Citation Nr: 21073237 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 17-25 179 DATE: December 7, 2021 ORDER As the reduction from 100 percent to 60 percent for service-connected coronary artery disease (CAD), effective February 1, 2016, was proper, the appeal is denied. FINDING OF FACT At the time of the November 2015 rating decision, which reduced the disability rating for service-connected CAD, the preponderance of the evidence showed improvement in the disability that actually reflected an improvement in the ability to function under the ordinary conditions of life and work. CONCLUSION OF LAW The reduction of the evaluation for service-connected CAD from 100 percent to 60 percent was proper. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.105(a), 3.344, 4.3, 4.104, Diagnostic Code 7005. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1966 to May 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Whether the reduction from 100 percent to 60 percent for service-connected CAD, effective February 1, 2016, was proper. The Veteran contends the reduction of his evaluation for service-connected CAD was improper because he has congestive heart failure. See Hearing Transcript (August 2021). The Veteran, through his representative, also asserted that the reduction was incorrect because the reduction was not based on METs as required by the relevant Diagnostic Code and because the examination used does not accurately reflect the level of the Veteran's functional impairment from CAD. See Hearing Transcript (August 2021). The Board finds that the reduction was proper as the preponderance of the evidence showed improvement in the Veteran's service-connected CAD that actually reflected an improvement in the ability to function under the ordinary conditions of life and work. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.105(a), 3.344, 4.3, 4.104, Diagnostic Code 7005. When determining whether a reduction was proper, there are two sequential questions that must be addressed. First, whether the agency of original jurisdiction (AOJ) satisfied the procedural requirements for a reduction, as set forth in 38 C.F.R. § 3.105. If so, the second question concerns whether the evidence shows an improvement in the severity of the service-connected disability, as defined in 38 C.F.R. § 3.344. With regard to the initial question, when a reduction in the evaluation of a service-connected disability is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. A veteran must be notified at his or her latest address of record of the contemplated action and furnished detailed reasons for the action. Additionally, a veteran must be given notice that he has (1) 60 days to present additional evidence to show that compensation payments should be continued at the present level, and (2) 30 days to request a predetermination hearing. 38 C.F.R. § 3.105(e), (i). If additional evidence is not received within that period, final rating action will be taken, and the award will be reduced or discontinued effective the last day of the month in which a 60-day period from the date of notice to a veteran of the final rating action expires. Also, if a predetermination hearing is not requested or if a veteran failed without good cause to report for a scheduled predetermination hearing, the final action will be based solely upon the evidence of record. If a reduction is then found warranted, the effective date of such reduction shall be the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final action expires. 38 C.F.R. § 3.105. The Board finds that the procedural requirements of § 3.105 were satisfied in this appeal. Notice of the proposed reduction was sent in a July 2015 letter that included a copy of the July 2015 rating decision among other things. See Rating Decision (July 2015); Correspondence (July 2015). The letter explained the effect the proposed reduction would have on the Veteran's combined disability evaluation and informed the Veteran of his options to submit additional evidence and request a personal hearing. See Correspondence (July 2015). The rating decision thoroughly presented the results of the 2015 VA examination as they related to the diagnostic criteria, as the reasons and bases for the proposed reduction. See Rating Decision (July 2015). Although the AOJ did not expressly cite to an improvement in the Veteran's ability to function under the ordinary conditions of life and work, the rating decision addressed the factors that would affect such a finding, to include the results of metabolic equivalent testing (MET) and related symptoms such as dyspnea, fatigue, angina, dizziness, or syncope. See Rating Decision (July 2015). The Veteran did not request a hearing but did submit additional evidence. See Medical Treatment Record Non-Government Facility (August 2015). By way of a November 2015 rating decision, the AOJ reduced the Veteran's disability rating from 100 to 30 percent, effective February 1, 2016. See Rating Decision (November 2015). The AOJ satisfied the requirements by allowing a 60-day period to expire before assigning the reduction effective date. See 38 C.F.R. § 3.105. The procedural requirements are thus met. Accordingly, the remaining question is whether the reduction in the disability rating is warranted based on the medical and lay evidence of record. Notably, although the RO initially reduced the evaluation from 100 percent to 30 percent, the RO later assigned a 60 percent evaluation, effective February 1, 2016. See Rating Decision (November 2015); Rating Decision (February 2019). Thus, the consideration here is whether the reduction from 100 to 60 percent was proper. A veteran's disability rating shall not be reduced unless an improvement in the disability is shown to have occurred. 38 U.S.C. § 1155. Prior to reducing a veteran's disability rating, VA is required to comply with several general VA regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect. 38 C.F.R. §§ 4.1, 4.2, 4.10, 4.13; Brown v. Brown, 5 Vet. App. 413, 420 (1993). Such review requires VA to ascertain, based upon review of the entire recorded history of the condition, whether an improvement in a disability has actually occurred but also if that improvement actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work. Faust v. West, 13 Vet. App. 342, 350 (2000). It is essential, both in the examination and in the evaluation of the disability, that each disability be viewed in relation to its history. 38 C.F.R. § 4.1. If an examination report does not contain sufficient detail, or the diagnosis is not supported by the findings on the examination report, it must be returned as inadequate for rating purposes. 38 C.F.R. § 4.2. When any change in evaluation is to be made, the rating agency should assure itself that there has been an actual change in the conditions, for better or worse, and not merely a difference in thoroughness of the examinations or in use of descriptive terms. 38 C.F.R. § 4.13. Finally, it must be considered that the basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. As to the propriety of the reduction, for reductions in rating to be properly accomplished, specific requirements must be met. 38 C.F.R. § 3.344; Dofflemyer v. Derwinski, 2 Vet. App. 277 (1992). The requirements for reduction of ratings in effect for five years or more are set forth at 38 C.F.R. § 3.344 (a) and (b). The duration of the rating is measured from the effective date of the rating to the effective date of the reduction. Brown, 5 Vet. App. at 418. Regarding the Veteran's service-connected CAD, a 100 percent evaluation was assigned effective November 26, 2013. See Rating Decision (May 2014). It was reduced to 60 percent effective February 1, 2016. See Rating Decision (November 2015); Rating Decision (February 2019). The 100 percent evaluation was thus in effect for less than five years. The additional requirements of 38 C.F.R. § 3.344(a) and (b) are therefore not for application. Thus, a single examination showing improvement may provide an adequate basis for a reduction in the rating. 38 C.F.R. § 3.344(c). In determining whether a reduction was proper, the Board must focus on evidence available to the AOJ at the time the reduction was effectuated, although post-reduction medical evidence may be considered in the context of evaluating whether the condition actually improved. Dofflemyer, 2 Vet. App. at 281-282. Arteriosclerotic heart disease is rated pursuant to 38 C.F.R. § 4.104, Diagnostic Code (DC) 7005. Under DC 7005, 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 warranted for 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. One 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. A May 2014 VA examination was conducted upon review of the claims file. The examiner found that the Veteran did not have congestive heart failure and that 1-3 METs caused dyspnea, fatigue, and angina. This level was consistent with activities such as eating, dressing, taking a shower, and slow walking for 1 to 2 blocks. Left ventricular ejection fraction was 50%. See C&P Exam (May 2014). Private medical records from December 2014 noted left ventricular ejection fraction of 45 percent or 55 to 60 percent. See Medical Treatment Record Non-Government Facility (August 2015). These records did not contain a notation of congestive heart failure. A July 2015 VA examination was conducted upon a review of the Veteran's VA medical records, the prior VA examination, and private medical records. The examiner found that the Veteran did not have congestive heart failure. An interview-based METs test showed that dyspnea and fatigue was caused by 5-7 METs, which was consistent with activities such as walking 1 flight of stairs, golfing without a cart, mowing a lawn, or heavy yard work. Ejection fraction was 55 to 60 percent. See C&P Exam (July 2015). In a September 2015 VA medical record, the ejection fraction was 52 percent. See CAPRI (September 2015). VA treatment records dated prior to November 2015 did not demonstrate congestive heart failure. See CAPRI (May 2014); CAPRI (July 2015); CAPRI (September 2015). After the rating decision was issued, the Veteran submitted a Disability Benefits Questionnaire (DBQ) filled out by his private physician. The examiner noted that there was chronic congestive heart failure. Estimated METs testing showed 3-5 METs caused fatigue, and angina. This METs level was consistent with activities such as light yard work, mowing lawn, and brisk walking. See VA 21-0960A-1 Ischemic Heart Disease Disability Benefits Questionnaire (December 2015). Additional private medical records were associated with the claims file in May 2017. See Medical Treatment Record Non-Government Facility (May 2017). Those records showed ejection fraction of 50 percent in 2014 and 2015 and 45 to 50 percent in November 2016. See Medical Treatment Record Non-Government Facility (May 2017). Congestive heart failure was not shown. The Board finds that the preponderance of the evidence shows an actual improvement in a disability. First, there was an improvement in the Veteran's METs and ejection fraction findings. The 2014 VA examination findings showed 1-3 METs and an ejection fraction of 50 percent. But the 2015 VA examination findings showed improvement, including 5 to 7 METs and an ejection fraction of 55 to 60 percent. See 38 C.F.R. § 4.104, DC 7005. VA and private treatment records also noted ejection fraction of 45 to 60 percent. These findings clearly do not support a 100 percent evaluation, which requires an ejection fraction of less than 30 percent or a workload of 3 METs or less. See 38 C.F.R. § 4.104, DC 7005. Although the private DBQ noted chronic congestive heart failure, this finding is not supported by the other evidence of record, to include medical records from the physician who completed the DBQ. Additionally, VA examiners determined there was no heart failure and VA treatment records also did not make such findings. Finally, later private treatment records indicate that the Veteran's CAD continues to result in ejection fraction findings of 45 to 50 percent, which does not support a 100 percent evaluation. Second, the preponderance of the evidence shows an improvement in the Veteran's ability to function under the ordinary conditions of life and work. The METs findings indicate that in 2014, the Veteran was having symptoms such as dyspnea, fatigue, and angina, with activities such as eating, dressing, taking a shower, and slow walking for 1 to 2 blocks. In 2015, the Veteran was having symptoms such as dyspnea and fatigue, with activities such as walking 1 flight of stairs, golfing without a cart, mowing a lawn, or heavy yard work. These findings indicate that the actual improvement in diagnostic findings translated to an improvement in the Veteran's ability to function in life and work. Thus, viewing the evidence over the history of the appeal period, the Board finds that the evidence shows improvement in the service-connected CAD such that the reduction from 100 percent to a 60 percent evaluation is appropriate, and that the evidence also shows actual improvement in the ability to function in life and work due a decrease in activities that cause CAD-related symptoms. Therefore, the reduction is proper. Accordingly, the appeal is denied. There is no doubt to resolve. 38U.S.C. §5107(b). C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.M., 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.