Citation Nr: A21019899 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 190823-28649 DATE: December 14, 2021 ORDER Entitlement to an increased rating in excess of 10 percent for myocardial infarction with atherosclerosis (myocardial infarction) is denied. FINDING OF FACT Throughout the period on appeal, the Veteran's symptoms relating to a myocardial infarction did not more nearly approximate a workload of greater than 5 metabolic equivalents of task (METs) but not greater than 7 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or was there evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. CONCLUSION OF LAW The criteria for a disability rating greater than 10 percent for myocardial infraction have not been met. 38 U.S.C. § 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.3, 4.7, 4.104, Diagnostic Code (DC) 7006. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 2007 through March 2011. This matter comes to the Board of Veterans' Appeals (Board) on an appeal of a May 2019 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In June 2019, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of the May 2019 decision. In July 2019, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior May 2019 rating decision. In a July 2019 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. Therefore, the Board may only consider the evidence of record at the time of the May 2019 AOJ decision on appeal, as well as any evidence submitted by the Veteran or her representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). Notably, the hearing was held in July 2021. No additional evidence was submitted. 1. Entitlement to an increased rating in excess of 10 percent for myocardial infarction from March 1, 2019 through May 30, 2019. In this case, the Veteran is currently assigned a 10 percent for myocardial infarction pursuant to 38 C.F.R. § 4.104, DC 7006. She disagrees with the rating assigned. As a preliminary matter, the Board notes that effective November 14, 2021, the rating criteria for cardiovascular disabilities was amended. However, because an amendment may not be applied prior to its effective date, those new criteria are not applicable to this claim. Under the version of Diagnostic Code 7006 in effect during this appeal, a 10 percent evaluation is warranted for a history of a documented myocardial infarction, resulting in a workload of greater than 7 METs but not greater than 10 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required. A 30 percent evaluation is warranted for a history of a documented myocardial infarction, resulting in a 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 dilatation on electrocardiogram, echocardiogram, or X-ray. A 60 percent evaluation is warranted for a history of a documented myocardial infarction, resulting more than one episode of acute congestive heart failure in the past year, or; in a workload of greater than 3 METs but not greater than 5 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent evaluation is warranted for warranted for a history of a documented myocardial infarction, resulting in chronic congestive heart failure, or; a 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 100 percent evaluation is also warranted during and for three months following myocardial infarction, documented by laboratory tests. One MET (metabolic equivalent) is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 millimeters per kilogram of body weight per minute. See 38 C.F.R. § 4.104, Note 1. In May 2019, treatment notes record the Veteran's complaint of dizziness days earlier. She informed that her blood pressure at the time was 127/87 and her cardiologist adjusted her medications. At the time of the visit, she had a blood pressure reading of 108/74 and her heart examination was normal. The Veteran was afforded a VA examination in May 2019 for her heart condition. Here, she reported that after the November 2018 heart attack, she had some occasional chest pain. There was no limitation to her activity levels, and she intermittently carried her nitroglycerin tabs. On examination, the examiner documented that the Veteran was taking continuous medication. The Veteran did not have congestive heart failure, arrhythmia, heart valves conditions, infectious heart conditions, or pericardial adhesions. The Veteran's heart rate was 70. Her heart rhythm and sounds were normal. There was no evidence of cardiac hypertrophy or dilatation. It was documented that the Veteran's April 2019 EKG and chest Xray were normal. An interview-based METs test noted that the Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity. At the July 2021 hearing, the Veteran testified that she has symptoms of dizziness. She also stated that her fatigue was just weakness. She testified that during these times, she would sip water with salt, drink tea, or eat bread or something for calories, which made her feel better. She had dizziness two times a week where she has to sit down. Based on the aforementioned, the Board finds that the Veteran is not entitled to an increased evaluation under Diagnostic Code 7006 for myocardial infarction for the period on appeal. The evidence does not show that she has a 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 dilatation on electrocardiogram, echocardiogram, or X-ray. During the May 2019 VA examination, the VA examiner reported that the Veteran denied experiencing symptoms with any level of physical activity during interview-based METs testing. Further, the Veteran did not have evidence of cardiac hypertrophy or dilatation on EKG or Xray. Rather, her April 2019 EKG and chest Xray were normal. Although the Veteran testified that she had some symptoms of weakness, dizziness, or fatigue during the July 2021 hearing, she also testified that such symptoms improved promptly with the intake of food or tea. The evidence has not demonstrated that these symptoms occurred with physical activities associated with a workload greater than 5 METS, or less. but not greater than 7 METS. Thus, a rating in excess of 10 percent for myocardial infraction is denied. The Veteran is competent to report symptoms because this requires only personal knowledge as it comes to her through his senses, and the Board has considered those statements. Layno v. Brown, 6 Vet. App. 465 (1994). She is not, however, competent to identify a specific level of disability of this disorder according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran's disabilities has been provided by the medical personnel who have examined her during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and the clinical records) directly address the criteria under which her disability is evaluated. As such, the Board finds these records to be more probative than the Veteran's subjective complaints of increased symptomatology. The Veteran's claim for a rating in excess of 10 percent for myocardial infraction from March 1, 2019 through May 30, 2019 is denied. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N.B. Mmeje, 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.