Citation Nr: 21012012 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 20-03 056 DATE: March 3, 2021 ORDER Entitlement to an evaluation in excess of 60 percent for coronary artery disease (CAD) from July 1, 2017 is denied. FINDING OF FACT From July 1, 2017 the Veteran’s CAD did not manifest as chronic congestive heart failure, or left ventricular dysfunction with an ejection fraction of less than 30 percent, or a workload of 3 Metabolic Equivalents (METs) or less resulting in dyspnea, fatigue, angina, dizziness, or syncope. CONCLUSION OF LAW From July 1, 2017, the criteria for a rating higher than 60 percent for CAD were not met. 38 U.S.C. § §§ 1155, 5107; 38 C.F.R. § § 4.104, Diagnostic Code (DC) 7017. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from July 1968 to June 1970. This matter comes before the Board of Veterans Appeals (Board) on appeal from a June 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The record reflects that the Veteran’s CAD may have prevented him from working during the appeal period. See January 2020 VA Form 9. As a total disability rating based on individual unemployability (TDIU) rating is part and parcel of any claim for an increased rating, and has been expressly raised by the Veteran’s representative in this case, it was previously added as an issue. See Rice v. Shinseki, 22 Vet. App. 447 (2009). In a May 2020 rating decision, the RO granted service connection for TDIU, which constitutes a full award of the benefits sought on appeal. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). Thus, this matter is no longer in appellate status. Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. § Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § § 1155; 38 C.F.R. § §§ 3.321(a), 4.1. Where there is a question as to which of two evaluations shall 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. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary 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). The Board has reviewed all of the evidence of record, with an emphasis on the evidence relevant to the Veteran’s claim. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the Veteran’s claim. The Veteran’s CAD is rated under 38 C.F.R. § § 4.104, DC 7017. Under DC 7017, a 100 percent rating is warranted for three months following hospital admission for coronary bypass surgery. Thereafter, in pertinent part, a 60 percent rating is warranted for more than one episode of acute congestive heart failure in the past year, or where a workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or for left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent rating is warranted for chronic congestive heart failure, or where a workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or for left ventricular dysfunction with an ejection fraction of less than 30 percent. The Board also notes that when the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination 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) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. By way of background, the Veteran was initially granted service connection for CAD in a March 2012 rating decision, and a 60 percent evaluation was assigned effective September 28, 2011. In April 2017, the Veteran requested an increased rating, and in a June 2017 rating decision the AOJ assigned a 100 percent rating for the period from March 17, 2017 to June 30, 2017 (a period of three months following the Veteran’s coronary bypass surgery), and assigned a 60 percent rating effective July 1, 2017. The Board has thoroughly reviewed the entire record, to include all VA examination reports and outpatient treatment records. The Veteran received a VA examination in May 2017. The examiner provided an interview-based METs test. The examiner indicated there was left ventricular dysfunction with an ejection fraction of 50 percent or less and a workload of greater than 3 METs but not greater than 5 METs. The examiner went on to indicate the Veteran’s limitation in METs level was solely due to his heart condition. The Board observes that the Veteran was afforded an additional VA heart examination in April 2020. In pertinent part, the examiner determined that an exercise stress test could not be performed for medical reasons. As such, the examiner provided an interview-based METs test. The examiner indicated that 5 to7 METs resulted in dyspnea, fatigue, and angina. The examiner went on to indicate the Veteran’s limitation in METs level was solely due to his heart condition. The Board observes, after a thorough review of the record, that for the period from July 1, 2017, there is no competent and probative evidence showing the Veteran’s heart disability manifested as chronic congestive heart failure, or left ventricular dysfunction with an ejection fraction of less than 30 percent, or that it manifested in a workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope. Accordingly, the Board find a rating in excess of 60 percent for the Veteran’s CAD is not warranted. 38 U.S.C. § 5107 (b); see also Gilbert v. Derwinski, 1 Ver. App. 49 (1990). (Continued on the next page)   Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). B. G. LeMoine Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Javed 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.