Citation Nr: 21006725 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 14-19 865A DATE: February 5, 2021 ORDER Entitlement to an initial rating in excess of 30 percent prior to September 25, 2019, and in excess of 60 percent thereafter for coronary artery disease is denied. FINDINGS OF FACT 1. For the period prior to September 25, 2019, the Veteran’s coronary artery disease was not manifested by more than one episode of acute congestive heart failure in the past year, a workload of greater than three but not greater than five metabolic equivalents (METs) resulting in dyspnea, fatigue, angina, dizziness, or syncope, or left ventricular dysfunction with an ejection fraction of 30 to 50 percent. 2. For the period after September 25, 2019, the Veteran’s coronary artery disease was not manifested by a history of chronic congestive heart failure, a workload of three METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope, or a left ventricular dysfunction with an ejection fraction of less than 30 percent. CONCLUSIONS OF LAW 1. Prior to September 25, 2019, the criteria for a disability rating in excess of 30 percent for coronary artery disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.7, 4.10, 4.104, Diagnostic Code 7005. 2. From September 25, 2019, the criteria for a disability rating in excess of 60 percent for coronary artery disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.10, 4.104, Diagnostic Code 7005. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1976 to December 1996. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2010 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded this case in April 2020 to obtain records from the Social Security Administration and associate them with the file. This development is now complete, and this matter is now before the Board for appellate review. The Veteran contends that his coronary artery disease should receive higher ratings, asserting that in addition to experiencing fatigue, angina, dizziness, and syncope, he meets the METs workload requirements for a higher rating. See June 2014 VA Form 9; Sept. 2020 Appellant’s Brief. 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 percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability, and separate diagnostic codes identify the various disabilities and criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two disability evaluations are potentially applicable, 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. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. In determining the propriety of the initial rating assigned after a grant of service connection, the evidence since the effective date of the grant of service connection must be evaluated and staged ratings must be considered. Staged ratings are appropriate when the evidence establishes that the claimed disability manifested symptoms that would warrant different ratings for distinct time periods during the course of the appeal. Fenderson v. West, 12 Vet. App. 119, 126-127 (1999). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other. Esteban v. Brown, 6 Vet. App. 259, 262 (1994); 38 C.F.R. § 4.14. The Veteran is competent to give evidence of symptoms observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Veteran’s disability has been rated under Diagnostic Code 7005 for coronary artery disease. Under Diagnostic Code 7005, a 10 percent evaluation is warranted where a workload of greater than seven METs but not greater than ten METs results in dyspnea, fatigue, angina, dizziness, or syncope; or, where continuous medication is required. A 30 percent evaluation is warranted where a workload of greater than five METs but not greater than seven METs results in dyspnea, fatigue, angina, dizziness, or syncope; or, where there is evidence of cardiac hypertrophy or dilation on electrocardiogram, echocardiogram or X-ray. A 60 percent evaluation is warranted where there has been more than one episode of acute congestive heart failure in the past year; or, a workload of greater than three METs but not greater than five METs results in dyspnea, fatigue, angina, dizziness, or syncope; or, where there is left ventricular dysfunction with a left ventricular ejection fraction (LVEF) of 30 to 50 percent. A 100 percent evaluation is warranted for chronic congestive heart failure; or, a workload of three METs or less results in dyspnea, fatigue, angina, dizziness, or syncope; or, where there is LVEF of less than 30 percent. 38 C.F.R. § 4.104, Diagnostic Code 7005. First, for the period prior to September 25, 2019, the Board finds that the evidence does not satisfy the criteria for a rating in excess of 30 percent. Throughout his appeal, the RO increased the Veteran’s initial rating for coronary artery disease from 10 to 30 percent following the receipt of medical evidence showing echocardiogram evidence of cardiac hypertrophy or dilation. See Apr. 2014 Rating Decision. During this time, the Veteran received several VA examinations as well as VA and private cardiac treatment. However, on review of these examinations and other treatment records, there is no medical evidence showing that the Veteran ever experienced congestive heart failure. See, e.g., Nov. 2010 VA Treatment Records at 2; Jan. 2011 VA Examination at 2. There is also no medical evidence to show that the Veteran ever experienced left ventricular dysfunction with a LVEF lower than 54 percent. See Apr. 2018 Private Treatment Records at 79 (measuring LVEF at 54 percent); see also June 2010 Private Treatment Records at 9 (measuring LVEF at 60 percent or greater); Jan. 2011 VA Examination at 79 (measuring LVEF at 60-65 percent); Nov. 2016 Private Treatment Records at 50 (measuring LVEF at 75 percent). Regarding workload, although the record shows the Veteran experienced angina, medical testing during this period shows a workload of 10 METs. See June 2010 Private Treatment Records at 17. Accordingly, as there is no indication that the Veteran meets any of the criteria required for a 60 percent disability rating prior to September 25, 2019, the Board finds that a rating in excess of 30 percent prior to September 25, 2019 is not warranted. See 38 C.F.R. § 4.104, Diagnostic Code 7005. Second, for the period beginning September 25, 2019, the Veteran has been assigned a 60 percent rating for coronary artery disease. See Oct. 2019 Rating Decision. The Veteran was afforded a VA examination in September 2019. During this examination, the Veteran underwent workload and LVEF testing. The examination results showed that the Veteran had a LVEF between 65 and 70 percent. See Sept. 2019 VA Examination at 5. The results also showed workload testing results between three and five METs with dyspnea, angina, and dizziness. See id. at 6. However, the examination did not show that the Veteran had or had ever experienced congestive heart failure. See id. at 2. Accordingly, as the medical evidence shows a workload between three and five METs, but does not show either LVEF lower than 30 percent or congestive heart failure, the Board finds that the medical evidence indicates severity consistent with a 60 percent disability rating for the Veteran’s coronary artery disease. See 38 C.F.R. § 4.104, Diagnostic Code 7005. The Board acknowledges the Veteran believes his coronary artery disease is entitled to a higher evaluation. However, while he is competent to report symptoms observable to his senses, he is not qualified to provide a medical opinion as to the severity of his condition. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Jandreau, 492 F.3d at 1372. Thus, while his reports of fatigue, angina, dizziness, and syncope, as well as his assertions concerning METs testing results are relevant evidence, medical testing is required to determine the severity of symptoms in accordance with the metrics provided in the rating schedule. Here, there is no medical evidence of record showing any congestive heart failure, LVEF below 54 percent, or workload testing at three or fewer METs. Accordingly, while the Veteran asserts that his coronary artery disease meets the requirements for a higher rating, the medical evidence of records does not support a disability rating of 100 percent. Finally, the Board finds that the assignment of a staged rating was appropriate for the Veteran’s coronary artery disease. During the September 2019 examination, the examiner found that the Veteran’s workload testing resulted in a workload between three and five METs. Upon review of this examination, the RO increased the Veteran’s rating from 30 to 60 percent, effective September 25, 2019. As the evidence shows an increase in disability in accordance with the criteria in Diagnostic Code 7005, the Board finds assignment of a staged rating was appropriate for the Veteran’s coronary artery disease. See Fenderson, 12 Vet. App. at 126-127. Accordingly, the Board concludes that a rating in excess of 30 prior to September 25, 2019, and in excess of 60 percent thereafter is not warranted. R. M. KELLY Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board O. Gomez, Law Clerk 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.