Citation Nr: 21009397 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 19-19 854 DATE: February 22, 2021 ORDER An initial rating evaluation of 60 percent for coronary artery disease is granted. From April 12, 2011, a 100 percent rating for coronary artery disease is granted. From March 30, 2016, special monthly compensation (SMC) is granted, subject to the laws and regulations governing the award of monetary benefits. FINDINGS OF FACT 1. The findings of a November 2006 private cardiology examination reflect that the Veteran had a workload of greater than 3 METs but not greater than 5 METs which resulted in angina. 2. The findings of April 2011 and March 2017 DBQs along with a June 2016 private cardiology examination reflect that the Veteran had a workload of 1-3 METs which resulted in symptoms of dyspnea, fatigue and dizziness. 3. The Board granted an increased rating of 100 percent for the Veteran’s service-connected coronary artery disease effective April 12, 2011. As of March 30, 2016, the Veteran’s additional service-connected disabilities were rated at 60 percent or more. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for coronary artery disease have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.10, 4.104, Diagnostic Code (DC) 7005. 2. From April 12, 2011 until present, the criteria for a 100 percent rating for coronary artery disease have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.10, 4.104, DC 7005. 3. From March 30, 2016, the criteria for SMC have been met. 38 U.S.C. § 1114 (s); 38 C.F.R. § 3.350 (i). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1954 to January 1955 and from May 1957 to April 1977. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a February 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2020, a videoconference hearing was held before the undersigned; a transcript is in the record. Increased Rating Legal Criteria Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the schedule, but that findings sufficient to identify the disease and the resulting disability and above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). Separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings.” Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). The Veteran’s service-connected coronary artery disease is rated under 38 C.F.R. § 4.104, DC 7005. Such code provides for a rating of 10 percent for documented coronary artery disease resulting in a workload of greater than 7 metabolic equivalents (METs) but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or continues medication required; a rating of 30 percent for with 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 rating for 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; and a 100 percent rating for 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. 1. An initial rating evaluation of 60 percent for coronary artery disease is granted. Factual Background The Veteran submitted the results of November 2006 private cardiology examination which revealed an initial METs level of 4. The conducting physician diagnosed the Veteran with stable angina. Analysis The Board finds that the preponderance of the evidence is in favor of a finding that the Veteran is entitled to an initial rating of 60 percent for coronary artery disease. The findings of the November 2006 private cardiology examination reflect that the Veteran had a workload of greater than 3 METs but not greater than 5 METs which resulted in angina. What remains for consideration is whether the Veteran is entitled to a still higher, 100 percent initial rating for coronary artery disease. The evidence of record does not indicate that the Veteran showed signs of chronic congestive heart failure, or 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. Accordingly, the Veteran does not meet the criteria for an initial 100 percent rating for coronary artery disease. 2. From April 12, 2011 until present, a 100 percent rating for coronary artery disease is granted. Factual Background An April 2011 Ischemic Heart Disease Disability Benefits Questionnaire (DBQ) indicates that the Veteran underwent a cardiac functional assessment which reflected a METs level of 1-3. The Veteran also displayed symptoms of dyspnea. The Veteran submitted the results of a June 2016 private cardiology examination which revealed an minimum METs level of 2.5 and an average METs level of 3. The Veteran also displayed symptoms of dyspnea. A March 2017 DBQ indicates that the Veteran underwent a cardiac functional assessment which reflected a METs level of 1-3. The Veteran also displayed symptoms of dyspnea, fatigue and dizziness. A June 2017 VA examination indicates that the Veteran underwent an interview-based METs test. The conducting physician reported that the METs level on the most recent interview-based METs test was between over 3 METs and 5 METs. The Veteran reported symptoms of dyspnea and fatigue. Analysis The Board finds that the preponderance of the evidence is in favor of a finding that from April 12, 2011 until present, the Veteran is entitled to a 100 percent rating for coronary artery disease. The findings of the April 2011 and March 2017 DBQs along with the June 2016 private cardiology examination reflect that the Veteran had a workload of 1-3 METs which resulted in symptoms of dyspnea, fatigue and dizziness. The Board acknowledges the medical evidence of record reflecting higher METs levels, including on VA examination in June 2017. However, despite the apparent fluctuations in severity of the Veteran’s coronary artery disease over the course of this appeal, the Board finds the weight of the evidence shows that his coronary artery disease manifestations and symptoms have more nearly approximated the criteria for a 100 percent schedular evaluation for the entirety of the period on appeal, for the reasons explained above. 3. From March 30, 2016, SMC is granted, subject to the laws and regulations governing the award of monetary benefits. Legal Criteria SMC is payable at the housebound rate where the veteran has a single service connected disability rated as 100 percent and (1) has additional service connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service connected disability or disabilities. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). SMC benefits “are to be accorded when a veteran becomes eligible without need for a separate claim.” Bradley v. Peake, 22 Vet. App. 280, 286 (2008); see also Buie v. Shinseki, 24 Vet. App. 242, 250-51 (2011); Akles v. Derwinski, 1 Vet. App. 118, 121 (1991) (observing that entitlement to SMC is an “inferred issue” in the context of an increased rating claim). VA has adopted the Akles rule for all complete claims. 38 C.F.R. § 3.155(d)(2) states, “VA will adjudicate as part of [a] claim entitlement to any ancillary benefits that arise as a result of the adjudication decision (e.g..... entitlement to [SMC] under 38 C.F.R. § 3.350...). The claimant may, but need not, assert entitlement to ancillary benefits at the time the complete claim is filed.” Factual Background As of March 30, 2016, the Veteran’s service-connected disabilities include coronary artery disease (100 percent); diabetes (10 percent); diabetic neuropathy of the left sciatic nerve (20 percent), right sciatic nerve (20 percent), left femoral nerve (20 percent), and right femoral nerve (20 percent); tinnitus (10 percent); and bilateral hearing loss (zero percent). Therefore, as of March 30, 2016, the Veteran’s service-connected disabilities separate and distinct from coronary artery disease are rated at 60 percent or more. See 38 C.F.R. § 4.25. Analysis As noted above, the Board grants a 100 percent rating for coronary artery disease effective April 12, 2011, and the Veteran has separate and distinct service-connected disabilities that combine for a rating of 60 percent or more from March 30, 2016; thus, the Board has an obligation to grant SMC at the housebound rate as of March 30, 2016, pursuant to 38 U.S.C. § 1114(s) and 38 C.F.R. § 3.350(i)(1). VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Alexander Bahus 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.