CORONARY ARTERY DISEASE (CAD)

Summary

The Veteran, who served from January 2003 to October 2009 and again from October 2012 to July 2022, appeals the denial of an increased disability rating for service-connected coronary artery disease (CAD). The July 2022 rating decision granted an initial 10 percent disability rating for CAD, effective August 1, 2022. The Veteran elected the Evidence Submission Docket, limiting the Board's review to evidence of record at the time of the July 2022 rating decision and evidence submitted within 90 days of the June 2023 appeal request. The Board reviewed the updated rating criteria for heart disease effective November 14, 2021, which applies to this claim. The Veteran's CAD is rated under Diagnostic Codes 7005-7006. The evidence indicated the Veteran experienced a myocardial infarction during service and was diagnosed with CAD. A subsequent VA examination in April 2022 noted the diagnosis and the need for continuous medication for control, but found no further heart failure symptoms, arrhythmias, or functional impact. The examiner's METs test did not elicit symptoms, and the Veteran denied experiencing cardiac symptoms with physical activity. The Board found the evidence persuasive against a rating higher than 10 percent, as the condition was controlled by medication and lacked current symptoms or functional impact, adhering to the principle that the present level of disability is the primary consideration. Service connection for CAD is maintained at 10 percent.

Rationale

Condition controlled with continuous medication; No further heart failure symptoms or functional impact noted; VA examination did not elicit symptoms at any METs level

Full Decision Text

Citation Nr: A25075491
Decision Date: 09/08/25	Archive Date: 09/08/25

DOCKET NO. 230629-358090
DATE: September 8, 2025

ORDER

Entitlement to an initial rating in excess of 10 percent disabled for service-connected coronary artery disease (CAD) is denied.

FINDING OF FACT

During the time period on appeal, the Veteran's CAD is controlled with continuous medication and does not manifest any related symptomology.

CONCLUSION OF LAW

The criteria for entitlement to an initial rating in excess of 10 percent disabled for service-connected CAD have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7; 38 C.F.R. § 4.104, Diagnostic Code (DC) 7005, 7006.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from January 2003 to October 2009 and from October 2012 to July 2022.

The rating decision on appeal was issued in July 2022 and constitutes an initial decision for the issue on appeal; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.  In the June 2023 VA Form 10182, Decision Review Request: Board Appeal, the Appellant elected the Evidence Submission docket.  Therefore, the Board may only consider the evidence of record at the time of rating decision on appeal and evidence submitted by the claimant within 90 days of the June 2023 VA Form 10182.  38?C.F.R. § 20.302.

The Board notes that the July 2022 rating decision was issued before the Veteran's discharge from service and granted an initial 10 percent disability rating for CAD effective August 1, 2022.  The Veteran elected the Evidence Submission Docket in lieu of other administrative review options such as a supplemental claim.  As a result of this choice, the Board cannot review any evidence of record not before the AOJ in July 2022, or submitted by the Veteran within 90 days of the June 2023 VA Form 10182.  If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence.  38 C.F.R. § 3.2501.  If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision.

1. Entitlement to an initial rating in excess of 10 percent disabled for service-connected CAD

Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4.  The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations.  38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1.

Separate diagnostic codes identify various disabilities and the criteria for specific ratings.  Relevant regulations do not require that all cases show all findings specified by the Schedule; however, findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases.  38 C.F.R. §§ 4.7, 4.21.

If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation.  Otherwise, the lower rating will be assigned.  38 C.F.R. § 4.7.  After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the veteran.  38 C.F.R. § 4.3.

In establishing an appropriate initial assignment of a disability rating, the proper scope of evidence includes all medical evidence submitted in support of the veteran's claim.  Fenderson v. West, 12 Vet. App. 119 (1999).  In cases where an assigned disability rating has been challenged or appealed, it is possible for a veteran to receive a staged rating.  A staged rating is an award of separate percentage evaluations for separate periods, based on the facts found during the appeal period. Id. at 126-28; see also Hart v. Mans
7.  After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the veteran.  38 C.F.R. § 4.3.

In establishing an appropriate initial assignment of a disability rating, the proper scope of evidence includes all medical evidence submitted in support of the veteran's claim.  Fenderson v. West, 12 Vet. App. 119 (1999).  In cases where an assigned disability rating has been challenged or appealed, it is possible for a veteran to receive a staged rating.  A staged rating is an award of separate percentage evaluations for separate periods, based on the facts found during the appeal period. Id. at 126-28; see also Hart v. Mansfield, 21 Vet. App. 505 (2007) (in determining the present level of a disability for any increased evaluation claim, the Board must consider staged ratings).

Effective November 14, 2021, VA amended the rating criteria for heart disease under 38 C.F.R. § 4.104.  86 Fed. Reg. 54089 (Sep. 30, 2021).  This amended regulation applies to all applications for benefits received by VA or that are pending before the AOJ on or after November 14, 2021, such as the claim currently under appeal.

The Veteran's heart disability is rated under DC 7005-7006.  Although a hyphenated code was applied by the AOJ, the criteria for DC 7005 and 7006 are essentially identical.  A 10 percent rating is warranted for a cardiovascular disability like CAD when a workload of 7.1-10.0 METs resulting in heart failure symptoms; or continuous medication required for control.  A 30 percent rating contemplates a workload of 5.1-7.0 METs resulting in heart failure symptoms; or, evidence of cardiac hypertrophy or dilation confirmed by electrocardiogram or equivalent.  A 60 percent rating is warranted where a workload of 3.1-5.0 METs results in heart failure symptoms.  A 100 percent rating is warranted where a workload of 3.0 METs or less results in heart failure symptoms.  38 C.F.R. § 4.104.  

The Board observes that the content of Note (2) and (3) of the General Formula, respectively defining a MET and listing common symptoms of heart failure, were included in the relevant pre-2021 DCs.  The Board also observes that the lowest, 10 percent criteria of the General Formula specifically contemplated the use of continuous medication for control of cardiac symptoms.  Therefore, the Board need not assess the ameliorative effects of any medications when evaluating the Veteran's cardiac disability.  See Jackson v. McDonough, 37 Vet. App. 87 (2023).

Under the General Formula, one 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 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, 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 those symptoms may be used.  Id.  For purposes of the General Formula, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope.  Id. Note (3).

During active service, the Veteran experienced a myocardial infarction.  November 2015 private medical records reflect treatment for the myocardial infarction, and the Veteran was diagnosed with CAD following treatment.

Prior to discharge and prior to the July 2022 rating decision on appeal, the Veteran underwent an April 2022 VA DBQ that noted the Veteran's myocardial infarction and diagnosed CAD.  The Veteran denied experiencing any further episodes of chest pain or other symptoms related to his heart subsequent to the November 2015 myocardial infarction.  The examiner noted that the Veteran required the continuous use of medication to control his heart condition.  The examiner noted no arrhythmia, no heart valve conditions, no infectious heart conditions, and no pericardial adhesions, and the physical examination was normal.  A corresponding April 2022 echocardiogram reflected no evidence of cardiac hypertrophy or cardiac dilation.  It did reflect sinus bradycardia, possible anterolateral ischemia or inferior
 an April 2022 VA DBQ that noted the Veteran's myocardial infarction and diagnosed CAD.  The Veteran denied experiencing any further episodes of chest pain or other symptoms related to his heart subsequent to the November 2015 myocardial infarction.  The examiner noted that the Veteran required the continuous use of medication to control his heart condition.  The examiner noted no arrhythmia, no heart valve conditions, no infectious heart conditions, and no pericardial adhesions, and the physical examination was normal.  A corresponding April 2022 echocardiogram reflected no evidence of cardiac hypertrophy or cardiac dilation.  It did reflect sinus bradycardia, possible anterolateral ischemia or inferior ischemia, and first degree atrio/ventricular block.  The examiner conducted an interview-based METs test, noting that exercise stress testing was not without risk in the Veteran's case.  The examiner noted no METs level that caused heart failure symptoms, and the Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity.  Additionally, the examiner noted no functional impact, indicating the Veteran's CAD did not impact his ability to perform any occupational tasks.  The Board notes that the claims file does not indicate that the Veteran's CAD prevented him from maintaining substantially gainful employment during the time period on appeal.

In this case, the Veteran's diagnosed CAD is controlled with continuous medication and does not manifest any further symptomology during the time period on appeal.  Therefore, the persuasive evidence is against a rating in excess of 10 percent for CAD.  The Board acknowledges the past history of MI, but the primary consideration is the present level of disability.  Francisco v. Brown, 7 Vet. App. 55, 58 (1994).  There is no remaining doubt of material fact to be resolved in the Veteran's favor.  38 U.S.C. § 5107(b). 

 

T. MAINELLI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Howell, Chad

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.