Citation Nr: 22051146 Decision Date: 09/08/22 Archive Date: 09/08/22 DOCKET NO. 18-34 784 DATE: September 8, 2022 ORDER Entitlement to an initial rating in excess of 10 percent for coronary artery disease is denied. FINDINGS OF FACT 1. The Veteran's coronary artery disease has not resulted in congestive heart failure. 2. Metabolic equivalent testing (METs) showed that the Veteran developed symptoms at a workload greater than 7 METs but not greater than 10 METS. 3. Echocardiogram results did not show cardiac hypertrophy or dilatation. CONCLUSION OF LAW The criteria for entitlement to an initial rating greater than 10 percent for coronary artery disease are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.100, 4.104, Diagnostic Code 7005. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from November 1972 to July 1984 and from February 2000 to February 2015. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision by a Department of Veterans Affairs (VA) regional office (RO). It was previously before the Board in April 2020 and March 2022. Both times, it was remanded for further development, to include the provision of a VA cardiovascular examination. Now, the Board finds that entitlement to a rating in excess of 10 percent for coronary artery disease is not warranted. Disability ratings are determined by applying the rating criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule) and represent, as far as can practicably be determined, the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. §§ 4.10, 3.321. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA compensation, as well as the whole recorded history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; see generally Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question of which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating is assigned. Id. Here, the Veteran has been rated under Diagnostic Code 7005 for coronary artery disease. Under Diagnostic Code 7005, a 10 percent evaluation is warranted where a workload of greater than seven metabolic equivalent (METs) but not greater than ten METS results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication is required. A 30 percent evaluation 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; there is evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. A 60 percent evaluation is warranted where there has been more than one episode of acute congestive heart failure in the past year; or, a workload of greater than three METs but not greater than five METs results in dyspnea, fatigue, angina, dizziness, or syncope; or, where there is left ventricular dysfunction with a left ventricular ejection fraction (LVEF) of 30 to 50 percent. Finally, a 100 percent evaluation is warranted for chronic congestive heart failure; or, when a workload of three METs or less results in dyspnea, fatigue, angina, dizziness, or syncope; or, where there is LVEF of less than 30 percent. 38 C.F.R. § 4.104, Diagnostic Code 7005. The Veteran was afforded two VA examinations in furtherance of this claim, one in June 2015 and another in September 2020. The Board notes that the Veteran contended that he experienced flare-ups, and the September 2020 VA examination did not note or discuss flare ups. However, a third examination was scheduled, but it was ultimately canceled because the Veteran failed to appear. See June 9, 2022 Exam Request. When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim is rated based on the evidence of record. 38 C.F.R. 3.655(b). Thus, the Board bases its evaluation upon the clinical evidence of record. To the extent that the Veteran has argued he experiences flare ups of his condition, he has not provided any lay evidence regarding the METs equivalent of the severity of his condition. As such, the statements he has provided are not entitled to probative weight and will not be considered. During the June 2015 examination, interview-based METs testing showed that the Veteran experienced dyspnea; however, the Veteran denied experiencing dyspnea with any level of physical activity. No congestive heart failure was found. An echocardiogram revealed a left ventricular ejection fraction (LVEF) of 65 percent and did not reveal cardiac hypertrophy or dilatation. On examination in May 2020, interview-based METs testing showed that the Veteran experienced fatigue at greater than 7-10 METs. Additionally, echocardiogram did not reveal cardiac hypertrophy or dilatation and LVEF of 60-65 percent. The examination did not show that the Veteran had or had ever experienced congestive heart failure. Because the Veteran developed no symptoms on activity at METs levels greater than 5 METs but not greater than 7 METs, did not experience cardiac hypertrophy or dilatation, did not have left ventricular dysfunction with LVEF 30 to 50 percent, and he has no history of congestive heart failure, the Board finds that the severity of the Veteran's service-connected coronary artery disease is adequately contemplated by the 10 percent rating, and the preponderance of the evidence is against assignment of a rating greater than 10 percent. Therefore, entitlement to a rating greater than 10 percent for coronary artery disease is denied. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Z. Sloley, 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.