Citation Nr: A21020665 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 210923-187340 DATE: December 30, 2021 ORDER A disability rating in excess of 30 percent for coronary artery disease is denied. FINDING OF FACT For the rating period on appeal from June 2, 2021, the coronary artery disease has been manifested by workload of greater than five METs but not greater than 7 METs resulting in dyspnea and fatigue, requirement of continuous medication, and left ventricular ejection fraction of 51 percent. CONCLUSION OF LAW For the rating period on appeal from June 2, 2021, the criteria for a disability rating in excess of 30 percent for the coronary artery disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.104, Diagnostic Code 7005. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army during the Vietnam Era from April 1968 to March 1970. The Veteran has been service connected for the coronary artery disease since April 24, 2012. The Veteran filed a claim for an increased disability rating for the coronary artery disease on June 2, 2021. An increased rating was denied in a July 2021 Rating Decision. The Veteran filed a timely appeal (notice of disagreement) in September 2021, requesting the Evidence Submission Docket. The July 2021 Rating Decision is the basis of the current appeal, and the current Board decision is governed under the Appeals Modernization Act. Rating the coronary artery disease For the entire rating period on appeal from June 2, 2021, the Veteran is in receipt of a 30 percent rating under DC 7005 for the coronary artery disease, based on workload greater than five METs but not greater than seven METs resulting in dyspnea and fatigue, requirement of continuous medication, left ventricular dysfunction with an ejection fraction of more than 50 percent, no acute episodes of congestive heart failure in the past year, and no evidence of cardiac hypertrophy or dilation shown by testing. Coronary artery disease is rated under DC 7005. A 30 percent rating is warranted under DC 7005 where there is either: workload of greater than five METs but not greater than seven METs resulting in dyspnea, fatigue, angina, dizziness, or syncope; or evidence of cardiac hypertrophy or dilation on ECG, echocardiogram, or X-ray. The next highest rating is a 60 percent rating. A 60 percent rating is warranted where there is either: more than one episode of acute congestive heart failure in the past year; workload of greater than three METs but not greater than five METs resulting in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricular dysfunction with an ejection fraction of 30 to 50 percent. The Veteran contends that he has a left ejection fraction of 50 percent, so should get a 60 percent rating. See September 2021 Veteran's Statement. The Veteran reported that he had submitted documentation evincing test results showing a left ejection fraction of 50 percent. In February 2015 the Veteran had submitted evidence of private medical treatment indicating a finding of left ventricular ejection fraction of 40-45 percent. This evidence is outside the one year look back period. See 38 C.F.R. § 3.400(o)(2) (providing that the increase must occur within the one year period prior to the claim for increase in order to get an effective date earlier than the claim for increase). VA treatment records include correspondence by the Veteran with VA, with a May 2021 email sent by the Veteran stating that a stress test had shown an ejection factor of 50 percent. Notwithstanding this representation, this stress test result does not appear to be in the record. The VA treatment records include a note from May 2021 confirming that outside medical records were provided, but there were no results of a stress test. Other VA treatment records indicate that the test was performed at a private facility, and may never have been completed: VA treatment records from April 2021 indicate that the Veteran was admitted to the emergency department with atrial fibrillation after he had begun (but not completed) a stress test at a private hospital. The Veteran received a VA examination for the heart in June 2021. The VA examiner confirmed the diagnosis of coronary artery disease, but found no evidence of congestive heart failure. The VA examiner estimated that a workload of greater than five METs but not greater than seven METs would result in dyspnea and fatigue. The examiner also noted a left ventricular ejection fraction of 51 percent, and that the Veteran requires continuous medication. After weighing the evidence, lay and medical, the Board finds that the coronary artery disease most approximates the criteria for a 30 percent rating under DC 7005. The VA examination showed that a workload of greater than five METs but not greater than seven METs resulted in dyspnea and fatigue, and that the left ventricular ejection fraction was greater than 50 percent. The evidence does not support the Veteran's assertion that of left ventricular ejection fraction of 50 percent. After a review of all the evidence of record, the Board finds that, for the entire rating period on appeal from June 2, 2021, the coronary artery disease has been manifested by workload of greater than five METs but not greater than 7 METs resulting in dyspnea and fatigue, requirement of continuous medication, and left ventricular ejection fraction of 51 percent. Accordingly, the Board finds that, for the rating period on appeal from June 2, 2021, the criteria for a disability rating in excess of 30 percent for the coronary artery disease are not met. 38 C.F.R. §§ 4.3, 4.7, 4.104. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Charles Plambeck 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.