Citation Nr: 22016199 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 19-18 854 DATE: March 21, 2022 REMANDED Entitlement to a disability rating in excess of 60 percent for bradycardia with implantation of pacemaker, coronary artery disease, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1963 to May 1973. This matter comes before the Board of Veteran's Appeals (Board) from an April 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). As a threshold matter it is observed the Veteran requested a hearing in his VA Form 9, Appeal to the Board. Unfortunately, the Veteran did not attend the scheduled hearing nor has good cause for missing the scheduled hearing been provided. As such, the Board deems the request for a hearing withdrawn. 38 C.F.R. § 20.704. Entitlement to a disability rating in excess of 60 percent for bradycardia with implantation of pacemaker, coronary artery disease (heart disability), is remanded. The Veteran seeks a disability rating in excess of 60 percent for his service-connected heart disability. He asserts he has met the criteria for a higher disability rating due to a workload level of 3 METs or under. See Notice of Disagreement (NOD) and VA Form 9. It should be noted that, during the course of this appeal, the schedular criteria to evaluate coronary artery disease under 38 C.F.R. § 4.104, DC 7005, were amended effective November 14, 2021. See 86 Fed. Reg. 54089 (September 30, 2021). Pertinent to this appeal, the amendments eliminated consideration of left ventricular dysfunction, as measured with ejection fraction percentages, from the rating criteria pertinent to a 60 percent rating and 100 percent rating. The current rating criteria, effective November 14, 2021, only consider the workload the Veteran is able to do without experiencing heart failure symptoms as measured in levels of METs (metabolic equivalent). 38 C.F.R. § 4.104, DC 7005. In January 2018, the Veteran was examined by VA to ascertain the severity of his condition. The examiner that subscribed the examination report found a workload of 3 METs or less resulted in fatigue and dizziness; based on the results of an interview based METs test. See Heart Conditions Disability Benefits Questionnaire dated January 2018 and associated with the claims file in March 2018. However, an Addendum to the Heart Conditions DBQ was associated with the claims file in March 2018. This addendum corrected in part the results of an echocardiogram performed on February 2018 as noted in the Heart Conditions DBQ and clarified the study revealed an LVEF function of between 50 and 55 percent. The subscriber noted that the echocardiogram results were the most accurate reflection of the Veteran's cardiac functional status and included the following instruction: "Please disregard 'the interview based METs as being most reflective of current cardiac status.'" See addendum, associated with the claims file in March 2018. The Heart Conditions DBQ and the addendum report appear to have been subscribed by different providers. There are no recent medical records available in the claims file, and there appear to be no recent medical determinations regarding the level of METs at which the Veteran experiences heart failure symptoms. Further, it is unclear from the addendum whether the interview based METs level was provided in error and should be disregarded or otherwise whether the Veteran reported experiencing heart failure symptomatology with a workload level of 3 METs or less. This must be clarified prior to adjudication, as the METs level is an important consideration in determining the severity of the Veteran's condition per the disability rating schedule. In view of the above, and the recent amendments to the rating criteria, the Board finds the evidence of record needs clarification as to the Veteran's heart-related symptomatology and his cardiac function, to include findings as to the level of METs at which heart failure symptoms manifest. The matter is REMANDED for the following actions: 1. Obtain any outstanding VA medical records. 2. Schedule the Veteran for an examination to determine the severity of his heart condition. a. The examiner is asked to address findings in the previous Heart Conditions DBQ and the addendum of March 2018, regarding the Veteran's cardiac function and estimated METs level, and determine which diagnostic test is more representative of the Veteran's heart disability. b. The examiner is asked to determine the workload or level of METs at which the Veteran experiences heart failure symptoms, currently. If 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. 3. After completing the above requested actions, and any additional notification and/or development deemed warranted, readjudicate the issue on appeal. If the benefit sought on appeal remains denied, furnish to the Veteran and his representative an appropriate supplemental statement of the case that includes clear reasons and bases for all determinations, and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. KRISTI L. GUNN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Gonzalez-Maldonado 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.