Citation Nr: 22016322 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 13-03 728 DATE: March 21, 2022 ORDER Entitlement to an initial disability rating in excess of 30 percent from July 1, 2001, to April 29, 2003, for ischemic heart disease (IHD) is denied. Entitlement to a disability rating in excess of 30 percent from November 1, 2003, to February 22, 2010, for IHD is denied. Entitlement to a disability rating in excess of 60 percent from February 23, 2010, for IHD is denied. FINDINGS OF FACT 1. From July 1, 2001, to April 29, 2003, the Veteran's IHD was not manifested by more than one episode of acute congestive heart failure in the past year; workload greater than 3 METs but no greater than 5 METs; or left ventricular ejection fraction (LVEF) of 30 to 50 percent. 2. From November 1, 2003, to February 22, 2010, the Veteran's IHD was not manifested by more than one episode of acute congestive heart failure in the past year; workload greater than 3 METs but no greater than 5 METs; or left ventricular ejection fraction (LVEF) of 30 to 50 percent. 3. From February 23, 2010, the Veteran's IHD hs not been shown to result in dyspnea, fatigue, angina, dizziness, or syncope with a workload of 3 metabolic equivalents (METs) or less; or left ventricular dysfunction with an ejection fraction of less than 30 percent. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating in excess of 30 percent from July 1, 2001, to April 29, 2003, for IHD have not been met. 38 U.S.C. § 5107; 38 C.F.R. § 4.104, Diagnostic Code 7005. 2. The criteria for a disability rating in excess of 30 percent from November 1, 2003, to February 22, 2010, for IHD have not been met. 38 U.S.C. § 5107; 38 C.F.R. § 4.104, Diagnostic Code 7005. 3. The criteria for a disability rating in excess of 60 percent from February 23, 2010, for IHD have not been met. 38 U.S.C. § 5107; 38 C.F.R. § 4.104, Diagnostic Code 7005. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from July 1968 to July 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) which granted service connection for ischemic heart disease and assigned an initial 100 percent evaluation from April 11, 2001; 10 percent from July 1, 2001; 100 percent from April 30, 2003; 10 percent from November 1, 2003; and 60 percent from February 23, 2010. An August 2020 rating decision increased the Veteran's rating from 10 percent to 30 percent from July 1, 2001, to April 29, 2003, and from November 1, 2003, to February 22, 2010. An August 2012 rating decision separately awarded a total disability rating based on individual unemployability (TDIU) effective June 30, 2011. In November 2021, the Board remanded the claim for the RO to consider evidence that was added to the claims file after the issuance of an August 2020 supplemental statement of the case (SSOC). The Board finds that the remand directives have been substantially complied with (SSOC was issued in November 2021) and therefore will proceed with a decision. Increased Rating Disability ratings are determined by application of the criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; see generally 38 C.F.R. § Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating applies. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. 1. IHD The Veteran has been assigned 30 percent ratings for his service-connected IHD from July 1, 2001, to April 29, 2003, and from November 1, 2003, to February 22, 2010, and a 60 percent rating from February 23, 2010, under Diagnostic Code 7005, for arteriosclerotic heart disease (coronary artery disease). Under Diagnostic Code 7005, a 30 percent rating is warranted for workload of greater than 5 METs but not greater than 7 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. A 60 percent evaluation 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 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 is 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. One metabolic equivalent (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. From July 1, 2001, to April 29, 2003, and from November 1, 2003, to February 22, 2010 VA treatment records show that following the Veteran's myocardial infarction in March 2001, his treatment plan included continuous medication of aspirin and beta blockers from July 1, 2001, to April 29, 2003. From November 1, 2003, to February 22, 2010, the Veteran was required to continue with his medications and beta blockers. In a March 2020 report, a VA examiner stated that after reviewing the Veteran's medical records from July 1, 2001, to April 29, 2003, and from November 1, 2003, to February 23, 2010, there was no additional functional loss and that the Veteran's METs score was estimated to be greater than 5 but less than 7 due to his service-connected heart condition. The Board finds the examiner's opinion to be both adequate and highly probative as to the question of the severity of the Veteran's disability during the periods in question. The opinion contains sufficient information for the Board to make an informed decision, and is directly responsive to the rating criteria for the issue. Accordingly, with consideration of the medical evidence during both periods, there is no evidence of congestive heart failure, a workload not greater than 5 METs, or left ventricular dysfunction with an ejection fraction of 30 to 50 percent, that would warrant a higher 60 percent rating. Thus, disability ratings higher than 30 percent from July 1, 2001, to April 29, 2003, and from November 1, 2003, to February 22, 2010, are not warranted. From February 23, 2010 A February 2010 VA examination report shows that the Veteran did not have a history of congestive heart failure. The examiner indicated that the Veteran's ejection fraction was 45-50 percent and that the estimated level of METs was 10. An October 2011 VA examination report indicated that the Veteran did not have congestive heart failure. The Veteran's ejection fraction was 50 percent and his estimated METs level was 10.1. A September 2016 VA examination report showed no history of congestive heart failure. Ejection fraction was 49 percent at rest and 51 percent during stress. His METs level was estimated to be greater than 5 but less than 7, which was consistent with activities such as walking one flight of stairs, golfing, mowing the lawn and heavy yard work. A July 2019 VA examination report indicated no history of congestive heart failure. Ejection fraction was 51 percent. Interview based METs test was determined to be greater than 5 but less than 7, which was consistent with activities such as walking one flight of stairs, golfing, mowing the lawn and heavy yard work. The Board finds each of these examinations adequate and probative as to the question of the proper disability rating. These reports were based on in-person examinations, contain information directly relevant to the rating criteria in question, and contain sufficient information for the Board to make a decision. (Continued on next page) From February 23, 2010, 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 7005 are not shown to have been met from February 23, 2010, and the claim must be denied. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Henriquez, 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.