Citation Nr: 22014306
Decision Date: 03/12/22	Archive Date: 03/12/22

DOCKET NO. 18-53 260A
DATE:       March 12, 2022

ORDER

Entitlement to a disability rating in excess of 30 percent for post-traumatic stress disorder (PTSD) is denied.

Entitlement to a disability rating in excess of 30 percent for ischemic heart disease is denied.

FINDINGS OF FACT

1. The Veteran's PTSD manifested as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).

2. The Veteran's ischemic heart disease manifested as a workload of 5.1-7.0 METs resulting in heart failure symptoms; or evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent (e.g., multi gated acquisition scan or magnetic resonance imaging).

CONCLUSIONS OF LAW

1. The criteria for a disability rating in excess of 30 percent for PTSD are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.130, Diagnostic Code 9411.

2. The criteria for a disability rating in excess of 30 percent for ischemic heart disease are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.104, Diagnostic Code 7005.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1968 to April 1970.

This appeal is before the Board of Veterans' Appeals (Board) from a January 2016 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO) and in November 2021 the Veteran appeared and provided testimony before the undersigned Veteran's Law Judge (VLJ) and a transcript of that hearing is associated with the claims file. 

Increased Rating

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3.

A disability rating may require re-evaluation in accordance with changes in a veteran's condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Nevertheless, where a veteran is appealing the rating for an already established service-connected condition, his present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, when an appeal is based on the assignment of an initial rating for a disability, following an initial award of service connection for this disability, the rule articulated in Francisco does not apply. Fenderson v. West, 12 Vet. App. 119 (1999). Instead, the evaluation must be based on the overall recorded history of a disability, giving equal weight to past and present medical reports. Id. Staged ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). 

1. PTSD

The Veteran seeks entitlement to a disability rating in excess of 30 percent for his PTSD.

The Veteran's PTSD is current rated under 38 C.F.R. § 4.130, Diagnostic Code 9411. A 30 percent disability rating is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events).

A 50 percent disability rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped, speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.

A 70 percent rating is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked inability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships.

A 100 percent rating is warranted where there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations, grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name.

The United States Court of Appeals for the Federal Circuit held that an evaluation under 38 C.F.R. § 4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating." Vasquez-Claudio v. Shinseki, 713 F3d 112, 11617 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather, "serve as examples of the type and degree of symptom, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering "not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas" i.e., "the regulation... requires an ultimate factual conclusion as to the Veteran's level of impairment in 'most areas.'" Vasquez-Claudio, 713 F.3d at 11718; 38 C.F.R. § 4.130, DC 9411.

Further, when evaluating a mental disorder, the Board must consider the "frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission." 38 C.F.R. § 4.126(a). The Board must also "assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of examination." Id.

Turning to the evidence of record, in February and May 2015, VA psychiatry notes indicate his mood was stable, he endorsed anxiety and depression, and denied suicidal and homicidal ideation. A mental status examination did not note any abnormalities or issues.

In July 2015, he underwent a VA PTSD examination report which included a review of the claims file, a recitation of complaints and medical history, and psychiatric examination results. The report determined he experienced occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. He reported a long-term girlfriend whom he had been with for 30 years. The report noted he experienced depressed mood, anxiety, suspiciousness, chronic sleep impairment, and disturbances of mood and motivation. The report noted he was fully alert and oriented, was appropriately dressed, maintained good grooming and eye contact, his speech was logical, he denied experiencing suicidal or homicidal ideation, and his judgement and insight were sound.

As a result of the above examination the RO assigned the Veteran a 30 percent disability rating.

A November 2015 VA psychiatry note indicated he maintained a relationship with a girlfriend and is contemplating moving in together, he voiced complaints related to anxiety and depression which have worsened since 2013. A mental status examination did not note any abnormalities or issues. 

In December 2015, the Veteran underwent a VA PTSD examination report which included a review of the claims file, a recitation of complaints and medical history, and psychiatric examination results. The report determined he experienced occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The Veteran reported being single and retired since 2012. The report noted he experienced depressed mood, anxiety, and chronic sleep impairment. The report noted his speech was normal, his affect and mood were depressed, he denied suicidal and homicidal ideation and delusions or hallucinations. 

Attached to his April 2016 Notice of Disagreement (NOD) he alleged his PTSD has worsened and stated he experienced social anxiety and sleeping difficulties.

In September 2016, a VA psychiatry note indicates he reported depression, irritability, anxiety. and he denied suicidal and homicidal ideation. A mental status examination did not reveal or note any abnormalities or deficiencies. In July 2018, a VA psychiatry note indicates he has symptoms of depression, irritability, decreased interest or pleasure, and social isolation. The record also indicates he denied suicidal and homicidal ideation. 

In October 2018, the Veteran underwent a VA PTSD examination report which included a review of the claims file, a recitation of complaints and medical history, and psychiatric examination results. The report determined he experienced occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The report noted he has a long-term girlfriend and maintains multiple hobbies. He also subjectively reported the following symptoms: irritability, withdrawal from others, feeling "empty", hypervigilance, easily startled, and occasionally experiencing intrusive distressing memories of what he experienced in Vietnam. The report noted he experienced depressed mood, anxiety, suspiciousness, chronic sleep impairment, and denied suicidal and homicidal ideation. A behavioral observations section did not note any abnormalities or issues.

In December 2018, a VA psychiatry note indicates he has moments of irritability, maintains a relationship with his girlfriend, has difficulty maintaining friendships, and he denied suicidal and homicidal ideation. A mental status examination did not note any abnormalities or issues. In June and August 2019, VA psychiatry notes indicate his girlfriend and him are now living together, he has some anxiety and low moods described as "dark times," he experiences anxiety and hypervigilance, and he denied suicidal and homicidal ideation. Mental status examinations did not reveal or note any abnormalities or deficiencies. In September 2019, a VA psychiatry record indicates he reported he had a friend tell him he contemplated suicide and the Veteran wondered to the psychiatrist, "what brings a person to the point of wanting to commit suicide." The Veteran also denied suicidal and homicidal ideation and a mental status examination did not reveal or note any abnormalities or deficiencies. In December 2019, a VA psychiatry record indicates he has his "ups and downs" and continues to have anxiety and depression. The record mentions the same conversation on suicide as in September 2019 and the Veteran denied suicidal and homicidal ideation. A mental status examination did not reveal or note any abnormalities or deficiencies. A suicide risk annual assessment indicates the Veteran denied experiencing thoughts of self-harm in the last 30 days and denied any ideation within the past 6 months. Ultimately, the assessment determined his risk level was "low/nil." In January 2020, a VA psychiatry records indicates he denied depression but endorsed "occasional feelings of 'emptiness.'" The record mentions the same conversation on suicide as in September 2019 and the Veteran denied suicidal and homicidal ideation. A mental status examination did not reveal or note any abnormalities or deficiencies. The assessment section states his anxiety and depression were improving. In April 2020, a VA psychiatry records indicate his mood and anxiety levels have been "about the same" and is "talking to others via the phone." He also reported feelings of "emptiness" and difficulty "with showering sometimes [due to] lack of interest, but forces himself to." The record mentions the same conversation on suicide as in September 2019 and the Veteran denied suicidal and homicidal ideation. A mental status examination did not reveal or note any abnormalities or deficiencies. In July 2020, VA psychiatric records indicate he is "about the same" and has "some low moods a couple of times per week for a couple of hours." The record mentions the same conversation on suicide as in September 2019 and the Veteran denied suicidal and homicidal ideation. A mental status examination did not reveal or note any abnormalities or deficiencies. In December 2020, VA records indicate a Columbia Suicide Severity Rating Scale revealed over the past month he did not have any instances of suicidal ideation. From December 8, 2020, to December 18, 2020, the Veteran was hospitalized due to injuries sustained in a car accident and during this time denied suicidal ideation and any increase in his PTSD symptoms and that he has "several friends, one of whom he lives with."

During the Veteran's November 2021, Board hearing he alleged that about once a week he experiences irritability and suicidal ideation and that he informed his VA psychologist of these symptoms. Specifically he stated:

I've had suicidal tendencies. They've become more often now. I don't know why but I always come to the fact that I'm actually --I always think about the part, at what point does it take you to the --push you over the edge to it, you know what I mean. I figure I don't have the guts to do it but I keep thinking about it. I say, at what moment or what day is it going to push me over the edge to attempt it?

Additionally, during the hearing the Veteran was advised by the undersigned VLJ to check the evidence of record and contact the Board if he believes any of his psychiatric records are not included in the claims file. To date, no response has been received.

A January 2021 VA psychiatry record indicates he is "doing well," experiences increased stress due to covid, and denied suicidal and homicidal ideation. A mental status examination did not reveal or note any abnormalities or deficiencies.

After a review of the claims file in conjunction with the applicable laws and regulations, the Board finds the weight of evidence is against finding the Veteran's PTSD warrants a disability rating in excess of 30 percent.

As previously stated, a 50 percent disability rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped, speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.

Here, the Board acknowledges the Veteran's November 2021 Board hearing statements regarding suicidal ideation. However, the evidence of record simply does not support the Veteran's claims. Indeed, the Veteran continually and repeatedly denied suicidal ideation and at no point endorsed such ideation. Moreover, the record indicates a friend of his endorsed suicidal ideation which lead the Veteran to inquire to his psychiatrist, "what brings a person to the point of wanting to commit suicide?" The Board does not find that this represents a personal statement of ideation, rather, it represents a question related to the general nature of ideation. Indeed, during the times he brings up this point in conversation with the VA psychiatrist, he has always denied experiencing suicidal ideation. As such, the Board finds the Veteran's PTSD has not manifested as suicidal ideation.

Additionally, the evidence of record does not reflect at any point the Veteran suffered from circumstantial, circumlocutory, or stereotyped, speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory; impaired judgment; impaired abstract thinking; or difficulty in establishing and maintaining effective social relationships. Indeed, the evidence indicates he has continually maintained a long-term girlfriend for many years and maintains multiple friendships one in which involved the Veteran living with and caring for a friend. While the Board by no means doubts the veracity of the Veteran's claims or difficulties he experiences with his PTSD, his symptoms simply do not rise to the level and severity contemplated by a 50 percent rating.

In conclusion, the weight of the evidence is against finding his PTSD warrants a disability rating in excess of 30 percent. To the extent that any higher rating is sought, the weight of the evidence is against the claim and the benefit of the doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. Accordingly, the Veteran's claim for a disability rating in excess of 30 percent for PTSD is denied.

2. Ischemic Heart Disease

The Veteran seeks entitlement to a disability rating in excess of 30 percent for his ischemic heart disease. 

During the pendency of the Veteran's claim, the rating criteria found at 38 C.F.R. § 4.104, Diagnostic Code 7005 changed as of November 14, 2021. 

Prior to November 14, 2021, VA regulation, 38 C.F.R. § 4.104, Diagnostic Code 7005, provided the following rating schedule regarding coronary artery disease (CAD), also classified as arteriosclerotic coronary heart disease:

A 100 percent rating was 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.

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 results in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricular dysfunction with an ejection fraction of 30 to 50 percent.

A 30 percent rating was warranted for 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.

Note (1): Evaluate cor pulmonale, which is a form of secondary heart disease, as part of the pulmonary condition that causes it. Note (2): One MET (metabolic equivalent) 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. 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. Note (3): For this general formula, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope.

The phrases "left ventricular dysfunction with an ejection fraction of 30 to 50 percent" (as found in the 60-percent rating) and "left ventricular dysfunction with an ejection fraction of less than 30 percent" (as found in the 100-percent rating) have been specifically defined in Otero-Castro v. Principi, 16 Vet. App. 375, 382 (2002). The Otero-Castro court held that a veteran is entitled to a 60-percent rating by showing "left-ventricular dysfunction" or "left-ventricular ejection fraction of 30% through 50%." Id. at 308, 382. The court concluded that a left-ventricular ejection fraction of 30% through 50% is itself evidence of dysfunction. Id. at 38182. The same analysis applies to the 100-percent rating by analogy.

Notably, 38 C.F.R. § 4.104, Diagnostic Code 7005 uses the word "or," which is disjunctive, within the disability criteria, i.e., 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. Id. The use of the word "or" provides for an independent basis rather than an additional requirement for a disability rating. A veteran need only prove the existence of any one of the listed criteria to satisfy the requirement for a disability evaluation.

After November 14, 2021, 38 C.F.R. § 4.104, Diagnostic Code 7005 was amended, and it now provides as follows:

A 100 percent rating is warranted for workload of 3.0 METs or less results in heart failure symptoms. A 60 percent rating is warranted for Workload of 3.1-5.0 METs results in heart failure symptoms. A 30 percent rating was warranted for workload of 5.1-7.0 METs results in heart failure symptoms; or evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent (e.g., multi gated acquisition scan or magnetic resonance imaging).

Note (1): Evaluate cor pulmonale, which is a form of secondary heart disease, as part of the pulmonary condition that causes it. Note (2): One MET (metabolic equivalent) 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. When the level of METs at which breathlessness, 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, a medical examiner may estimate the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in those symptoms. Note (3): For this general formula, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope.

A noticeable difference following the amendments is that the left ventricular dysfunction with an ejection fraction is no longer part of any of the rating criteria; instead, only METs are included.

Because the Veteran's appeal has been pending prior to these amendments, the Board is required to analyze his claim under both versions of 38 C.F.R. § 4.104, Diagnostic Code 7005, as of November 14, 2021, and whichever criteria is more favorable to the Veteran will be applied. See Ervin v. Shinseki, 24 Vet. App. 318 (2011) (discussing retroactivity and effects of changes in law or regulation during the pendency of an appeal), opinion corrected, 25 Vet. App. 178 (2012).

Turning to the evidence of record, in December 2015, he underwent a VA heart conditions examination report which included a review of the claims file, a recitation of complaints and medical history, and physical examination results. He subjectively reported getting tired "easily," frequent dizziness, and denied shortness of breath and angina. The report determined he was negative for myocardial infarction, congestive heart failure, arrhythmia, a heart valve condition, and pericardial adhesions. An interview based METs test determined he could perform greater than 5-7 METs. 

Based on the above findings, the RO continued the Veteran's 30 percent disability rating. 

A March 2016 VA cardiology note indicates he denied shortness of breath and will start "golfing and riding a bike soon." In December 2016, a VA stress test indicated he achieved a level of 10 METs. A March 2017 VA cardiology note indicates he reported an improved condition and less fatigue and no substernal pain or pressure since last visit. An October 2017 VA cardiology note indicates he had "fatigue with exertion" and had a negative stress test. The report also states, "This symptom has improved... No dyspnea. When he mows the lawn, he feels whole body tiredness and needs to rest." 

In October 2018, he underwent a VA heart conditions examination report which included a review of the claims file, a recitation of complaints and medical history, and physical examination results. He subjectively reported chest pain, fatigue and the record states, "Asking for the increase in disability because, his pain continues." The report determined he was negative for myocardial infarction, congestive heart failure, arrhythmia, a heart valve condition, and pericardial adhesions. His ejection fraction was 55-60 percent. An interview based METs test determined "The Veteran denied experiencing symptoms attributable to cardiac condition with any level of physical activity." The remarks section states, "The claimant says he gets intermittent chest pain. They are most likely due to GI condition or irritation secondary to stent placement... For the VA established diagnosis of ischemic heart disease, there is no change in the diagnosis. At this time the claimant's condition is in remission."

A December 2018 VA cardiology note indicates he "walks regularly and mows the lawn without chest pain, shortness of breath, lightheadedness." A December 2019 VA cardiology note indicates he reported slight chest pain that occurs when walking and improves with rest, he walks regularly, mows his lawn, and shovels snow without any heart symptoms. A June 2020 VA cardiology note indicates he has slight chest discomfort that lasts for a few moments and becomes worse when lifting boxes over his head. He reported he still mows his lawn once a week and "he denied shortness of breath, lightheadedness, or heart palpitations." A September 2020 VA cardiology record indicates he has "intermittent slight chest discomfort" and he denied shortness of breath. He also stated that he tires more easily when mowing the lawn and sometimes has chest pain when performing yard work and he thinks it is muscular. In December 2020, VA records indicate that during his previously mentioned period of hospitalization he described himself as an "active person, mowing his lawn and traversing stairs several times daily. He does not exercise but walks frequently." A February 2021 VA cardiology note indicates he denied chest pain and did not report any symptoms.

During the Veteran's November 2021 Board hearing he stated he has "little pains" that he believes to be his angina.

After a review of the claims file in conjunction with the applicable laws and regulations, the Board finds the weight of the evidence is against finding the Veteran's ischemic heart disease warrants a disability rating in excess of 30 percent.

As previously stated, the criteria for Diagnostic Code 7005 changed and the Board may apply the prior version of Diagnostic Code 7005 to prior to November 14, 2021, but may apply whichever set of criteria is more favorable to periods after November 14, 2021, as this claim was pending prior to this date. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003).

As to his coronary artery disease under the previous version of Diagnostic Code 7005, it provided 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. 38 C.F.R. § 4.104, Diagnostic Code 7005.

Here, at no point has the evidence of record indicated the Veteran's ischemic heart disease manifested symptoms commensurate with the criteria for a 60 percent rating under the prior code at any point during the appeal period. The evidence indicates his METs testing revealed either 5-7 or 10 METs. Indeed, nothing in the claims file indicates he manifested less than 5 METs. Additionally, his most recent VA examination's interview based METs test in October 2018 determined "The Veteran denied experiencing symptoms attributable to cardiac condition with any level of physical activity;" and his ischemic heart disease was in remission. Moreover, there is no medical evidence of an MI, congestive heart failure or an ejection fraction of less than 50 percent at any time during the appeal period. Furthermore, the Veteran is not deemed competent to self-diagnose MI or congestive heart failure, express his percentage of ejection fraction, or express his workload capacity in terms of METs. Lastly, the evidence of record is devoid of any competent or credible medical evidence indicating his disability warrants a 60 percent rating under the prior code at any point during the appeal period.

As to his coronary artery disease under the current version of Diagnostic Code 7005, a 60 percent rating is warranted for Workload of 3.1-5.0 METs results in heart failure symptoms. However, as outlined above, the Veteran's METs testing never resulted in less than 5 METs and most recently in October 2018 was determined to be in remission. Again, the Veteran is not deemed competent to self-diagnose MI or congestive heart failure, or express his workload capacity in terms of METs. Lastly, the evidence of record is devoid of any competent or credible medical evidence indicating his disability warrants a 60 percent rating under the current code at any point during the appeal period.

The Board notes the Veteran has continually complained of chest pain which he alleges is related to his ischemic heart disease; however, the October 2018 VA examiner determined that pain is the result of a "GI condition or irritation secondary to stent placement." As such, a separate rating related to his chest pain is not warranted. 

In conclusion, the weight of the evidence is against finding the Veteran's ischemic heart disease warrants a disability rating in excess of 30 percent. In reaching this decision, the Board has considered the doctrine of reasonable doubt; however, as the weight of the evidence is against the claim, the doctrine is not for application. 38 U.S.C. § 5107. Accordingly, the Veteran's claim for a disability rating in excess of 30 percent for ischemic heart disease is denied. 

 

 

JONATHAN B. KRAMER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Law Clerk, Tyler R. Masters

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.