Citation Nr: 21005962 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 16-52 863 DATE: February 3, 2021 ORDER Entitlement to a disability rating in excess of 10 percent for ischemic heart disease is denied. FINDING OF FACT The preponderance of the evidence shows that the Veteran’s service-connected ischemic heart disease is not manifested by a workload of 7 or less METs resulting in dyspnea, fatigue, angina, dizziness, or syncope; left ventricular dysfunction with an ejection fraction of less than 50 percent; or evidence of cardiac hypertrophy or dilation on electrocardiogram, echocardiogram, or X-ray. CONCLUSION OF LAW The criteria for a disability rating in excess of 10 percent for ischemic heart disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.104, Diagnostic Code 7005. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from October 1965 to October 1967. These matters come before the Board of Veterans’ Appeals (Board) on appeal of March 2013 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c); 38 U.S.C. § 7107(a)(2). In November 2019, the Board remanded this claim for additional development. It has returned to the Board for further appellate review. Increased Ratings Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each service-connected disability is rated on the basis of specific criteria identified by Diagnostic Codes. 38 C.F.R. § 4.27. When rating the Veteran’s service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Separate higher or lower compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as “staged” ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). Regulations require that where there is a question as to which of two evaluations is to be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The assignment of a particular diagnostic code to evaluate a disability is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the diagnosis, and demonstrated symptomatology. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). In evaluating the evidence in any given appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in so doing, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307, 310-11 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). Entitlement to a disability rating in excess of 10 percent for ischemic heart disease. The Veteran is currently assigned a 10 percent disability rating for ischemic heart disease under 38 C.F.R. § 4.104, Diagnostic Code (DC) 7005 for arteriosclerotic heart disease (coronary artery disease), effective August 31, 2010. The Veteran’s contends that his symptoms are productive of a higher rating. Under DC 7005, a 10 percent disability evaluation is assigned when a workload of greater than 7 METs (metabolic equivalent), but not greater than 10 METs, results in dyspnea, fatigue, angina, dizziness, or syncope; or, continuous medication is required. 38 C.F.R. § 4.104, DC 7005. Important for this case, a 30 percent rating is warranted when a workload of greater than 5 METs, but not greater than 7 METs, results in dyspnea, fatigue, angina, dizziness, or syncope; or, there is evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or x-ray. A 60 percent disability evaluation is warranted when there is more than one episode of acute congestive heart failure in the past year; a 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 when there is chronic congestive heart failure; a 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. In July 2020, the Veteran obtained a pharmaceutical stress myocardial perfusion study with wall motion evaluation and ejection fraction estimation. The study showed ejection fraction of 78% and no wall motion abnormality. The study was found to be unremarkable and there was no evidence of reversible ischemia. Pursuant to the November 2019 Board remand, the Veteran was provided a VA examination for heart conditions in July 2020. The Veteran was diagnosed with ischemic heart disease. The examiner found that continuous medication is required for control of the Veteran’s heart condition. The examiner found that the Veteran has not had a myocardial infarction, congestive heart failure, arrhythmia, heart valve condition, an infectious cardiac condition, or pericardial adhesions. The examiner noted the Veteran’s 2002 angioplasty. The examiner found no evidence of cardiac hypertrophy or cardiac dilation. The examiner noted that Veteran’s July 2013 echocardiogram, which showed left ventricular ejection fraction of 65 percent, normal wall motion, and normal wall thickness. The examiner found dyspnea, due solely to the Veteran’s cardiac conditions, at was >7 to 10 METS, consistent with activities such as climbing stairs quickly, moderate bicycling, sawing wood, and jogging (6 mph). The Veteran’s treatment records also show left ventricle ejection fractions of 78 percent in February 2015, 65 percent in October 2013, 74 percent in June 2010, and 76 percent in June 2010. The Veteran’s treatment records do not show cardiac dilation or cardiac hypertrophy. Accordingly, the Board finds that the Veteran’s service-connected ischemic heart disease in not manifested by a workload of 7 or less METs resulting in dyspnea, fatigue, angina, dizziness, or syncope; left ventricular dysfunction with an ejection fraction of less than 50 percent; or evidence of cardiac hypertrophy or dilation on electrocardiogram, echocardiogram, or X-ray. Therefore, the Board finds that the criteria for a rating in excess of 10 percent are not met. See 38 C.F.R. § 4.104; Fenderson, supra. While the Veteran believes that a higher rating is warranted for ischemic heart disease, the evidence of record does not support this belief. While the Veteran is competent to report the symptoms of his disabilities, he is not competent to opine on matters requiring medical knowledge, such as determining the severity of his medical condition at any given time, based on the criteria above. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Again, it is important for the Veteran to understand that the medical findings provide highly probative evidence against the claims that the Board cannot, unfortunately, ignore. The medical findings outweigh the Veteran’s belief that his disability warrants a higher disability rating and provide a clear basis for the opinion. Therefore, the Board provides more weight to the competent medical evidence of record and must deny the claim. This does not suggest, in any way, that the Veteran is not having problems with his ischemic heart disease. It is these problems that are the basis of the current ratings. While the Board acknowledges the Veteran has problems as a result of his ischemic heart disease, the evidence of record does not indicate that the Veteran meets the rating criteria for higher evaluations or additional separate ratings. The Veteran clearly has a problem with this disability, but the current evaluation takes this into consideration. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, where the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable. See U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Neither the Veteran nor his representative has identified any other rating criteria that would provide a higher rating or an additional rating. However, the potential applications of various provisions of Title 38 of the Code of Federal Regulations (2016) have been considered as required by the holding of the Court in Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. VanValkenburg, 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.