Citation Nr: 22012285 Decision Date: 03/03/22 Archive Date: 03/03/22 DOCKET NO. 16-04 514 DATE: March 3, 2022 ORDER A 60 percent rating, but no higher, for ischemic heart disease (IHD) prior to October 5, 2018, and a 100 percent rating thereafter is granted. FINDINGS OF FACT 1. Resolving any reasonable doubt in favor of the Veteran, prior to October 5, 2018, his IHD more closely approximated a workload of 3.1 and 5.0 METs resulting in symptoms of heart failure as of his claim for service connection. 2. As of October 5, 2018, the Veteran was diagnosed with chronic congestive heart failure. CONCLUSION OF LAW 1. The criteria for 60 percent rating, but no higher, for IHD prior to October 5, 2018, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.104, Diagnostic Code (DC) 7006. 2. The criteria for a 100 percent rating as of October 5, 2018, for IHD are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.104, DC 7006. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from July 1967 to April 1976. He is the recipient of the Combat Infantryman Badge, Purple Heart, Bronze Star with Valor, Vietnam Campaign Medal, and Vietnam Service Medal. The Veteran appeared at a hearing before a Veterans Law Judge (VLJ) in January 2019. A transcript of the hearing is in the Veteran's file. The VLJ who conducted the January 2019 hearing is now retired from the Board. In July 2021, the Board sent the Veteran a letter asking him if he wished to testify at another hearing before a different VLJ as the VLJ who holds a hearing shall participate in the final determination of the case. The Veteran responded in August 2021 and indicated that he did not wish to appear at an additional Board hearing. Increased Ratings Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 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. Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3. IHD prior to December 23, 2019 The Veteran's IHD is rated pursuant to DC 7006, for myocardial infarction. Effective November 14, 2021, the criteria for rating certain cardiovascular disorders were revised. For Diagnostic Code 7006, there is now a General Rating Formula for diseases of the heart. Claims, such as this, pending prior to the effective date will be considered under both old and new rating criteria from that date, and whichever criteria is more favorable to the Veteran will be applied from that date. Thus, in this matter the prior regulations of DC 7006 are more favorable to the Veteran and apply to his claim prior to his December 23, 2019, 100 percent rating. Under the prior regulations, DC 7006 mandated that a 60 percent rating was 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 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 was warranted for 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. A 100 percent rating is also warranted during and for three months following myocardial infarction documented by laboratory tests. 38 C.F.R. § 4.104, DC 7006. The evidence shows that the Veteran was granted service connection as of May 27, 2008. An October 2010 VA examination noted the Veteran had a history of myocardial infarction (MI) in 1996 which resulted in 5 stents being placed. Subsequently, he had additional MI with stents placed in 1999 and 2001. The Veteran reported dizziness and breathlessness. He was noted to have congestive heart failure. His METs were reported at a 6. The examiner, however, did not indicate if the METs testing was done at the examination or from a prior noted stress tests done in 2009. In his January 2019 hearing, the Veteran testified that he had multiple surgical procedures done on his heart at a private hospital and was diagnosed with chronic heart failure in October 2018. He reported that he had symptoms of dizziness and fatigue and was unable to perform most physical activity due to limitations of his heart. Private medical records show that the Veteran presented to the emergency room in June 2011 with a racing heart and burning chest pain. He was diagnosed with atrial fibrillation and admitted for observation. The Veteran's private treating physician submitted a summary of his medical care in December 2019. The physician reported that the Veteran had the following procedures: 3 stents placed in 2014, ablation in 2015, cardio conversion, 1 stent, and atrial fibrillation in 2015, ablation in 2016, balloon angioplasty in 2017, triple bypass surgery, ablation, and chronic diastolic heart failure in 2018. Specifically, the Veteran was diagnosed with chronic diastolic heart failure on October 5, 2018. The Board notes that diastolic heart failure is a type of congestive heart failure. See Dorland's Illustrated Medical Dictionary, 1791 (32d ed. 2012). Thus, as of October 5, 2018, the Veteran met the criteria for a 100 percent rating. Prior to October 2018, the Board finds that the Veteran's heart condition more closely approximated a 60 percent rating. The Veteran's records document severe heart disability, with multiple procedures, hospitalizations, and limitations on the Veteran's activities of daily living. Considering the totality of the evidence presented, the Board finds that the criteria for a 60 percent rating prior to October 5, 2018, have been met. The Board notes that two prior remands have attempted to obtain more information regarding the specific rating criteria at issue in the Veteran's case to no avail. The Board finds that further Remand would only continue to frustrate the resolution of the Veteran's claim without a high probability of providing more detailed information. In sum, a 60 percent rating prior to October 5, 2018, and a 100 percent rating thereafter for the Veteran's IHD are granted. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Parrish 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.