CORONARY ARTERY DISEASE (CAD)

BETHANY L. BUCK · 2026 · Case ID: A26006182

MIXED

Summary

The veteran, who served from March 1970 to October 1971, appeals the denial of an increased disability rating for coronary artery disease (CAD). The veteran was initially service-connected for CAD in February 2011 with a 10 percent rating, which became final. Subsequent claims for increased ratings and TDIU were filed, leading to a 30 percent rating effective September 25, 2020. The veteran contended that his CAD was worse than reflected by the 30 percent rating, particularly from July 25, 2025, onward. The Board reviewed the evidence, including multiple VA examinations and private medical opinions. A March 2024 VA examination was found inadequate due to contradictions with other evidence. A private opinion from Dr. K.G. in March 2025 assessed the veteran's METs level as 3.0-5.0, consistent with the veteran's reports of symptoms with minimal exertion. An August 2025 VA examination assessed METs at 5.1-7.0 with functional impacts, but the Board found the private opinion more persuasive due to its detailed explanation and review of records. The Board found the evidence in equipoise between 3.0-5.0 METs and 5.1-7.0 METs from July 25, 2025, and applied the benefit of the doubt to grant a 60 percent rating from that date. Ratings for prior periods remained at 30 percent and 10 percent respectively.

Rationale

Evidence in equipoise from July 25, 2025, regarding METs level.; Benefit of the doubt applied due to equipoise.; Private opinion from Dr. K.G. assessed METs level as 3.0-5.0.

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7005

Docket No.

251013-584190

Full Decision Text

Citation Nr: A26006182
Decision Date: 01/22/26 Archive Date: 01/22/26

DOCKET NO. 251013-584190
DATE: January 22, 2026

ORDER

From July 25, 2025, entitlement to a rating of 60 percent for coronary artery disease (CAD) is granted.

From September 25, 2020 to July 23, 2025, entitlement to a rating in excess of 30 percent for CAD is denied.

Prior to September 25, 2020, entitlement to a rating in excess of 10 percent for CAD is denied.

FINDING OF FACT

1. From July 25, 2025, the Veteran's CAD was manifested by a workload of greater than three METs but not greater than five METs resulting in heart failure symptoms, but did not manifest by a workload of three METs or less resulting in heart failure symptoms.

2. From September 25, 2020 to July 24, 2025, the Veteran's CAD was manifested by a workload of greater than five METs, but not greater than seven METs resulting in heart failure symptoms, but did not manifest by a workload of greater than three METs but not greater than five METs resulting in heart failure symptoms; more than one episode of acute congestive heart failure in the past year; or left ventricular dysfunction with an ejection fraction of 30 to 50 percent.

3. Prior to September 25, 2020, the Veteran's CAD required continuous medication, but did not manifest by a workload of greater than five METs, but not greater than seven METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray.

CONCLUSION OF LAW

1. From July 25, 2025, the criteria for entitlement to a rating of 60 percent for CAD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.104, Diagnostic Code 7005.

2. From September 25, 2020 to July 24, 2025, the criteria for entitlement to a rating in excess of 30 percent for CAD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.104, Diagnostic Code 7005.

3. Prior to September 25, 2020, the criteria for entitlement to a rating in excess of 10 percent for CAD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.104, Diagnostic Code 7005.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from March 1970 to October 1971.

This matter comes before the?Board of Veterans' Appeals?(Board) on appeal from an August 2025 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In the October 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the August 2025 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

The Veteran's claim for an increased rating for CAD has a lengthy procedural history. The Veteran was originally service connected for CAD in a February 2011 rating decision, which assigned a 10 percent rating, effective November 19, 2009. The Veteran did not file a Notice of Disagreement with this decision within one year. That decision became final.

On
issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

On April 14, 2014, the Veteran filed a new claim for a total disability based on individual unemployability. The RO treated the claim as a request for an increased rating for CAD and continued the Veteran's 10 percent rating in an October 2014 rating decision. In September 2015, the Veteran filed a Notice of Disagreement with the October 2014 rating decision. In February 2018, VA offered the Veteran the opportunity to have his claim adjudicated under the Appeals Modernization Act through a process called the Rapid Appeals Modernization Program (RAMP). In August 2018, the Veteran opted into RAMP and elected to have his claim processed as a Supplemental Claim. The RO issued a rating decision in February 2019 in response to the Veteran's RAMP opt-in and continued the 10 percent rating for CAD.

In February 2020, the Veteran requested Higher Level Review of the February 2019 rating decision. An error was identified during the Higher Level Review, and after additional development, the RO issued a rating decision in October 2020 which increased the Veteran's rating for CAD to 30 percent, effective September 25, 2020. In October 2021, the Veteran requested Higher Level Review of this rating decision. In November 2021, the RO continued the 30 percent rating. The Veteran filed a Supplemental Claim in November 2022, and in February 2023 (with March 1, 2023 notice), the 30 percent rating was again continued. The Veteran filed another Supplemental Claim on March 1, 2024. The 30 percent rating was continued in a June 2024 rating decision. The Veteran filed another Supplemental Claim in June 2025, which was decided in August 2025. This appeal followed in October 2025. Thus, given continuous pursuit, the appeal period before the Board stems from April 14, 2014.

1. From July 25, 2025, entitlement to a rating of 60 percent for CAD

2. From September 25, 2020 to July 23, 2025, entitlement to a rating in excess of 30 percent for CAD

3. Prior to September 25, 2020, entitlement to a rating in excess of 10 percent for CAD

The Veteran contends that his CAD is worse than reflected by his 30 percent disability rating.

Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes.?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 a system or organ of the body to function under the ordinary conditions of daily life including employment.?38?C.F.R. §?4.10.

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 benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability.?38?C.F.R. §§?4.1, 4.2; Schafrath v. Derwinski,?1?Vet. App.?589, 595?(1991).

If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned.?38?C.F.R. §?4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances.?38?C.F.R. §?4.21.

In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staging the ratings." See Fenderson v. West
1).

Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See?Francisco?v. Brown,?7?Vet. App.?55, 58?(1994). For such non-initial increased rating claims, "[t]he relevant temporal focus for adjudicating an increased-rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim." Hart v. Mansfield, 21?Vet. App.?505, 509 (2007);?38?U.S.C. §?5110?(b)(2);?38?C.F.R. §?3.400?(o).?

Given that this is a non-initial rating claim, the Board will look back and review the evidence from April 14, 2013, which is one year prior to the April 14, 2014 claim, which has been continuously pursued to the present.?Francisco, at 58; Hart, at 509;?38?U.S.C. §?5110?(b)(2);?38?C.F.R. §?3.400?(o).?

The Veteran's CAD is currently rated as 30 percent disabling from September 25, 2020, and 10 percent disabling from November 19, 2009, pursuant to 38 C.F.R. § 4.104, Diagnostic Code (DC) 7005.

Effective November 14, 2021, VA amended the rating criteria for arteriosclerotic heart disease (coronary artery disease/CAD) under DC 7005. 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. Claims pending prior to the effective date will be considered under both the pre- and post-amendment rating criteria, and whichever is more favorable to the Veteran will be applied. However, the Board may not apply the post-amendment rating criteria to a period prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Conversely, the Board is not precluded from applying the pre-amendment rating criteria to a period on or after the effective date of the post-amendment rating criteria so long as it was in effect during the pendency of the appeal.

Prior to November 14, 2021, under 38 C.F.R. § 4.104, DC 7005, for CAD, a 30 percent rating is warranted where a workload of greater than 5.0 METs but not greater than 7.0 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; there is cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray.

A 60 percent rating is warranted where there is more than one episode of acute congestive heart failure in the past year, or; a workload of greater than 3.0 METs but not greater than 5.0 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent. This latter requirement is referred to in medical evaluations as left ventricular ejection fraction, or LVEF.

A 100 percent rating is warranted where there is chronic congestive heart failure, or; a workload of 3.0 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent.

Under the pre-amendment rating criteria, one MET is the energy
0 METs but not greater than 5.0 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent. This latter requirement is referred to in medical evaluations as left ventricular ejection fraction, or LVEF.

Under the pre-amendment rating criteria, 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 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.

For the purposes of a 60 percent evaluation, the pre-amendment rating criteria do not require a separate showing of left ventricular dysfunction in addition to an ejection fraction of 30 to 50 percent. Otero-Castro v. Principi, 16 Vet. App. 375, 382 (2002). Additionally, the phrase "30 to 50 percent" means 30 percent through 50 percent. Id. at 380.

For the purposes of a 100 percent evaluation, the pre-amendment rating criteria do not require a separate showing of left ventricular dysfunction in addition to an ejection fraction of less than 30 percent. See id. at 382.

Effective November 14, 2021, under 38 C.F.R. § 4.104, DC 7005, CAD is rated in accordance with the General Rating Formula for Diseases of the Heart. A 30 percent rating is warranted where a workload of 5.1-7.0 METs results in heart failure symptoms, or where there is cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent (e.g., multigated acquisition scan or magnetic resonance imaging). 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.

Under the post-amendment rating criteria, 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 Rating Formula for Diseases of the Heart, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope. 38 C.F.R. § 4.104, Note (3).

Facts & Analysis

In August 2014, the Veteran underwent a VA examination. Continuous medication was required to control the Veteran's CAD. The Veteran did not have congestive heart failure. There was no functional impact due to the Veteran's CAD. METs testing was not performed, as the examiner asserted that it was not a reliable indicator of the Veteran's cardiac status. The Veteran's LVEF was noted to be 61 percent. There was no left ventricle hypertrophy observed via echocardiogram.

The August 2014 VA examination therefore reflects that the Veteran's CAD was not manifested by a workload of greater than 5 METs but not greater than 7 METs that resulted in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray; or 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 that resulted in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent; or 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. The 10 percent rating assigned prior to September 25, 2020 is therefore the correct one.

During a July 2020 Higher Level Review conference, the Veteran reported that shortness of breath affected his employment.

During an October 2020 VA examination, the Veteran reported chest pain, shortness of breath, and fatigue. Continuous medication was required to control the Veteran's CAD. The Veteran did not have congestive heart failure. An exercise stress test was not performed because it was not required as part of the Veteran's current treatment plan and was not without significant risk. Interview based METs testing was assessed to be 5.1-7.0 METs with symptoms of fatigue. Functional impact consisted of fatigue with physical exertion. There was no evidence of cardiac hypertrophy. A September 2020 echocardiogram revealed an LVEF of 65 percent.

In a December 2022 statement, the Veteran reported that he was constantly short of breath. He had chest pains once or twice a week. He was out of breath constantly, particularly when climbing stairs or doing chores. He constantly had to stop and catch his breath, including during sleep.

At a December 2022 VA examination, the Veteran reported fatigue. Continuous medication was required for control of his CAD. An exercise stress test was not performed because it was not required as part of the Veteran's current treatment plan and was not without significant risk. Interview based METs testing was assessed to be 5.1-7.0 METs with symptoms of fatigue. LVEF was 65 percent. The Veteran did not have congestive heart failure. Functional impact consisted of fatigue limiting certain job functions such as climbing a flight of stairs.

During a March 2024 VA examination, the examiner concluded that continuous medication was not required for control of the Veteran's heart condition. Exercise-based METs testing was not performed, though no reason was given as to why it was not performed. Interview estimated METs was 5.0-7.0. There was no functional impact due to the Veteran's CAD.

The Veteran has specifically challenged the adequacy of the March 2024 VA examination. While the examiner is presumed to be competent, the Board agrees that this examination suffers from a lack of probative value. The examiner reached certain conclusions, including that the Veteran's CAD did not require continuous medication and produced no functional impact, that are at odds with the remainder of the evidence in the claims file. The Board therefore assigns low weight to this opinion.

In March 2025, the Veteran submitted a statement in which he reported that since 2020, his heart condition had caused issues with his daily life. He was constantly out of breath most of the day. Walking a city block or climbing one set of stairs was difficult for him. He was not able to wash his car, do light gardening, go to the gym, or ride his bicycle. He had chest pain after any form of exertion. He was winded after climbing stairs, and fatigue was a daily occurrence. He had heaviness in his chest with any vigorous activity. He experienced dizziness when getting up from a sitting or kneeling position. He had shortness of breath when showering, dressing, and walking. He could not do many activities of daily life because of his condition.

Between September 25, 2020 and July 24, 2025, the evidence reflects a workload of 5.1-7.0 METs resulting in heart failure symptoms. This is the METs level assessed by VA examiners in October 2020 and December
go to the gym, or ride his bicycle. He had chest pain after any form of exertion. He was winded after climbing stairs, and fatigue was a daily occurrence. He had heaviness in his chest with any vigorous activity. He experienced dizziness when getting up from a sitting or kneeling position. He had shortness of breath when showering, dressing, and walking. He could not do many activities of daily life because of his condition.

Between September 25, 2020 and July 24, 2025, the evidence reflects a workload of 5.1-7.0 METs resulting in heart failure symptoms. This is the METs level assessed by VA examiners in October 2020 and December 2022. These examiners are competent to form their opinions, which are credible because they are based on an in-person examination of the Veteran, and a review of his records. The evidence also reflects an LVEF of no less than 61 percent at any point during the period on appeal. Even setting aside the inadequate March 2024 VA examination, the remainder of the record reflects that the Veteran's CAD was rated appropriately as 30 percent disabling between September 25, 2020 and July 24, 2025.

On July 25, 2025, Dr. K.G. authored a private opinion regarding the Veteran's CAD. Dr. K.G. noted the Veteran's reports that he had to stop activities due to cardiac compromise. His chest pain required him to stop and rest in order to reduce it. He experienced chest pain and/or dyspnea even with activities that involved less exertion. Since 2020, the effort involved in taking a shower resulted in cardiac symptoms. He was unable to walk the golf course, mow grass, go up and down stairs, or go grocery shopping without limitation. He even experienced dyspnea when cutting up food and had to catch his breath prior to eating. Dr. K.G. formed the opinion that the Veteran's METs level was appropriately assessed as between 3.0 and 5.0.

Dr. K.G. is competent to form the opinion provided. The opinion is credible because it is based upon a full review of the Veteran's medical records and lay statements. Dr. K.G. did not perform an in-person examination of the Veteran, but the conclusions reached are well explained using his statements and records, and the Board has no reason to question Dr. K.G.'s medical assessment, even in the absence of an examination. The Board assigns high weight to the opinion.

In August 2025, the Veteran underwent a VA examination. He stated that he had been having increased shortness of breath, fatigue, and occasional chest pain with exertion. He was winded climbing stairs in his house and had shortness of breath when walking more than a block. He was taking daily medication for his CAD. The examiner concluded that continuous medication was required for control of the Veteran's heart condition. His symptoms produced functional impacts on activity, exercise, and house work due to shortness of breath and fatigue with occasional exertional chest pain.

An exercise stress test was last performed in May 2019. The test did not show ischemia. It indicated normal myocardial perfusion imaging study, with no scintigraphic evidence of ischemia or infarction, as well as normal left ventricular size and wall motion with a post stress LVEF of 79%, which was increased compared to a prior myocardial perfusion study. The test was terminated due to symptoms related to the cardiac condition. An interview-based METs test was performed in July 2025. Symptoms of breathlessness, fatigue, and angina were observed during activity. The METs level was assessed to be 5.1-7.0 METs. The Veteran's METs level was due solely to his CAD. The Veteran had not had congestive heart failure. His echocardiogram LVEF was 65 percent.

The August 2025 VA examiner is competent to form the opinion provided. The opinion is credible because it is based upon an in-person examination of the Veteran, and consideration of both his medical records and his lay statements. The Board assigns high weight to the opinion. The Board also concludes that any error on the part of VA which may be attributed to the inadequate March 2024 VA examination has been cured by the August 2025 VA examination.

From July 25, 2025, the evidence is roughly in equipoise as to whether the Veteran's METs level was 3.0-5.0 or 5.1-7.0. Because the Veteran is entitled to the benefit of the doubt, the Board concludes that as of July 25, 2025, the Veteran's METs level was 3.0-5.0 resulting in heart

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