Citation Nr: 21075402 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 17-01 610 DATE: December 20, 2021 ORDER Entitlement to a rating in excess of 60 percent for coronary artery disease (CAD), beginning October 8, 2020, is denied. REMANDED Entitlement to an initial rating in excess of 10 percent for CAD, from June 22, 2000 to April 27, 2014, is remanded. Entitlement to a rating in excess of 60 percent for CAD from April 28, 2014 to February 2, 2015, is remanded. Entitlement to a rating in excess of 30 percent for CAD from February 3, 2015 to October 7, 2020, is remanded. Entitlement to an effective date prior to March 20, 2014 for entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDING OF FACT Beginning October 8, 2020, the Veterans CAD manifested in a workload of 3.1-5.0 metabolic equivalents (METs) with symptoms of dyspnea, fatigue, and angina; but did not manifest in congestive heart failure (CHF) or left ventricular dysfunction with ejection fraction of less than 30%. CONCLUSION OF LAW The criteria for entitlement to a rating in excess of 60 percent for CAD, beginning October 8, 2020, have not been met. 38 U.S.C. §§ 1155; 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.7, 4.22, 4.104, Diagnostic Codes 7005 (2021), (86 Fed. Reg. 54095 (Sept. 30, 2021)). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1968 to March 1970. The Veteran testified before the Board of Veterans' Appeals (Board) and the undersigned Veterans Law Judge in May 2019. The matters were remanded by the Board in July 2020. During the pendency of the appeal, in August 2021, the agency of original jurisdiction (AOJ) granted a 60 percent rating from April 28, 2015 to February 2, 2015; and a 60 percent rating beginning October 8, 2020. This decision constitutes a partial grant of the benefits sought on appeal; therefore, the claims remain on appeal. See AB v. Brown, 6 Vet. App. 35 (1993). In a rating decision dated April 2021, the AOJ granted entitlement to TDIU with an effective date of March 20, 2014, the date of claim. The Board notes that the appellate period for the CAD increased rating claims dates back to June 22, 2000. Therefore, pursuant to Harper, the issue of a TDIU prior to March 20, 2014 is still pending in conjunction with the claims for increased ratings. See Harper v. Wilkie, 30 Vet. App. 356 (2018). Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where 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. After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The evaluation of the same disability under various diagnoses, and the evaluation of the same manifestation under different diagnoses, are to be avoided. 38 C.F.R. § 4.14. The Veteran's entire history is reviewed when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where the question for consideration is the propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of a "staged rating" (assignment of different ratings for distinct periods of time, based on the facts found) is required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Prior to November 14, 2021, Diagnostic Code 7005 provided ratings for arteriosclerotic heart disease (CAD), and requires documented coronary artery disease. CAD resulting in workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; when continuous medication is required, is rated 10 percent disabling. CAD resulting in 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, is rated 30 percent disabling. CAD resulting in more than one episode of acute CHF 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, is rated 60 percent disabling. CAD resulting in chronic CHF, 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, is rated 100 percent disabling. During the pendency of this appeal, VA amended the Schedule for Rating Disabilities: The Cardiovascular System, 86 Fed. Reg. 54089, 54095 (Sept. 30, 2021), effective November 14, 2021. Under the new amendments, CAD is rated under the General Rating Formula for Diseases of the Heart. CAD with workload of 3.1-5.0 METs resulting in heart failure symptoms is rated at 60 percent; and CAD with workload of 3.0 METs or less resulting in heart failure symptoms is rated at 100 percent. 38 C.F.R. § 4.104, Diagnostic Code 7005 (86 Fed. Reg. 54095 (Sept. 30, 2021)). Under Note (3), heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrythmia, palpitations, and syncope. Id. In the report of a VA examination in October 2020, the Veteran was diagnosed with angina as a symptom of CAD. The Veteran had no history of CHF, and METs were measured at 3.1-5.0 METs with symptoms of dyspnea, fatigue, and angina. The Veteran was provided with a VA examination in June 2021. The Veteran was diagnosed with angina as a symptom of CAD. The Veteran had no history of CHF. The left ventricular ejection fraction (LVEF) measured at 60%; and METs were measured at 3.1-5.0 METs with symptoms of dyspnea, fatigue, and angina. Having carefully reviewed the evidence of record, the Board finds that the preponderance of the evidence is against the claim for a rating in excess of 60 since October 8, 2020. The criteria for a 100 percent evaluation have not been met, nor are they more nearly approximated. The evidence of record does not establish that the Veteran suffered CHF, a workload of less than 3 METs, or LVEF less than 30 percent. Therefore, the Veteran's symptoms throughout this period most closely approximate the 60 percent disability rating. The Veteran's heart condition is rated under Diagnostic Code 7005. The Board has considered whether rating the condition under a different Diagnostic Code would afford him the greatest benefit possible. However the Veteran is only service connected for CAD, and no other Diagnostic Code is appropriate. Additionally, the Board notes that there is no evidence since November 14, 2021 which is commensurate to a 100 percent rating under the amended rating criteria, notably because the evidence does not show workload measurements of 3.0 METs or less. Accordingly, the Board finds that the criteria for a rating in excess of 60 percent, beginning October 8, 2020, have not been met. The preponderance of the evidence is against the claim for a rating in excess of 60 percent, and the claim is denied. 38 U.S.C. § 5107(b). REASONS FOR REMAND 1. Entitlement to increased ratings for CAD prior to October 8, 2020 In the Veteran's claims file, private treatment records related to the CAD were provided on December 9, 2015 ; December 18, 2015; and May 15, 2019. Within these files, there are multiple relevant exercise stress test from October 1999 to September 2015 in which the measurements for METs were not clearly delineated. Accordingly, a retroactive addendum opinion is required in order to determine the METs measurements during the applicable exercise stress test from October 1999 to September 2015. 2. Entitlement to an effective date prior to March 20, 2014 for TDIU The issue of an earlier effective date for TDIU is inextricably intertwined with the increased rating claims remanded herein, and thus must also be remanded. The matters are REMANDED for the following action: Forward the Veteran's claims file to a qualified medical professional in order to obtain an addendum medical opinion. The examiner should review the claims file, to include this REMAND. The examiner is asked to review the private treatment records added to the claims file on December 9, 2015; December 18, 2015; and May 15, 2019; and provide METs measurement estimates for all exercise stress test dated since 1999. If estimates cannot be made, a clear explanation for the lack of the requested information must be provided. A complete rationale must be given for all opinions and conclusions expressed. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. N. Quarles, 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.