaluation for atrial fibrillation have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.100, 4.104, Diagnostic Code (DC) 7010.   REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably on active duty in the U.S. Air Force from November 1988 to November 1992. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a December 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ) in August 2020. The Board finds that all requirements for hearings have been met. 38 C.F.R. § 3.103 (c)(2); Bryant v. Shinseki, 23 Vet. App. 488 (2010). The Veteran has filed claims of secondary service connection for deep vein thrombosis and pulmonary embolism as secondary to the service-connected atrial fibrillation, and it appears the RO is undertaking appropriate development on those claims. See May 2020 claim and notification letter. Thus, those issues are not specifically referred to the RO herein. The Board is fully granting the Veteran’s increased rating claim and any prior duty to assist errors are moot. 1. Entitlement to an initial evaluation higher than 10 percent for atrial fibrillation The Veteran seeks a 30 percent initial evaluation for service-connected atrial fibrillation. See October 2017 notice of disagreement. 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 (2019). 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 (2019). 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 (2019). 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 (2019). 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 (2019). 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 a claim for an increased initial evaluation, the relevant time period is from the date of the claim. Moore v. Nicholson, 21 Vet. App. 211, 215 (2007), rev’d in irrelevant part, Moore v. Shinseki, 555 F.3d 1369 (2009). The service-connected atrial fibrillation is rated at DC 7010 for supraventricular arrhythmias at 38 C.F.R. § 4.104. Under DC 7010, a 10 percent evaluation is assigned for permanent atrial fibrillation (lone atrial fibrillation), or; one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor. A maximum 30 percent evaluation is assigned for paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by ECG or Holter monitor. The Veteran underwent a telephonic interview VA examination in December 2016. The 2016 VA examiner documented the Veteran had short episodes of arrhythmia in service that had worsened over the years and developed into overt atrial fibrillation. Based on interview of the Veteran and review of a May 2015 EKG, the examiner documented the Veteran had cardiac arrhythmia/atrial fibrillation with more than 4 episodes of atrial fibrillation documented per EKG. During severe episodes of palpations, the Veteran had to lie down. Private medical records document that in January 2017 the Veteran complained of heart palpitations several times per day. A February 2017 48-hour Holter monitor study showed rare isolated premature ventricular ectopics (at least 2) and premature supraventicular ectopics (at least 2) and 1 episode of atrial tachycardia. Overall, the 2017 Holter monitor study documented at least 5 events in a 48-hour period. Atrial fibrillation was confirmed again on EKG in November 2018 and sinus tachycardia was confirmed on EKG in January 2019. At the August 2020 hearing, the Veteran described symptoms of lightheadedness and fatigue that required him to lie down. He described a feeling of a fluttering in his chest and being afraid he would lose consciousness. He reported those episodes could occur 25 to 30 times on a bad day.   Here, there is medical and lay evidence of more than 4 episodes of arrhythmia per year in the setting of atrial fibrillation, with more than 4 events confirmed by Holter monitor study. See February 2017 private treatment notes; see August 2020 hearing testimony. Thus, the criteria for an initial 30 percent evaluation are met and the claim is granted. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Smith, 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.