Citation Nr: 21062541 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 14-00 674 DATE: October 7, 2021 ORDER Entitlement to an initial rating in excess of 10 percent for Wolff-Parkinson-White syndrome is denied. FINDING OF FACT The Veteran's Wolff-Parkinson-White syndrome has been manifested by no worse than one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia. CONCLUSION OF LAW The criteria for entitlement to an initial rating in excess of 10 percent for Wolff-Parkinson-White syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.104, Diagnostic Code 7010-7011. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1971 to September 1974. The Board remanded this case in July 2016. In that remand, the Board noted that the Veteran had not appeared for a scheduled Board hearing, but that notice for that hearing had been returned as undeliverable. The Board therefore directed the agency of original jurisdiction (AOJ) to verify the Veteran's address, schedule the Veteran for a Board hearing, and notify the Veteran of the scheduled hearing at his current address. Pursuant to the remand, the AOJ obtained the Veteran's current address, scheduled the Veteran for a Board hearing, and notified the Veteran and his representative of that scheduled hearing in July 2021. Accordingly, the Board finds that VA at least substantially complied with the July 2016 remand. See 38 U.S.C. § 5103A(b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). The Veteran did not appear for the Board hearing. The letter informing the Veteran of that hearing was sent to his last known address and was not returned as undeliverable. Furthermore, neither the Veteran nor his representative has provided an explanation as to why he did not appear for the hearing. Accordingly, the hearing request is considered withdrawn. See 38 C.F.R. § 20.704(d). In the substantive appeal for this case, the Veteran's representative stated that the Veteran "has been unable to work for the past two years due to his heart issues." However, in correspondence dated in January 2015, the Veteran's representative clarified that the "Veteran is not submitting or requesting a claim for individual unemployability." Based on the January 2015 correspondence, the Board concludes that the issue of entitlement to a total disability rating due to individual unemployability has not been raised as part of the increased rating issue on appeal. Neither the Veteran nor his representative has raised any issues with regard to the duty to notify or duty to assist as they pertain to the issue denied in this decision. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issue denied in this decision. The Veteran should not assume that evidence that is not explicitly discussed in the decision has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). Entitlement to an initial rating in excess of 10 percent for Wolff-Parkinson-White syndrome The Veteran seeks a higher initial rating for Wolff-Parkinson-White syndrome. The applicable rating period is from July 27, 2012, the effective date for the award of service connection for that disability, through the present. See 38 C.F.R. § 3.400. He contends that an initial rating of 100 percent is warranted for the disability because he has had two heart attacks that he believes are related to his service-connected Wolff-Parkinson-White syndrome. Disability ratings are determined by the application of VA's Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). The Veteran's Wolff-Parkinson-White syndrome is currently rated at 10 percent under 38 C.F.R. § 4.104, Diagnostic Code 7010-7011. A hyphenated diagnostic code is used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned. The additional diagnostic code is shown after the hyphen. In this case, rating the Veteran's service-connected Wolff-Parkinson-White syndrome under Diagnostic Code 7010, which pertains to supraventricular arrythmias, requires the use of Diagnostic Code 7011, which pertains to ventricular arrhythmias (sustained). Under Diagnostic Code 7010, a 10 percent rating is warranted when there is 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 30 percent rating is warranted when there is paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by ECG or Holter monitor. In relevant part, under Diagnostic Code 7011, a 30 percent rating is warranted when a workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; there is evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. A 60 percent rating is warranted when there is 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; there is left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent rating is warranted when there is chronic congestive heart failure, or; a 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. A 100 percent rating is also warranted for indefinite period from the date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia, or; for an indefinite period from the date of hospital admission for ventricular aneurysmectomy, or; with an automatic implantable Cardioverter-Defibrillator (AICD) in place. One metabolic equivalent (MET) 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. 38 C.F.R. § 4.104, Note (2). When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing 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. Id. Turning to the evidence of record, the Veteran's medical treatment records show that he was admitted in October 2012 for chest pain and irregular tachycardia consistent with atrial fibrillation. He underwent ablation therapy for the arrhythmia and was treated for a myocardial infarction. During the admission, he reported that he was diagnosed with Wolff-Parkinson-White syndrome at age 22 and that his last severe episode was approximately five years prior. At the time of discharge, he was considered stable. In November 2012, it was noted that the Veteran's Wolff-Parkinson-White syndrome "should be resolved with [the] ablation" that was performed in October 2012. In May 2013, the Veteran was admitted for myocardial infarction and underwent a coronary arteriogram with stent placement. During that admission, his heart rate and rhythm were normal without murmurs or gallops. In September 2013, he reported that he had two episodes of chest pain over the prior month or two, but that both episodes resolved with nitroglycerin. On examination, he had a normal heart rate and rhythm, normal heart sounds, and no heart murmur. He was determined to be stable with regard to his coronary artery disease. In addition, there was no evidence of decompensated heart failure or recurrent arrhythmia. At a January 2013 VA heart conditions examination, the Veteran reported a history of supraventricular tachycardia episodes every few months that would usually stop with laying down and breathing deeply, but that occasionally required visits to the emergency room for cardioversion. He also reported the October 2012 myocardial infarction and treatment with cardiac ablation for atrial fibrillation. He reported that he had had no episodes of atrial fibrillation or supraventricular tachycardia since the ablation. The examiner diagnosed the Veteran with coronary artery disease and Wolff-Parkinson-White syndrome with arrythmias. She noted the Veteran's history of myocardial infarction and that the Veteran was on continuous medical for the infarction and for atrial fibrillation. She indicated that the Veteran had intermittent paroxysmal episodes of atrial fibrillation and supraventricular tachycardia one to four times in the prior 12 months. She also indicated that the Veteran had a METs workload capacity of greater than 5 but not greater than 7. However, she stated that the Veteran's METs limitations are due to his myocardial infarction and not his arrhythmia. She also explained that the Veteran's myocardial infarction is secondary to his coronary artery disease and is not related to his Wolff-Parkinson-White syndrome because coronary artery disease and Wolff-Parkinson-White syndrome are separate unrelated conditions and Wolff-Parkinson-White syndrome does not predispose one to coronary artery disease or myocardial infarction. Based on the relevant evidence of record, the Board concludes that the criteria for an initial rating in excess of 10 percent for Wolff-Parkinson-White syndrome have not been met. The medical treatment records shows that the Veteran had an episode of atrial fibrillation in October 2012. At that time, the Veteran reported that the most recent previous severe episode of atrial fibrillation had been five years prior. Subsequent records do not show that the Veteran experienced further episodes of supraventricular arrhythmias. The medical treatment records are consistent with the January 2013 VA examiner's finding that the Veteran had between one and four episodes of intermittent paroxysmal episodes of atrial fibrillation and supraventricular tachycardia in the prior one-year period. Accordingly, the Veteran has not had more than four episodes of paroxysmal atrial fibrillation or other supraventricular tachycardia in a one-year period at any time during the relevant period, as is required for a higher rating under Diagnostic Code 7010. The Board acknowledges that the Veteran has had other cardiovascular signs and symptoms, to include myocardial infarction and a workload of greater than 5 METs but not greater than 7 METs, that could warrant a rating in excess of 10 percent under Diagnostic Code 7011 and other relevant diagnostic codes. However, the January 2013 VA examiner explained that those signs and symptoms are attributable to the Veteran's nonservice-connected coronary artery disease and not to his service-connected Wolff-Parkinson-White syndrome. The Board affords the examiner's statements in that regard probative weight because the examiner is a medical professional with the knowledge and expertise to differentiate the Veteran's signs and symptoms between his multiple cardiovascular diagnoses. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Prejean v. West, 13 Vet. App. 444 (2000). Therefore, those signs and symptom are not for consideration in rating the Veteran's service-connected Wolff-Parkinson-White syndrome. The Board acknowledges the Veteran's assertions that his myocardial infarctions are due to his service-connected disability and should be considered in rating that disability. However, he has not been shown to possess the medical knowledge and expertise to differentiate his various cardiovascular signs and symptoms between his multiple diagnosed cardiovascular conditions. Therefore, his statements are not considered competent. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Consequently, his statements in that regard are not probative and do not weigh against the probative value of the January 2013 VA examiner's opinions. Neither the Veteran nor his representative has raised any other issues with regard to the rating for the service-connected Wolff-Parkinson-White syndrome, nor have any other such issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017). The Board therefore finds that the criteria for entitlement to an initial rating in excess of 10 percent for Wolff-Parkinson-White syndrome have not been met at any time during the rating period. Accordingly, there is no basis for staged rating of the Veteran's Wolff-Parkinson-White syndrome pursuant to Fenderson, 12 Vet. App. at 126-27. As the preponderance of the evidence is against the assignment of a higher initial rating, the doctrine of reasonable doubt is not for application, and the appeal must be denied. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. J. Anthony, 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.