Citation Nr: 21068517 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 16-42 427 DATE: November 10, 2021 ORDER Restoration of a 60 percent rating for coronary artery disease (CAD) from April 1, 2014 is granted. FINDING OF FACT The rating reduction for CAD from 60 percent to 10 percent was not based on adequate and thorough examinations. CONCLUSION OF LAW The criteria for restoration of a 60 percent rating for CAD are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.105, 3.344, 4.104, Diagnostic Code (DC) 7005. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the U.S. Army from May 1968 to June 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision. The Veteran testified at a Board hearing in December 2020 before a Veterans Law Judge who is no longer at the Board. In October 2021, the Veteran was notified that he may testify at an additional hearing if he so chose. To date, however, he has not responded to that letter. Historically, the Veteran had a 60 percent rating for his CAD under 38 C.F.R. § 4.104, DC 7005 in effect from April 11, 2011. In a September 2013 rating decision, the Agency of Original Jurisdiction (AOJ) proposed to reduce that rating to 10 percent. That reduction was implemented in a January 2014 rating decision and made effective from April 1, 2014. The Veteran's 60 percent rating for CAD was in effect for a period of less than five years. Therefore, the specific protocols for reducing protected ratings are inapplicable to his claim for restoration that rating. See 38 C.F.R. § 3.344(a), (b). Reexaminations disclosing improvement in this disability will warrant reduction in rating. 38 C.F.R. § 3.344(c). However, VA must determine (1) whether the evidence reflects an actual change in the disability based upon review of the entire recorded history of the condition; (2) whether the examination reports reflecting such change are based upon thorough examinations; and (3) whether any improvement reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work. Murphy v. Shinseki, 26 Vet. App. 510, 516-17 (2014) (citing Brown v. Brown, 5 Vet. App. 413, 421 (1993)). For reference, DC 7005 provides for a 10 percent rating for workload of greater than 7 METs but not greater than 10 METs resulting in dyspnea (shortness of breath), fatigue, angina, dizziness, or syncope, or if continuous medication is required. A 30 percent rating is warranted for workload of greater than 5 METs but not greater than 7 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilation on electrocardiogram, echocardiogram, or x-ray. A 60 percent rating is warranted for 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 results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent rating is assigned for chronic congestive heart failure, or; 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. A May 2011 exercise test documented that the Veteran was capable of a workload of more than 7 METs. Later, the September 2013 rating decision proposing the reduced rating cited to a March 2013 VA opinion as a basis for the reduction. However, that opinion was based only on a review of the relevant records, without any in-person or telehealth examination of the Veteran. The examiner noted an August 2012 echocardiogram which showed a left ventricular ejection fraction of 50 to 55 percent, as well as a cardiology visit from earlier in March 2013 which showed stable cardiac symptoms without progression. The examiner concluded that the Veteran had not experienced any new cardiac events since his last examination, and therefore he would still be expected to be capable of a workload of more than 7 METs. Another VA opinion was obtained in December 2015. Again, the opinion did not include an in-person or telehealth examination of the Veteran. Based on the available treatment records, the examiner stated that a revised METs score was not necessary because there had been no interval change in the Veteran's condition since his last evaluation in 2013. Moreover, because the Veteran had unexplained syncope, tremor, chronic low back pain, and variety of other conditions, determining a METs score based solely on his cardiac function would be speculative. Finally, the Veteran was afforded a more complete VA examination in April 2021. That examination included an interview-based METs score of 1 to 3 and a finding of chronic congestive heart failure. He was subsequently assigned a 100 rating for his CAD based on those examination findings. In sum, the Veteran's rating reduction was based on a 2013 VA examination which did not measure his METs score through an actual exercise test or an interview-based test, and the subsequent examination in 2015 was similarly deficient. Indeed, the only measure of his METs workload capability after 2011 was the recent 2021 VA examination, which showed impairment consistent with a 100 percent rating. Because the examinations upon which the reduction was based were not thorough and adequate, the reduction was not proper, and restoration of the 60 percent rating is appropriate. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shamil Patel, 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.