Citation Nr: 21012786 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 19-00 948 DATE: March 5, 2021 ORDER A rating in excess of 60 percent for coronary artery disease, status post coronary artery bypass grafts, is denied. FINDING OF FACT The Veteran’s coronary artery disease, status post coronary artery bypass grafts, did not result in chronic congestive heart failure, or; workload of 3 METs less resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent. CONCLUSION OF LAW The criteria for a rating in excess 60 percent for coronary artery disease, status post coronary artery bypass grafts, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.104, Diagnostic Code 7017. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from United States Army from September 1966 to September 1968. His award and decorations include a Purple Heart. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2016 rating decision. In August 2020, the Veteran testified at a Board hearing via videoconference before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In September 2020, the Board remanded the matter for additional evidentiary development. INCREASED RATING Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Entitlement to a rating in excess of 60 percent for coronary artery disease, status post coronary artery bypass grafts. The Veteran filed an increased rating claim in March 2016 which was denied by a rating action of May 2016. He contends that a 100 percent evaluation is warranted for his coronary artery disease, status post coronary artery bypass grafts. The Veteran’s coronary artery disease, status post coronary artery bypass grafts, is rated under 38 C.F.R. § 4.104, Diagnostic Code 7017. Diagnostic Code 7017 provides ratings for coronary bypass surgery. For three months following myocardial infarction, documented by laboratory tests, a 100 percent rating is assigned. Thereafter, status post coronary bypass surgery 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, is rated 100 percent disabling. Impairment resulting in 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, is rated 60 percent disabling. 38 C.F.R. § 4.104, Diagnostic Code 7017. Private treatment records of September 2017 reveal findings of a transesophageal echocardiogram study. The Veteran’s treating cardiologist Dr. A.R. indicated “Left ventricular systolic function is normal” with Ejection Fraction of 55-60 percent. See records from Jackson Clinic, Jackson Madison County General Hospital dated September 2017. A VA examination of April 2016 shows no congestive heart failure, reflects echocardiogram conducted in March 2016 revealing Left ventricular ejection fraction (LVEF) of 60-65 percent. Based on interview, the examiner estimated the Veteran’s METs level to be greater than 3 but less than 5, which was consistent with activities such as light yard work (weeding), mowing lawn (power mower), and brisk walking (4mph). The examiner noted symptoms of dyspnea and fatigue. See Heart Conditions Disability Benefits Questionnaire (DBQ) of April 2016. report. Private treatment records of July 2020 show the Veteran’s treating physician finding “normal left ventricular function”. Another visitation of August 2020 noted the Veteran’s activities included gardening, farm work, and yardwork. See records from Dr. L.C. of Stern Cardiovascular Center dated March to September 2020. In compliance with the Board’s September 2020 remand, the Veteran was afforded a VA contract examination in December 2020. The examiner found no history of congestive heart failure. An echocardiogram revealed LVEF at 50-55 percent. The interview-based METs test indicated the Veteran’s METs level to be greater than 5 but less than 7, which is consistent with activities such as walking 1 flight of stairs, golfing (without car), mowing lawn (push mower), heavy yard work (digging). See Heart Conditions DBQ of December 2020. Based on the objective evidence above, the Board finds the Veteran is adequately compensated by the assigned 60 percent evaluation for the entire appeal period, and a higher rating of 100 percent is not warranted. There is no competent evidence to show that the Veteran has chronic congestive heart failure, a workload of 3 METs or less, or has ejection fraction of 30 percent or less. As noted, April 2016 and December 2020 VA examiners both indicated no history of congestive heart failure. The Veteran has not submitted any evidence to the contrary. As for ejection fraction, objective findings demonstrate that the Veteran’s ejection fraction has remained consistently above 30 percent with ejection fraction ranging from 50 to 65 percent, consistent with a 60 percent disability rating under Diagnostic Code 7017. In fact, the Veteran’s private treating physician in 2017 indicated ejection fraction of 55 to 60 percent and found normal left ventricular function. Likewise, VA examination in 2016 showed LVEF at 60 to 65 percent, and VA contract examination in 2020 showed LVEF at 50 to 55 percent. With regard to METs levels, the Veteran’s METs level are estimated to be greater than 3 but less than 5, which does not meet those levels required to meet the criteria for the next higher 100 percent rating. In summary, when viewed in the context of contemporaneous medical evidence, the Board finds that the evidence is insufficient to show that the Veteran has chronic congestive heart failure, a workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope; or that he has an ejection fraction of less than 30 percent, required for a 100 percent rating. Accordingly, the criteria for an evaluation in excess of 60 percent under Diagnostic Code 7017 are not shown to have been met, and the claim must be denied. Further, the Board has considered whether a staged rating is warranted. Hart v. Mansfield, 21 Vet. App. 505 (2007). However, the Board observes that the Veteran has simply not demonstrated a level of impairment in excess of the 60 percent to warrant staged ratings. Therefore, staged ratings are not warranted. The Board also has considered entitlement to an increased rating pursuant to other schedular criteria for cardiovascular disorders. The Veteran’s disability picture does not, however, more closely approximate other diagnostic criteria or other analogous schedular criteria for such disorders as the remainder of the schedular criteria are the same as those used to rate coronary bypass surgery under Diagnostic Code 7017. 38 C.F.R. § 4.104. Meaning, an increased rating under Diagnostic Codes 7005, 7006 for myocardial infarction and arteriosclerotic heart disease (coronary artery disease) are not warranted for the same reasons that an increased rating for coronary bypass surgery under Diagnostic Code 7017 is not warranted. Based on a review of the foregoing evidence and the applicable laws and regulations, the Board finds that the Veteran’s coronary artery disease, status post coronary artery bypass grafts, symptomatology does not more nearly approximate the criteria required for the next higher 100 percent rating under Diagnostic Code 7017. As a preponderance of the evidence is against the award of an increased rating, the benefit of the doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. An, 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.