Citation Nr: 21072165 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 15-35 246A DATE: December 2, 2021 ORDER Entitlement to a rating in excess of 30 percent for coronary artery disease prior to May 26, 2021 is denied. FINDING OF FACT Prior to May 26, 2021, the Veteran's coronary artery disease was not productive of congestive heart failure, left ventricular dysfunction with an ejection fraction of 50 percent or less, or a workload of 5 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope. CONCLUSION OF LAW The criteria for entitlement to a rating in excess of 30 percent for coronary artery disease prior to May 26, 2021 have not been met. 38 U.S.C. § 1155, 38 C.F.R. § 4.104, Diagnostic Code (DC) 7005. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1965 to May 1969. The Veteran filed a claim for an increased rating for coronary artery disease (CAD) in August 2014. His existing disability rating for CAD was at 30 percent. In a February 2015 rating decision, the Department of Veterans Affairs (VA) regional office (RO) denied the claim for increase and continued the evaluation of CAD at 30 percent. The Veteran timely appealed. This claim was previously remanded by the Board of Veterans Appeals (Board) for further evidentiary development, in August 2018 and November 2020. The November 2020 remand required the RO to obtain an echocardiogram along with a new examination. The RO obtained an echocardiogram and examination as directed, the claim was readjudicated in an August 2021 rating decision, and a supplemental statement of the case was issued. As such, the Board concludes its remand orders have been substantially complied with. See Stegall v. West, 11 Vet. App. 268 (1998). In the August 2021 rating decision, the RO assigned a 100 percent rating for CAD with an effective date of May 26, 2021the date of the VA examinationand denied a rating in excess of 30 percent prior to that date. SMC(s) at the housebound rate was also awarded effective May 26, 2021 due to the Veteran meeting the statutory criteria of having one disability rated as total and additional service-connected disabilities independently ratable at 60 percent or more. The Veteran, through his representative, indicated disagreement with the RO's denial of a rating in excess of 30 percent prior to May 26, 2021. Therefore, that issue remains on appeal. Entitlement to a rating in excess of 30 percent for coronary artery disease prior to May 26, 2021 The Veteran contends he is entitled to a rating in excess of 30 percent for CAD prior to May 26, 2021. Disability ratings are determined by comparing a Veteran's present symptoms with criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. The Veteran's increased rating claim for CAD is evaluated under Diagnostic Code 7005. Under this code, a 100 percent rating requires chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent. A 60 percent rating requires 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 30 percent rating requires 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. One MET, or 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. This is commonly referred to as an interview-based METs test. A VA records review examination in February 2015 noted that VA records reflected the Veteran had an interview-based METs test in October 2014, at which he denied experiencing the symptoms listed above with any level of physical activity. The Veteran was noted to require continuous medication for control of his heart condition. Although the Board ultimately found the February 2015 examination inadequate for its failure to obtain an in-person or telehealth interview examination to assess the current severity of the Veteran's condition, the Board notes that the Veteran's reported symptomatology two months after filing his claim for increase is competent, probative, and relevant to the Board's determination. The Veteran was afforded another VA examination in October 2019. At this examination, he reported he was a "gym rat," going to the gym for exercise six days a week and participating in spinning classes, Zumba, and weightlifting. The Veteran reported feeling well while exercising, with no chest pain or shortness of breath even when performing high intensity exercise. The examination reflects that an echocardiogram was completed in April 2019, with an LVEF at 55 percent. The examination further notes that an exercise stress test was also conducted in April 2019, during which the Veteran performed at a METs level of 10.5. At the October 2019 examination, an interview-based METs test was conducted, which indicated a METs level of 5-7 METs, after which the Veteran reported experiencing fatigue and dizziness. Although the Board ultimately found this examination inadequate due to its reliance on the April 2019 echocardiogram and failure to obtain a new echocardiogram, the Veteran's reported statements regarding his exercise habits and symptomatology are nevertheless competent, credible, and are given great weight. This workload of 5-7 METs is consistent with a 30 percent rating. Pursuant to the Board's most recent remand directive, the Veteran was afforded a VA examination in May 2021. An echocardiogram was also completed, in April 2021, which determined the Veteran's LVEF was 59 percent. It also noted basal to mid inferior wall hypokinesis consistent with prior history of infarction; no change was noted from the last echocardiogram. At the examination, the Veteran reported shortness of breath, decreased activity, and a need for increased rest periods. He reported fatiguing easily with activity, stating that even watering his plants around the house necessitated stopping and resting. The examiner noted the Veteran had shortness of breath with minimal exertion. The examiner evaluated the Veteran as having a maximum workload of 1-3 METs, which was the basis for the RO ultimately assigning a 100 percent rating. VA treatment records note that in February 2018, the Veteran reported regular exercise at the gym. In October 2018, he reported exercising six days per week with aerobics and strength training. In December 2020, the Veteran reported less frequent gym exercise due to COVID-19. His CAD was noted to be asymptomatic. In June 2021, he reported wanting to get back to the gym. Private medical treatment records reflect the Veteran reported exercising in May 2020. In August 2020, he reported trying to walk four miles per day. No new symptoms due to CAD were noted. His provider recommended adding "brisk" walking intervals to his daily walks. By July 2021, he reported not exercising at all. After reviewing the evidence of record, the Board finds that a rating in excess of 30 percent is not warranted for coronary artery disease for the period prior to May 26, 2021. Higher ratings are available for congestive heart failure, LVEF of 50 percent or less, or a workload of 5 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope. The evidence weighs against symptoms of such severity. For the period under consideration, the Veteran has not been noted to have congestive heart failure, his LVEF has always been within a normal range, i.e., it is not low enough to warrant a 60 percent or higher rating, and, prior to the May 2021 examination, all METs testing, whether interview-based or an exercise stress test, have resulted in METs workloads that are commensurate with a thirty percent rating at most. The Veteran has not presented, and the Board has not seen, any evidence that would enable the Board to determine any ascertainable increase in the severity of his CAD prior to the May 2021 VA examination. See 38 C.F.R. § 3.400(o). In sum, the Board finds that the evidence does not support an evaluation for CAD in excess of 30 percent prior to May 26, 2021. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not for application and the claim for increase prior to that date is denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Medley, 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.