Citation Nr: 21041252 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 10-30 530 DATE: July 8, 2021 ORDER Service connection for posttraumatic stress disorder (PTSD) is denied. Service connection for an acquired psychiatric disorder, including major depressive disorder, is denied. A disability rating in excess of 30 percent from May 9, 2008 to August 27, 2013, and in excess of 60 percent from August 27, 2013 through April 25, 2019 for ischemic heart disease is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has been diagnosed with PTSD in accordance with VA regulations during the period on appeal. 2. The Veteran's acquired psychiatric disorder is not secondary to service-connected prostate cancer and/or ischemic heart disease and is not otherwise related to an in-service injury or disease. 3. For the period of May 9, 2008 through August 27, 2013, the Veteran's ischemic heart disease did not cause more than one episode of acute congestive heart failure in a yearlong span; a 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. 4. For the period of August 27, 2013 through April 25, 2019, the Veteran's ischemic heart disease did not manifest in 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. The criteria for entitlement to service connection for PTSD have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 2. The criteria for entitlement to service connection for an acquired psychiatric disorder, including major depressive disorder, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 3. The criteria for entitlement to a disability rating in excess of 30 percent from May 9, 2008 to August 27, 2013, and in excess of 60 percent from August 27, 2013 through April 25, 2019 for ischemic heart disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.6, 4.7, 4.14, 4.104, Diagnostic Code (DC) 7005. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from September 1969 to May 1971. These matters are before the Board of Veterans' Appeals (Board) from an April 2009 rating decision, a September 2011 rating decision, and a December 2011 rating decision of Department of Veterans Affairs (VA) Regional Offices (RO) (Agency of Original Jurisdiction (AOJ)). This matter was most recently before the Board in December 2020. The Board remanded on these issues to seek addendum opinions and to translate records that were in Spanish. A review of the file reflects that addendum opinions were obtained and the records in question were translated into English. The Board thus finds that the AOJ substantially complied with the remand directives in accordance with Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection Service connection may be granted for a current disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The requirement that a current disability exist is satisfied if the claimant had a disability at the time the claim for VA disability compensation was filed or during the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted, on a secondary basis, for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995) (holding that service connection on a secondary basis requires evidence sufficient to show that the current disability was caused or aggravated by a service-connected disability). In order to prevail under a theory of secondary service connection, there must be: (1) evidence of a current disorder; (2) evidence of a service-connected disability; and, (3) medical nexus evidence establishing a connection between the service-connected disability and the current disorder. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Lay evidence is competent to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994). When a condition is capable of lay observation and may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature." Lay evidence can be competent and sufficient to establish a diagnosis when a layperson (1) is competent to identify the medical condition; or, (2) is reporting a contemporaneous medical diagnosis; or, (3) describes symptoms at the time which supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Although a lay person is competent in certain situations to provide a diagnosis of a simple condition, a lay person is not competent to provide evidence as to more complex medical questions. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Likewise, mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). A veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. See Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (2009). In making its ultimate determination, the Board must give a veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. See Fagan, 573 F.3d at 1287 (quoting 38 U.S.C. § § 5107(b)). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. In evaluating a claim, the Board must determine the value of all evidence submitted, including lay and medical evidence. 38 U.S.C. §§ 1154(a); Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). 1. Entitlement to service connection for PTSD 2. Entitlement to service connection for an acquired psychiatric disorder As an initial matter, the Board observes that the Veteran is seeking service connection for both an acquired psychiatric disorder and PTSD. However, the regulations pertaining to an award of service connection for PTSD are distinct and specific, and require that a diagnosis be offered in accordance with the DSM criteria. The Veteran contends that he has an acquired psychiatric disorder (to include PTSD) as a result of his active duty service in the Army specifically, his service in Vietnam. He asserts that he has been treated by a private physician for PTSD since the early 2000s. Conversely, he suggests that his acquired psychiatric disorder is secondary to his service-connected ischemic heart disease and/or prostate cancer. The record reflects that the Veteran has a current diagnosis of an acquired psychiatric disorder, but not of PTSD. In October 2010, he received a VA examination for PTSD; however, he was not diagnosed with PTSD based on the results of the assessment. Instead, the physician diagnosed him with depressive disorder NOS, stating "Veteran meets the DSM-IV stressor criteria for PTSD, as well as the symptom criteria for persistent re-experiencing the traumatic event and the symptom criteria for persistent hyper arousal. However, he does not fulfill the symptom criteria for persistent avoidance of the stimulus." The Veteran's private treatment records, primarily handwritten in Spanish, were largely deemed illegible by the verified translation expert. However, the parts that were transcribed reflect entries describing symptoms of depression and anxiety. His CAPRI VA treatment records include diagnoses of depression and major depressive disorder. A diagnosis of moderate major depressive disorder was also documented during a May 2014 VA examination and an April 2019 VA examination, the latter of which explicitly stated that the Veteran did not meet the DSM-V criteria for PTSD. The Board is cognizant that its October 2017 decision referenced a diagnosis of PTSD by Dr. L. at San Juan VA Medical Center. However, upon further review, these records state "rule out PTSD," indicating further testing was required to accurately and definitively diagnose the Veteran's psychiatric condition. A comprehensive assessment was thereafter performed in July 2014. The Veteran scored a 76 on a PTSD checklist (which includes the 17 DSM-IV symptoms of PTSD) where a score of 50 is positive in military populations. The psychologist nonetheless documented moderate recurrent major depressive disorder based on DSV-V criteria. VA had previously adopted the American Psychiatric Association: Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), for rating purposes. VA implemented DSM-V, effective August 4, 2014, and the VA Secretary determined that DSM-V applies to claims certified to the Board on and after August 4, 2014. See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). This claim was certified to the Board on April 24, 2017 and as such, the DSM-V applies. Regardless, the psychologist, even after accepting the findings of the PSTD checklist, recorded a diagnosis of major depressive disorder, indicating that a diagnosis of PTSD was not warranted. It is also critical to note that nowhere else in the record does the evidence suggest that the Veteran has a current diagnosis for PTSD offered per the DSM. Indeed, a January 2021 opinion provided by the physician who performed the April 2019 VA examination stated: "The Veteran meet[s] the DSM-V stressor criteria for [PTSD] which is combat experience (Vietnam). Although he does not meet the DSM-V symptoms criteria for a diagnosis of PTSD. The Veteran does not fulfill the symptoms criteria for persistent re-experiencing the traumatic event, nor the symptoms criteria for avoiding reminders of the trauma, nor the symptoms criteria for increased anxiety and emotional arousal related to military service. Neither did the military service nor the trauma exposure cause impairment in marital relation, parenting performance, social, occupational nor other areas of functioning. There is no change in functional status or in quality of life due to trauma exposure. Therefore, a diagnosis of PTSD cannot be done." The examiner included in his report that the Veteran did not have PTSD during any point of the appeals period. Based on this opinion, as well as the other evidence of record, the Veteran's claim for PTSD must be denied, as a diagnosis has not been offered in accordance with VA regulations at any time. 38 C.F.R. § 3.304(f). The Board, however, does find that the Veteran has a current diagnosis of major depressive disorder. Moreover, the Board acknowledges that the Veteran is presently service-connected for ischemic heart disease and prostate cancer, both of which are currently evaluated as 100 percent disabling. Nonetheless, the evidence of record does not establish that the Veteran's major depressive disorder is etiologically related to his ischemic heart disease and/or prostate cancer. The examiner who performed the April 2019 VA examination stated that his "neuropsychiatry condition" is not related to, aggravated by, or secondary to his service-connected conditions, explaining that the Veteran's private physician identified his job as his stressor and there is no relation to his service-connected conditions. He acknowledged, though, that any mental disorder, to include the Veteran's major depression, can be temporarily or permanently worsened beyond its natural progression by a cancer diagnosis. In a February 2021 addendum opinion, he explained: "In any cancer diagnosis and/or treatment is frequently found an 'acute' adjustment disorder with anxious and/or depressed mood. In [the] Veteran's case having a baseline history of major depression before his cancer treatment, the reported increased anxiety symptoms of his major depression spectrum was temporary and not to the level that need increasing antidepressive. It was the contrary 'mental' medication was decreased by 50 percent and there was no evidence any 'new or acute' adjustment disorder with the cancer diagnosis/treatment. At present, the temporary worsen[ed] anxiety symptoms with the cancer treatment are resolved, no evidence of any new mental diagnosis as per [January 2021] assessment..." Disability which is proximately due to or the result of a service-connected disease or injury also shall be service-connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310. As to the aggravation component, secondary service connection does not require a "permanent worsening" of disability but rather whether a service-connected disability results in any additional functional impairment associated with the nonservice-connected disability. See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019); Saunders v. Wilkie, 886 F.3d. 1356, 1363 (Fed. Cir. 2018); Garner v. Tran, U.S. App. Vet. Claims LEXIS 81 (Jan. 26, 2021). Based on this opinion, as well as the other medical evidence of record, the Board finds that the Veteran's major depressive disorder was not proximately due to or caused by his ischemic heart disease or prostate cancer. While he did experience temporarily increased symptoms as a result of his diagnoses, these diagnoses did not seemingly result in additional functional impairment. Indeed, the examiner stated, "there was a temporary increase of anxiety...due to his cancer surgery, but no gross change in his social, family, occupational, nor economic areas was found. There was a 50 percent reduction in his mental medication treatment at that time." Thus, any perceptible worsening of his symptoms was due to a change in his medications and did not result in any additional functional impairment. On this basis, the Board therefore is unable to grant secondary service connection for an acquired psychiatric disorder. Moreover, the Board must deny the Veteran's claim under the theory of direct service connection as well. The Veteran's service treatment records (STRs) do not include reference to any nervous condition or psychiatric treatment during service. CAPRI VA treatment records, however, suggest that he "[has a] tendency to brood and ruminate about experiences in Vietnam." Nonetheless, the May 2014 VA opinion suggests it is less likely than not that the Veteran's major depressive disorder is due to or the result of his active duty service. The examiner rationalized, "There is no evidence of psychiatric complaints, psychiatric findings, nor psychiatric treatment prior to military service...during military service...[or] within one year after discharge from the military...Veteran started private psychiatric treatment in 2002." The VA examiner who performed the April 2019 VA examination also cited to similar evidence when opining it was less likely than not that the Veteran's major depressive disorder was incurred in or caused by his active duty service. Private treatment records document that the Veteran's initial consults with his mental health provider did revolve around stress pertaining to his job. Based on the aggregate evidence of record, the Board finds that it is unable to award entitlement to service connection for an acquired psychiatric condition under the theory of direct service connection. Even if the claimed in-service incurrences were conceded, there is no direct nexus thereto. In offering this finding, the Board acknowledges the Veteran's contention that his current psychiatric condition is related to service. However, he is not shown to possess the training or expertise to offer a competent opinion as to complex medical matters, including the etiology of a medical condition. Layno v. Brown, 6 Vet. App. 465, 469 (1994); Jones v. West, 12 Vet. App. 383, 385 (1999) (where the determinative issue is one of medical causation or a diagnosis, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue). Further, the Veteran's competent testimony was contemplated by his medical examiners who repeatedly found no nexus to his current psychiatric condition, whether on direct or secondary bases. Rather, the preponderance of the evidence is against the claims such that the benefit-of-the-doubt rule is not applicable, and the appeals seeking service connection for an acquired psychiatric disorder and PTSD are hereby denied. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All reasonable doubt as to the degree of disability is resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. In determining the propriety of the initial rating assigned after a grant of service connection, the evidence since the effective date of the grant of service connection must be evaluated and staged ratings must be considered. Staged ratings are appropriate when the evidence establishes that the claimed disability manifested symptoms that would warrant different ratings for distinct time periods during the course of the appeal. Fenderson v. Brown, 12 Vet. App. 119, 12627 (1999). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other condition. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994); Amberman v. Shinseki, 570 F.3d 1377, 1381 (Fed. Cir. 2009). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. In evaluating a claim, the Board must determine the value of all evidence submitted, including lay and medical evidence. 38 U.S.C. § 1154(a); Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). 3. Entitlement to a disability rating in excess of 30 percent from May 9, 2008 to August 27, 2013, and in excess of 60 percent from August 27, 2013 through April 25, 2019, for ischemic heart disease The Veteran's ischemic heart disease is evaluated pursuant to 38 C.F.R. § 4.104, DC 7005, providing the criteria for arteriosclerotic heart disease. Under DC 7005, a 10 percent rating is warranted where a workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication required. A 30 percent rating is warranted where 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 dilation on electrocardiogram, echocardiogram, or X-ray. A 60 percent rating is warranted 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. A 100 percent rating is warranted 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. One MET 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. 38 C.F.R. § 4.104, Note (2). 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. Id. As an initial matter, the Board observes that the Veteran is in receipt of a 100 percent disability rating for ischemic heart disease from April 25, 2019. As such, the Board will only analyze whether the Veteran is entitled to an increased disability rating through that date, as 100 percent represents the highest rating one can receive. May 9, 2008 through August 27, 2013 The evidence of record reflects the following as it pertains to the Veteran's ischemic heart disease from May 9, 2008 through August 27, 2013. The Veteran filed his claim for a heart condition on May 9, 2008, contending that he was treated for this condition "right after service." Private treatment records reflect that in August 2002, he was diagnosed with coronary artery disease by Dr. L.M.F. These records also included treatment notes from 2007, providing that the Veteran was not experiencing shortness of breath or chest pain. Nonetheless, his claim was denied in an April 2009 rating decision, with the AOJ rationalizing that the condition did not occur in service, nor was it caused by active duty. Thereafter, the Veteran submitted a Notice of Disagreement and VA treatment records were associated with his file, indicating that he was deemed "clinically stable" from a cardiovascular standpoint as late as May 2002. Subsequent treatment notes from April 2003 reflected a diagnosis of coronary artery disease, however, though he denied symptoms including chest pain and dyspnea. In September 2010, the Veteran received a VA examination for his heart condition. The examiner recorded the following as the Veteran's medical history: "[Veteran has a] history of coronary artery disease diagnosed in 2002 by private cardiologist. Report that a cardiac catheterism was done and found with coronary artery disease and stent were place on two vessels. Report that following year another cardiac catheterism was done due to chest pain but found normal. Report that has not developed further episodes of chest pain after cardiac catheterism. Report that continue under treatment with cardiologist and recently his medications for high blood pressure were increased. Denies history of smoking, chest pain, fatigue, dizziness, or syncope." He also documented the findings of a perfusion study in 2002, which stated: "[There is] scintigraphic evidence suggesting the presence of moderate reversible perfusion changes on the anterolateral wall of the left ventricle as seen with myocardial ischemia for the heart rate obtained." The examiner then recorded a diagnosis of ischemic heart disease. The Veteran's private cardiologist Dr. L.M.F. submitted a Disability Benefits Questionnaire (DBQ) in December 2010. He documented that the Veteran has cardiac dilation based on the findings of an echocardiogram with an ejection fraction of 61 percent. He also included that the Veteran is on continuous medication for his coronary artery disease and that he has not experienced congestive heart failure. Based on diagnostic exercise testing, the Veteran's METs level was estimated to be over 7-10 METs. Additional treatment records from Dr. L.M.F. were provided, reflecting that the Veteran's ejection fractions were consistently over 50 percent. Based on the findings of the VA examination as well as the private treatment records, the AOJ granted entitlement to service connection for ischemic heart disease in a September 2011 rating decision, awarding a 10 percent disability rating based on the Veteran's workload being greater than 7 METs but not greater than 10 METs and resulting in dyspnea, fatigue, angina, dizziness, or syncope, or continuous medication required. The Veteran filed a Notice of Disagreement in September 2012, contending that his heart condition warranted a higher disability rating. CAPRI VA treatment records from this date through August 27, 2013 simply explain he sees a private cardiologist for his condition and does not go into detail regarding his heart problems, including his symptomatology or additional testing. Based on the evidence of record for this time period, the Board finds that the Veteran is not entitled to a rating in excess of 30 percent prior to August 27, 2013. Dr. L.M.F. recorded cardiac dilation following an echocardiogram in the December 2010 DBQ, founding the basis for a 30 percent rating. A 60 percent rating is not warranted because there is no evidence he experienced any episodes of acute congestive heart failure, had a workload greater than 3 METs but less than 5 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or had an ejection fraction of 30-50 percent. For these reasons, the Board finds that a 30 percent disability rating prior to August 27, 2013 is appropriate and contemplates the Veteran's full disability picture during the period on appeal. The claim is denied. August 27, 2013 through April 25, 2019 The Veteran received a VA examination for his heart in February 2014. The examiner documented that the Veteran is on continuous medication for his condition and that he does not have congestive heart failure. Based on an interview with the Veteran, the examiner determined that he experiences dyspnea, fatigue, and angina with a workload over 3 METs but less than 5 METs. He further found no evidence of cardiac hypertrophy or dilation based on a chest x-ray. Following this examination, the AOJ awarded a 60 percent disability rating for ischemic heart disease effective August 27, 2013 in a February 2014 rating decision. Private treatment records from Dr. J.M.'s cardiology office dated November 2014 reflect the Veteran had a "mildly dilated" left ventricle and mild concentric left ventricular hypertrophy with an ejection fraction of over 55 percent. His CAPRI VA treatment records are unremarkable for any changes to his ischemic heart disease until January 2016 when he presented to the emergency room for right sided chest pain. Electrocardiogram results did not show ischemic changes and the chest pain subsided. A stress test was also performed, which also did not reveal evidence of ischemia. The following year, in March 2017, he received an echocardiogram which revealed left ventricular concentric hypertrophy, an ejection fraction of 60-65 percent, and METs over 4. Another echocardiogram was performed in July 2017, which revealed an ejection fraction of 55 to 60 percent and right ventricular dilation. Thereafter, both private and VA treatment records suggest his condition was stable. The Veteran received a VA examination for his heart condition in April 2019. He complained of dyspnea and chest pain on exertion, as well as shortness of breath with minimal efforts such as bathing and changing clothes. The examiner documented that the Veteran is on continuous medication for his condition and that he does not have congestive heart failure. He found no evidence of cardiac hypertrophy, but documented the evidence of cardiac dilation shown via the echocardiogram in July 2017. He also recorded that the Veteran had a normal stress test in March 2019 that showed a left ventricular ejection fraction of 63 percent. Based on an interview with the Veteran, the examiner determined that he experiences dyspnea, fatigue, and angina with a workload over 1 METs but less than 3 METs. However, he estimated that the limitation in METs level is due to multiple conditions, not just his ischemic heart disease. He also determined it is not possible to accurately estimate the percent of METs limitation attributable to each medical condition. Based on the evidence of record for this time period, the Board finds that the Veteran is not entitled to a rating in excess of 60 percent from August 27, 2013 through April 25, 2019. At no point during this period did the Veteran suffer from chronic congestive heart failure or left ventricular dysfunction with an ejection fraction of less than 30 percent. Moreover, it was not until the April 2019 VA examination that the evidence suggests he experienced dyspnea, fatigue, and angina with a workload of 3 METs or less. However, it was determined the Veteran experiences dyspnea, fatigue, and angina with a workload over 3 METs but less than 5 METs, warranting a 60 percent rating. For these reasons, the Board finds that a 60 percent disability rating from August 27, 2013 through April 25, 2019 is appropriate and the Veteran's claim is denied. Briefly, the Board seeks to offer a point of clarification as to the effective date of the current 60 percent rating. Historically, the Veteran was awarded service connection in a September 2011 rating decision. He properly appealed this determination to the Board. While his appeal was pending, the Veteran also attempted to submit an increased rating claim in August 2013. The RO mistakenly accepted this as a new claim (rather than part and parcel of the pending initial rating appeal), and used the August 2013 "claim" date as the effective date of the higher award. In claims for increased disability compensation, the effective date will be the earliest date as of which it is factually ascertainable that an increase in disability has occurred, if the claim is received by VA within one year after that date. Otherwise, the effective date will be the date of receipt of claim or date entitlement arose, whichever is later. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2). Here, it is factually ascertainable that the increase in disability occurred commensurate with the February 2014 VA examination. Thus, the Veteran is in receipt of an earlier effective date for this award than that established under VA regulations. The Board will not take any negative action against the Veteran to correct this effective date, but is prohibited from offering an earlier date on this basis. [CONTINUED ON NEXT PAGE] Of final note, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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). Kate E. Kovarovic Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Victoria A. Banis, 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.