Citation Nr: 21008574 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 17-34 887 DATE: February 17, 2021 ORDER Entitlement to a disability rating of 100 percent for coronary artery disease, status post coronary artery bypass, from April 1, 2014 through March 12, 2017 is granted. REFERRED In a July 2015 statement (VA Form 21-4138), the Veteran requested consideration of an earlier effective date of service connection for coronary artery disease pursuant to the Nehmer provisions set forth in 38 C.F.R. § 3.816. In this regard, he pointed out that a diagnosis of ischemic heart disease is shown in a December 2010 VA treatment record. This issue is referred to the agency of original jurisdiction for appropriate action. See 38 C.F.R. § 19.9(b). FINDING OF FACT From April 1, 2014 through March 12, 2017, the Veteran’s coronary artery disease was manifested by a workload of 3 METS or less. CONCLUSION OF LAW The criteria for entitlement to a disability rating of 100 percent for coronary artery disease from April 1, 2014 through March 12, 2017 have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.104, Diagnostic Code 7005. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army from December 1963 through July 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision(s) of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida, that granted service connection for coronary artery disease (CAD), status post coronary artery bypass, with an evaluation of 10 percent effective September 30, 2012, to November 12, 2013; an evaluation of 100 percent from November 13, 2013, to March 31, 2014; an evaluation of 30 percent from April 1, 2014, to March 12, 2107; and an evaluation of 100 percent from March 13, 2107, forward. This matter was previously remanded by the Board in December 2019, at which time the Board granted an initial 100 percent rating for the Veteran’s CAD from September 30, 2012, to November 12, 2013. The issue of entitlement to a rating in excess of 30 percent for CAD from April 1, 2014, to March 12, 2107, was remanded for further development. That development having been completed, the matter has now returned to the Board. 1. Entitlement to a disability rating of 100 percent for coronary artery disease, status post coronary artery bypass, from April 1, 2014 to March 12, 2017 is granted. Disability ratings are assigned in accordance with VA's Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from disability. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Separate diagnostic codes (DCs) identify the various disabilities. See generally 38 C.F.R. Part 4. If two disability evaluations are potentially applicable, 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. Reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Consistent with the facts found, the rating may be higher or lower for periods of the time under review on appeal, that is, the rating may be "staged". See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990) (when the evidence supports the claim or is in relative equipoise, the claim will be granted). The Veteran seeks a higher rating for his service-connected coronary artery disease for the period of April 1, 2014 through March 12, 2017, currently rated as 30 percent disabling, under Diagnostic Code (DC) 7005. Under Diagnostic Code 7005, a 30 percent rating is assigned for a 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. A 60 percent requires more than one episode of acute congestive heart failure 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. A 100 percent rating is warranted for coronary artery disease resulting in chronic congestive heart failure, 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. 38 C.F.R. § 4.104, DC 7005. One MET (metabolic equivalent) is defined as the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. 38 C.F.R. § 4.104, Note (2). The Veteran was afforded a VA examination in April 2014, where METs testing was not performed, but the VA examiner estimated a METs level of less than 5-7 METs. In July 2015, he had a METs functional capacity level at less than 4. See July 2015 CAPRI Medical Records. In March 2016, the Veteran was afforded another VA examination, where METs testing was not performed, but the VA examiner estimated a METs level of less than 7-10 METs. While outside of the appeal period, in February 2013, he was found to be complaining of exertional chest discomfort, with a METs functional capacity level at less than 4. See February 2013 CAPRI Medical Records. Finally, while also shortly outside of the appeal period, on March 13, 2017, the Veteran was afforded a VA examination where METs testing was not performed, as the examiner noted that the Veteran could not walk long enough without symptoms of angina, dyspnea on exertion, and fatigue; the examiner estimated the Veteran’s METs level to be at 1-3 METs. As discussed above, a 100 percent rating is warranted for coronary artery disease resulting in workload of 3 METs or less. 38 C.F.R. § 4.104, DC 7005. The Board notes that the Veteran’s METs levels over the years are varied. He has a disability rating of 100 percent from September 30, 2012 through March 31, 2014, and from March 13, 2017 forward; therefore, the only period for which he does not currently have a 100 percent disability rating is the period on appeal. Considering the July 2015 METs functional capacity level at less than 4, the close proximity to the period on appeal of METs levels less than 4 in February 2013 and March 2017, and   resolving all doubt in favor of the Veteran, the Board finds that a 100 percent rating is warranted for the Veteran’s coronary artery disease for the period of April 1, 2014 through March 12, 2017. 38 U.S.C. § 5107. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Mohammad 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.