Citation Nr: 21004881 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 18-22 921A DATE: January 28, 2021 ORDER Entitlement to a 100 percent disability rating for service-connected coronary artery disease (CAD) is denied. REMANDED The claim of entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDING OF FACT The Veteran’s CAD has not resulted in chronic congestive heart failure, workload of 3 metabolic equivalents (METs) or less, or left ventricular dysfunction with an ejection fraction of less than 30 percent. CONCLUSION OF LAW The criteria for a rating higher than 60 percent for service-connected CAD are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.104. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1967 to July 1970. This matter comes to the Board of Veterans’ Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Board remanded this matter for additional medical inquiry. The case is again before the Board for appellate review. Increased Rating The Veteran has been service connected for CAD since he filed his claim of entitlement to service connection on March 2, 2015. The disability has been rated as 60 percent disabling since then. He asserts entitlement to the next-highest and maximum rating of 100 percent. Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes (DCs). 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When 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. “Staged” ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). The Veteran’s heart disorder is rated under Diagnostic Code (DC) 7005 of 38 C.F.R. § 4.104. The rating formula under DC 7005 incorporates objective measurements of the level of physical activity, expressed numerically in METs, at which cardiac symptoms develop. MET (one metabolic equivalent) 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. See 38 C.F.R. § 4.104, Note 2. Ratings of 10, 30, 60, and 100 percent are authorized under DC 7005. The Board will limit its analysis to whether a 100 percent rating – the only rating higher than the assigned 60 percent rating – has been warranted during the appeal period. 38 C.F.R. § 3.400. A 100 percent rating is warranted under DC 7005 for chronic congestive heart failure, workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular dysfunction with an ejection fraction of less than 30 percent. 38 C.F.R. § 4.104. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on the merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Symptomatology attributed to a nonservice-connected disability cannot be differentiated from symptomatology attributed to a service-connected disability unless medical evidence does so. Mittleider v. West, 11 Vet. App. 181, 182 (1998) (per curiam). In the absence of such medical evidence, the reasonable doubt doctrine dictates that all symptoms be attributed to the service-connected disability. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The evidence in this matter consists of lay assertions, VA and private treatment records, and VA compensation examination reports dated in October 2015, August 2017, and December 2019. This evidence demonstrates that the criteria for a 100 percent rating has not been met at any time during the appeal period. None of the evidence indicates the presence of chronic congestive heart failure, a workload restricted to 3 METs or less, or left ventricular dysfunction with an ejection fraction of less than 30 percent. 38 C.F.R. § 4.104, Diagnostic Code 7005. Inasmuch as the October 2015 and August 2017 VA reports indicated METs near 3 (i.e., greater than 3-5), the Board sought in its May 2019 remand additional medical inquiry in an effort to determine whether METs could be below 3. In the December 2019 report, the examiner found greater than 5-7 METs based on his interview and on exercise stress testing during the appeal period. Further, as with the August 2017 examiner, the December 2019 examiner found that non-cardiac factors such as deconditioning contributed to the reduced METs. The examiner also noted private medical evidence indicating that the stress test showed normal results for the heart. In sum, the rating criteria for the assignment of a 100 percent rating for CAD under DC 7005 of 38 C.F.R. § 4.104 are not met. The lay evidence in support of the claim has been considered, but it is not probative on the question of whether the criteria for a 100 percent rating under DC 7005 have been met. A lay person is competent to report observable symptoms such as dyspnea, fatigue, angina, dizziness, or syncope. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, a lay person such as the Veteran is not competent to determine medical issues such as diagnosis and etiology, particularly issues involving internal pathologies such as heart disease and its effects. The degree to which CAD affects the heart is a medical issue. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). On the complex question before the Board, involving determinations regarding congestive heart failure, measuring METs, and ejection fraction scores, the Veteran’s lay assertions are outweighed by the medical evidence. As the preponderance of the evidence is against the claim of entitlement to a higher initial rating for CAD, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102, 4.3. REMAND A remand is warranted for the claim of entitlement to a TDIU because the record indicates that development into the claim is ongoing. In July 2020, the Veteran filed VA Forms 21-8940, Application for Increased Compensation Based on Unemployability, and 21-4192, Request for Employment Information in Connection with Claim for Disability Benefits. In response, the RO requested relevant information from previous employers. The record indicates that the RO is awaiting their response. The matter is REMANDED for the following action: Once development for the TDIU claim has been completed, readjudicate the claim and return to the Board if in order. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Christopher McEntee, 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.