Citation Nr: 21009179 Decision Date: 02/19/21 Archive Date: 02/19/21 DOCKET NO. 16-01 678 DATE: February 19, 2021 ORDER An initial rating in excess of 30 percent from March 29, 2012 to November 4, 2017, and in excess of 60 percent from March 1, 2018, for the service-connected ischemic heart disease (IHD) is denied. FINDINGS OF FACT 1. From March 29, 2012 to November 4, 2017, the Veteran did not have acute congestive heart failure, a workload of greater than 3 METs but not greater than 5 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or a left ventricular dysfunction with an ejection fraction (LVEF) of 30 to 50 percent. 2. From March 1, 2018, the Veteran has not had chronic congestive heart failure; 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. CONCLUSIONS OF LAW 1. On March 29, 2012 to November 4, 2017, the criteria for an initial rating in excess of 30 percent for the service connected IHD have not been met. 38 U.S.C. § 1155, 5107(b); 38 C.F.R. § 4.104, Diagnostic Code (DC) 7005. 2. On March 1, 2018 and thereafter, the criteria for rating in excess of 60 percent for the service connected IHD have not been met. 38 U.S.C. § 1155, 5107(b); 38 C.F.R. § 4.104, DC 7005. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October1966 to June 1970. Increased Ratings Disability ratings are determined by comparing a Veteran’s present symptoms with criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. Ischemic Heart Disease (IHD) The Veteran asserts entitlement to higher ratings for his service connected IHD. As noted earlier herein, this service-connected disability is evaluated as 30 percent disabling from March 29, 2012 to November 4, 2017 and as 60 percent disabling from March 1, 2018. (As his service-connected IHD was rated as totally disabling from November 5, 2017 until February 28, 2018, that portion of the appeal period need not be addressed herein.) Under DC 7005, the criteria for a 30 percent rating requires evidence of a workload 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-rays. The next higher evaluation of 60 percent requires more than one episode of acute congestive heart failure in the past year; 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 rating requires documented 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 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 decision of METs by exercise testing 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) resulting in dyspnea, fatigue, angina, dizziness, or syncope may be used. Note 2, 38 C.F.R. § 4.104. 30 percent from March 29, 2012 to November 4, 2017 Prior to March 29, 2012, the Veteran underwent a December 2011 VA examination stress test related to his IHD. There, examiner documented that, upon standard treadmill exercise, the Veteran’s maximum workload was 6.50 METs. Likewise, the examiner noted that Veteran’s LVEF at 56 percent. This stress test is referenced throughout the medical evidence of record. A June 2012 medical note indicated that the Veteran’s LVEF estimated at 60 percent. Later in December 2012, he underwent VA examination. There, the examiner confirmed the IHD diagnosis and reported no diagnosis of congestive heart failure. Further, the examiner did not perform METs testing or an echocardiogram. Instead, the examiner referred to the December 2011 VA examination report which reflected a maximum workload for the Veteran of 6.50 METs and an LVEF of 56 percent. On November 4, 2017, the Veteran exhibited chest, neck, and arm pain and was hospitalized for a heart attack. At that time, VA medical reports indicate that the Veteran’s LVEF was 50 – 55 percent. As such, the RO adjusted the Veteran’s rating to 100 percent from November 5, 2017 to February 28, 2018 following a myocardial infarction. Given the above, assignment of a rating higher than 30 percent from March 29, 2012 to November 4, 2017 is not warranted. First, there is no evidence or allegation of any episode of congestive heart failure. Second, the relevant evidence indicates that the Veteran had a METs finding of 6.50 which is greater than the allotted limit for the next higher scheduler rating of 60 percent. Further, the evidence shows that his LVEF of 56 percent, which is above the 50 percent limitation for the higher rating of 60 percent. Thus, the Board finds that, from March 29, 2012 to November 4, 2017, the Veteran’s IHD was more consistent with a 30 percent disability rating and that the level of disability necessary to support the assignment of the next higher evaluation of 60 percent is absent. A preponderance of the evidence is against this portion of the claim, and there is no reasonable doubt to be resolved. 60 percent from March 1, 2018 and thereafter On March 1, 2018, following the total schedular rating awarded from November 5, 2017 to February 28, 2018, the agency of original jurisdiction awarded a 60 percent evaluation for the Veteran’s service-connected IHD. In a March 2018 VA medical report, the examiner indicated that the Veteran’s LVEF was “normal.” Then, in December 2019, the Veteran underwent another VA examination. He reported dull, constant pain across the precordium, pain radiating to his arms and hand, and aggravation upon light exercise. The examiner reported no diagnosis of congestive heart failure. Interview-based METs testing was greater than 3 but less than 5 caused by fatigue associated with activities such as light yard work, mowing the lawn, and brisk walking. However, the examiner noted that the Veteran’s METs, solely due to his heart condition, was greater than 5 but less than 7 but provided no rational or explanation regarding this finding. Further, the examiner did not provide an echocardiogram as part of the examination and, instead, referenced a December 2011 report of the Veteran’s LVEF at 56 percent. An October 2020 VA examiner confirmed a diagnosis of myocardial infarction and cardiovascular disease. Upon an examination interview, the Veteran reported current concern of loss stamina and shortness of breath since having a mild heart attack in November 2017. The examiner reviewed the Veteran’s medical records, which indicated that he does not have congestive heart failure. Interview-based METs testing was greater than 3 but less than 5 causing fatigue and was solely due to the heart condition. The examiner referenced an August 2020 echocardiogram which showed LVEF of 55 percent. Considering the evidence, the criteria for a rating higher than 60 percent have not been met for any portion of the appeal period from March 1, 2018. There is no evidence the Veteran experienced chronic congestive heart failure, a workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope, or LVEF of less than 30 percent. Accordingly, the Board finds that, since March 1, 2018, the Veteran’s IHD is more consistent with a 60 percent disability rating and that the level of disability necessary to support the assignment of the next higher evaluation of 100 percent is absent. A preponderance of the evidence is against this portion of the claim, and there is no reasonable doubt to be resolved. With regard to both timeframes, the Board has also considered whether a separate and/or higher rating may be assigned under a different diagnostic code, but there is no evidence that the Veteran’s IHD would be better classified under a different diagnostic code. The remaining cardiovascular codes all have the same criteria as (CONTINUED ON NEXT PAGE) DC 7005, for which the Veteran has already been assigned the current 30 percent and 60 percent evaluations. DCs 7000-7008, 7011-7020. 38 C.F.R. § 4.104. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. R. Bobb, 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.