ISCHEMIC HEART DISEASE

Summary

The veteran, who served from May 1967 to May 1969, appeals the denial of increased ratings for his service-connected ischemic heart disease (IHD) and chronic kidney disease (CKD), and the grant of Total Disability based on Individual Unemployability (TDIU). The Board found the evidence did not support a rating higher than 30 percent for IHD, as the veteran's workload capacity was estimated at 5-7 METs, with no cardiac dilation, congestive heart failure, or significantly reduced ejection fraction. The Board also denied an increased rating for CKD, as the veteran's eGFR remained above 30 mL/min/1.73 m2 and he did not require dialysis or transplant eligibility. However, regarding TDIU, the Board found the veteran's combined service-connected disabilities, including IHD and CKD, precluded him from substantially gainful employment. The Board applied the benefit-of-the-doubt rule due to relative equipoise between positive and negative evidence concerning unemployability, granting the TDIU claim. The Board noted the private physician's opinion was probative, finding the veteran's cumulative symptoms would impair his ability to obtain or maintain employment.

Rationale

Workload capacity estimated at 5-7 METs.; No cardiac dilation, congestive heart failure, or LVEF < 50%.; VA medical opinions found more probative than lay evidence.

Full Decision Text

Citation Nr: A26007347
Decision Date: 01/27/26	Archive Date: 01/27/26

DOCKET NO. 251022-587354
DATE: January 27, 2026

ORDER

Entitlement to a rating of more than 30 percent for ischemic heart disease is denied.

Entitlement to a rating of more than 60 percent for chronic kidney disease is denied. 

Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is granted. 

FINDINGS OF FACT

1. The symptoms and functional impairment of the service-connected ischemic heart disease most nearly approximated a workload of greater than 5 but not greater than 7 METs (metabolic equivalent). Symptoms include fatigue, dizziness, breathlessness but not angina or syncope. There is no evidence of congestive heart failure. Left ventricular ejection fraction was not less than 50 percent.

2. The symptoms and functional impairment of the service-connected chronic kidney disease most nearly approximated chronic kidney disease with glomerular filtration rate (GFR) from 30 to 44 mL/min/1.73 m2 for at least 3 consecutive months during a 12-month period. The Veteran did not receive regular routine dialysis; and he was not an eligible kidney transplant recipient.

3. The Veteran's service-connected heart and liver disease disabilities prevent him from being able to obtain and maintain substantially gainful employment.

CONCLUSIONS OF LAW

1. The criteria for a disability rating of more than 30 percent for ischemic heart disease are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.100, 4.104, Diagnostic Code 7005.

2. The criteria for a disability rating of more than 60 percent for chronic kidney disease are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.115a, Diagnostic Code 7541.

3. The criteria for a TDIU have been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.15, 4.16, 4.19, 4.25.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 1967 to May 1969.

The rating decision on appeal was issued in November 2024. The modernized review system, also known as the Appeals Modernization Act (AMA), applies. See 38 C.F.R. § 3.2400(a)(1).

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 November 2024 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or 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. 

In December 2021, the Veteran filed a VA Form 21-526EZ Application for Disability Compensation and Related Compensation Benefits seeking increased evaluations of his service-connected ischemic heart disease and chronic kidney disease. In an October 2022 rating decision, both increased rating claims were denied. In September 2023, the Veteran filed a VA Form 20-0996 and requested Higher-Level Review. The increased rating claims were denied in a January 2024 rating decision. In May 2024, the Veteran filed a Supplemental Claim regarding his increased rating claims for ischemic heart disease and kidney disease claims to include TDIU

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,
 rating claims were denied. In September 2023, the Veteran filed a VA Form 20-0996 and requested Higher-Level Review. The increased rating claims were denied in a January 2024 rating decision. In May 2024, the Veteran filed a Supplemental Claim regarding his increased rating claims for ischemic heart disease and kidney disease claims to include TDIU

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. 

Increased Ratings 

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. When a reasonable doubt arises regarding the degree of disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107.

Additionally, it is possible for a veteran to be awarded separate percentage evaluations for separate periods (staged ratings), based on the facts. See Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered because of, or otherwise related to, military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where an increase in the disability rating is at issue, the present level of the veteran's disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994).

However, for claims other than those appealing the initial rating assigned, attention in adjudicating an increased rating claim will be directed to evidence concerning the state of the disability from the period of one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007).

The evaluation of the same disability under several diagnostic codes, known as "pyramiding," must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury, so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other condition. 38 C.F.R. § 4.14.

1. Evaluation of ischemic heart disease 

The Veteran contends that he is entitled to a rating higher than 30 percent for ischemic heart disease (IHD). 

The Veteran's IHD is rated pursuant to 38 C.F.R. § 4.104, Diagnostic Code 7005, and is evaluated in accordance with the General Rating Formula for Diseases of the Heart (General Rating Formula). A 10 percent rating is warranted where a workload of 7.1-10.0 METs results in heart failure symptoms, or continuous medication is required for control. 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., 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.

One MET
 the Heart (General Rating Formula). A 10 percent rating is warranted where a workload of 7.1-10.0 METs results in heart failure symptoms, or continuous medication is required for control. 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., 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.

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).

The Veteran was provided with a VA examination and in a January 2022 VA ischemic heart disease (IHD) Disability Benefits Questionnaire (DBQ) the Veteran was diagnosed with IHD. The Veteran denied any past instances of heart attacks. He has reportedly been treated for hypertension and cholesterol. The condition has remained the same since onset and the Veteran was assessed as stable with the current regimen. The Veteran did not have a cardiac arrythmia or heart valve condition. A physical examination reflected regular rhythm with a heart rate of 104 and blood pressure of 142/70. There was no evidence of cardiac hypertrophy, cardiac dilation, and a June 2016 echocardiogram was reportedly normal. An interview-based MET test was conducted, and the Veteran was assessed as having a range of 5-7 METs. This METs level has been found to be consistent with activities such as walking 1 flight of stairs, golfing (without cart), mowing lawn (push mower), heavy yard work (digging). Left Ventricular ejection fraction (LVEF) was 54%. There was no functional impact related to the IHD noted. 

The Veteran was provided with another VA examination in October 2024. In a DBQ the Veteran was diagnosed with IHD. The Veteran reported symptoms including breathlessness, dizziness, and fatigue. Continuous medication was not required to control the Veteran's heart condition though the Veteran did report taking medication but did not recall the names of his medicine. The Veteran did not have a cardiac arrythmia or heart valve condition. A physical examination reflected regular rhythm with a heart rate of 68 and blood pressure of 130/76. There was evidence of cardiac hypertrophy documented in an August 2022 echocardiogram. There was no cardiac dilation or congestive heart failure. An August 2022 echocardiogram reflected abnormal moderately increased wall thickness. An interview-based MET test was conducted, and the Veteran was assessed as having a range of 5-7 METs. Left Ventricular ejection fraction (LVEF) was 55%. Functional impact related to the IHD was noted and the examiner reported that the Veteran would be restricted to sedentary work. 

The Board finds that at no point does the evidence support a rating of more than 30 percent for the Veteran's ischemic heart disease. The evidence does not otherwise show any cardiac dilation, congestive heart failure, or left ventricular ejection fraction lower than 50 percent. The Veteran's workload capacity was not less than 5.0 METs and there were no episodes of acute congestive heart failure. As such, a higher 60 percent disability rating is not warranted at any time during the period on appeal.

The Veteran is competent to report his readily observable symptoms; however he is not shown to be competent to provide a medical opinion on his condition. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the more probative evidence of record, to include medical testing and expertise, does not indicate that the assignment of evaluations in excess of those presently assigned are warranted.
ricular ejection fraction lower than 50 percent. The Veteran's workload capacity was not less than 5.0 METs and there were no episodes of acute congestive heart failure. As such, a higher 60 percent disability rating is not warranted at any time during the period on appeal.

The Veteran is competent to report his readily observable symptoms; however he is not shown to be competent to provide a medical opinion on his condition. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the more probative evidence of record, to include medical testing and expertise, does not indicate that the assignment of evaluations in excess of those presently assigned are warranted. In so finding, the Board notes that it weighed the lay and medical evidence and finds more probative opinions rendered by VA medical professionals given their expertise in evaluating cardiac disorders. As there is no contrary probative medical evidence favoring an increased disability rating for IHD, the evidence is against a rating of more than 30 percent.

As the evidence of record persuasively weighs the claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Evaluation of chronic kidney disease

The Veteran contends that he is entitled to an evaluation of more than 60 percent for his service-connected chronic kidney disease (CKD). 

The Veteran's CKD is rated pursuant to 38 C.F.R. § 4.115b, Diagnostic Code 7541. Under Diagnostic Code 7541, 7541, chronic kidney disease with glomerular filtration rate (GFR) less than 15 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months; or requiring regular routine dialysis; or eligible kidney transplant recipient is rated 100 percent. Chronic kidney disease with GFR from 15 to 29 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months is rated 80 percent. Chronic kidney disease with GFR from 30 to 44 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months is rated 60 percent. A 30 percent rating is warranted for either chronic kidney  disease with GFR from 45 to 59 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months; GFR from 60 to 89 mL/min/1.73 m2 and either recurrent red blood cell (RBC) casts, white blood cell (WBC) casts, or granular casts for at least 3 consecutive months during the past 12 months; or GFR from 60 to 89 mL/min/1.73 m2 and structural kidney abnormalities (cystic, obstructive, or glomerular) for at least 3 consecutive months during the past 12 months. A noncompensable rating is warranted for GFR from 60 to 89 mL/min/1.73 m2 and albumin/creatinine ratio (ACR) greater than or equal to 30 mg/g for at least 3 consecutive months during the past 12 months. 38 C.F.R. § 4.115a.

The Note under 38 C.F.R. § 4.115a states that GFR, estimated GFR (eGFR), and creatinine-based approximations of GFR will be accepted for evaluation purposes under this section when determined to be appropriate and calculated by a medical professional.

The Veteran was provided with a VA examination in March 2021. He was diagnosed with diabetic nephropathy. The examiner indicated that the Veteran did not require regular dialysis. The only symptom due to renal dysfunction was proteinuria which occurred constantly. There was no colic with infection (pyonephrosis) and no kidney, uretal or bladder calculi (urolithiasis). The Veteran has not had a kidney transplant or removal and was not transplant eligible. BUN results were normal; creatine results were abnormal at 2.15 (normal range from .76 to 1.27) and his eGFR was 34 mL/min/1.73 m2. 

The Veteran was provided with a VA examination in January 2022. He was diagnosed with diabetic nephropathy and chronic kidney disease, stage I. The examiner indicated that the Veteran's current symptoms included steadily increasing creatinine levels, trace protein and low eGFR. The examiner indicated that the Veteran did not require regular dialysis. There was no colic with infection (pyoneph
 bladder calculi (urolithiasis). The Veteran has not had a kidney transplant or removal and was not transplant eligible. BUN results were normal; creatine results were abnormal at 2.15 (normal range from .76 to 1.27) and his eGFR was 34 mL/min/1.73 m2. 

The Veteran was provided with a VA examination in January 2022. He was diagnosed with diabetic nephropathy and chronic kidney disease, stage I. The examiner indicated that the Veteran's current symptoms included steadily increasing creatinine levels, trace protein and low eGFR. The examiner indicated that the Veteran did not require regular dialysis. There was no colic with infection (pyonephrosis) and no kidney, uretal or bladder calculi (urolithiasis). The Veteran has not had a kidney transplant or removal and was not transplant eligible. Creatine results were abnormal at 2.15 (normal range from.76 to 1.27) and his eGFR was 34 mL/min/1.73 m2.  

The Veteran was provided with a VA examination in October 2024. He was diagnosed with chronic kidney disease, stage III.  The Veteran reported not knowing what medication he was taking and reported increased urination. The examiner indicated that the Veteran did not require regular dialysis. There was no colic with infection (pyonephrosis) and no kidney, uretal or bladder calculi (urolithiasis). The Veteran has not had a kidney transplant or removal and was not transplant eligible. His eGFR was 34 mL/min/1.73 m2. 

The treatment records also do not show chronic kidney disease with GFR less than 30 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months; or that the Veteran required regular routine dialysis or is eligible kidney transplant recipient. Treatment records reflect a 37 eGFR in April 2024, and 38 eGFR in January 2024. A March 2024 treatment note from an attending nephrology physician reported "Renal function has been stable over past 3 years and the EGFR is around 30 to 35 cc/min."

At no time did the Veteran require regular dialysis and was not eligible for a kidney transplant. Further, at no time does the record reflect that the Veteran's CKD manifested GFR less than 30 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. As there is no contrary probative medical evidence favoring an increased disability rating for CKD, the evidence is against a rating of more than 60 percent.

As the evidence of record persuasively weighs the claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

3. TDIU

Total disability will be considered to exist where there is present any impairment of mind and body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340. Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow a substantially gainful occupation because of service-connected disabilities, provided that the Veteran meets the schedular requirements.  If there is only one service-connected disability, this disability should be rated at 60 percent or more; if there are two or more disabilities, at least one should be rated at 40 percent or more with sufficient additional service-connected disability to bring the combination to 70 percent or more. 38 C.F.R. § 4.16(a).

In determining whether unemployability exists, consideration may be given to the Veteran's level of education, special training, and previous work experience, but it may not be given to his or her age or to any impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. 38 C.F.R. § 4.16(b); see also Fanning v. Brown, 4 Vet. App. 225 (1993). The Veteran's service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue must be addressed. 38 C.F.R. § 4.16(b).

In Ray v. Wilkie, 31 Vet. App. 58, 73 (2019), the U.S. United States Court of Appeals for Veterans Claims (Court) defined the term
 her age or to any impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. 38 C.F.R. § 4.16(b); see also Fanning v. Brown, 4 Vet. App. 225 (1993). The Veteran's service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue must be addressed. 38 C.F.R. § 4.16(b).

In Ray v. Wilkie, 31 Vet. App. 58, 73 (2019), the U.S. United States Court of Appeals for Veterans Claims (Court) defined the term "unable to secure and follow a substantially gainful occupation" as having two components: one economic and one noneconomic. The economic component means an occupation earning more than marginal income (outside of a protected environment) as determined by the U.S. Department of Commerce as the poverty threshold for one person. The non-economic component includes consideration of the following: the Veteran's history, education, skill, and training; whether the Veteran has the physical ability to perform the type of activities required by the occupation at issue; and whether the Veteran has the mental ability to perform the activities required by the occupation at issue.

The Veteran's IHD has been rated at 30 percent and CKD 60 percent for the entire period on appeal and he was also service connected for other disabilities. Accordingly, the Veteran's service-connected disabilities met the rating percentage threshold for a TDIU. 38. C.F.R. § 4.16(a). The remaining question before the Board was whether the Veteran's service-connected disabilities precluded him from securing or following substantially gainful employment. 38 C.F.R. § 3.321, 3.340, 3.341, 4.16.

The Veteran contends he is unable to work because of his service-connected disabilities. In the Veteran's May 2024 Application for Increased Compensation Based on Unemployability, the Veteran reported that he had not worked since July 31, 2012. He reported last being employed with the Pentagon Police. 

In a September 2024 individual unemployability statement, the VA examiner concluded that the Veteran would be limited to performing sedentary work. Therefore, the Board finds that the Veteran is unable to light, medium or heavy work and its analysis would focus on if the Veteran can perform sedentary work. The Board notes that VA regulations contain many factors to be considered as part of a TDIU analysis. See 38 C.F.R. §§ 4.16, 4.19.  Whether a Veteran can perform "sedentary work" or "sedentary employment" is not among them.  In fact, neither the term nor any similar phrase is mentioned, much less defined, in any relevant VA statute or regulation.

The Board must sufficiently explain how it interpreted the use of the term "sedentary" and how the concept of sedentary work figures into a Veteran's overall disability picture and vocational history. Withers v. Wilkie, 30 Vet. App. 139 (2018). Withers declined to adopt a specific definition of the phrase "sedentary employment" for VA purposes when adjudicating entitlement to a TDIU, but instead held, as noted above, that the Board must provide a definition on a case-by-case basis.  

In this case, the Board will apply the definition used by the Social Security Administration in defining physical exertion in 20 CFR § 404.1567(a). Sedentary work involves lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met. Most unskilled sedentary jobs require good use of the hands and fingers for repetitive hand-finger actions. "Occasionally" means occurring from very little up to one-third of the time. Since being on one's feet is required "occasionally" at the sedentary level of exertion, periods of standing or walking should generally total no more than about 2 hours of an 8-hour workday and sitting should generally total approximately 6 hours of an 8-hour workday. 

The record reflects that the Veteran has a GED and no education beyond the high school level, no vocational training, and no transferrable skills given his work as police officer at the Pentagon would not be relevant to an unskilled sedentary job. The Veteran reporting working as a police officer for the Pentagon Force Protection Agency
 hand-finger actions. "Occasionally" means occurring from very little up to one-third of the time. Since being on one's feet is required "occasionally" at the sedentary level of exertion, periods of standing or walking should generally total no more than about 2 hours of an 8-hour workday and sitting should generally total approximately 6 hours of an 8-hour workday. 

The record reflects that the Veteran has a GED and no education beyond the high school level, no vocational training, and no transferrable skills given his work as police officer at the Pentagon would not be relevant to an unskilled sedentary job. The Veteran reporting working as a police officer for the Pentagon Force Protection Agency until his retirement in 2012 after working there for 42 years. The Veteran reported he felt that he was forced to retire due to being unable to pass required physical examinations and was placed doing light duty performing security in the laundry room for about a year.

In a May 2024 statement, the Veteran described the limitations that his service-connected disabilities have on his ability to perform tasks and daily functioning. He reported his IHD makes him feel like he is going to fall over and that his ability to walk is limited. He reported that his CKD results in frequent use of a restroom. He is also service connected for diabetes, which caused vision issues and neuropathy in his hands, shoulders and feet. The Veteran's spouse also submitted a statement in May 2024, which reported frequent use of the restroom due to the CKD, resulting in daily fatigue and napping during the day. She reported that he was no longer able to perform household tasks or yard work. 

In October 2025, the Veteran's representative submitted an opinion from a private physician. The physician reported reviewing the entire claims file. The private physician reported consulting with the Veteran in October 2025 and discussing with symptoms, including his symptoms. The private opinion reported that his "chronic kidney disease that causes him to experience increased and prolonged episodes of urination that often keeps him up throughout the night with frequent and long trips to the restroom, interrupting his ability to get a good night's sleep and leaves him tired and fatigued, often resulting in multiple naps throughout the day in an effort to catch up on sleep, as well as episodes of nodding off during times of inactivity. He further experiences symptoms of fatigue, lightheadedness, and dizziness as a result of his service connected ischemic heart disease. He reported incidents of standing from a seated position that would cause him to suddenly become dizzy with the sensation of an impending fall." The private physician concluded that the "culmination of symptoms related to the veteran's service connected conditions would impair his ability to return to his previous employment nor obtain or maintain substantial gainful employment in a new field, thus eliminating him from employment in any capacity."

This opinion was assigned probative value as the private physician had access to the claims file and was sufficiently informed of the relevant facts including the Veteran's lay statements, and an interview with the Veteran, so as to be able to form an appropriate medical opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).  

When considering the Veteran's work and education history and physical impairments due to his service-connected IHD and CKD, the evidence is at least in a state of relative equipoise as to whether the Veteran is unable to secure and follow a substantially gainful occupation within the meaning of the applicable regulation. Geib v. Shinseki, 733 F.3d 1350, 1354 (Fed. Cir. 2013) (the "applicable regulations place responsibility for the ultimate TDIU determination on the VA, not a medical examiner"). Accordingly, the Board finds that the combined effects of the Veteran's service-connected IHD and CKD preclude the Veteran from performing even sedentary work due to symptoms including fatigue, dizziness, limitations with the ability to walk, etc. The combined effect of these service-connected disabilities, which create serious limitations in concentration and focus needed to perform work tasks, along with the Veteran's limited education and lack of transferable vocational skills, realistically mean that the Veteran is unable to perform even sedentary work.  

The Board finds that there is at least an approximate balance of positive and negative evidence regarding the question of whether the Veteran's service-connected disabilities render him incapable of securing or following substantially gainful employment. Consequently, the claim for TDIU benefits is granted.  

 

MICHAEL LANE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	N. Keogh, 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