Case A26040572

L. B. CRYAN · 2026 · Case ID: A26040572

GRANTED

Summary

The Veteran, who served from November 1967 to July 1968, appeals the denial of an initial compensable rating for service-connected bilateral carotid artery stenosis and the dismissal of an appeal related to a supplemental claim for Special Monthly Compensation (SMC) Aid & Attendance (A&A). The Veteran also sought a higher rating for service-connected supraventricular arrhythmia (paroxysmal atrial fibrillation). The Board dismissed the appeal for bilateral carotid artery stenosis as the Veteran withdrew it. For the supraventricular arrhythmia, the Board found that while service connection was granted, the evidence supported only a 10 percent rating, separately from the Veteran's existing heart condition. The Board noted that the initial rating decision improperly combined the arrhythmia with the service-connected ischemic heart disease/coronary artery bypass graft (CABG), which was rated separately. The Board also dismissed the appeal concerning the July 2025 VA letter that informed the Veteran his March 2025 supplemental claim for SMC (A&A) could not be processed without the correct form (VA Form 21-526EZ). The Board found this letter was not an appealable decision and that the Veteran had not reasonably raised an SMC (A&A) claim within the scope of his other appeals, despite his wife's caregiver benefits award. The Veteran was advised to file the correct form to pursue the SMC (A&A) claim.

Special Benefit

SMC - AID & ATTENDANCE

Docket No.

251003-581152

Full Decision Text

Citation Nr: A26040572
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 251003-581152
DATE: April 30, 2026

ORDER

The appeal seeking an initial compensable rating for service-connected bilateral carotid artery stenosis is dismissed.

A separate initial 10 percent rating for service-connected supraventricular arrhythmia, diagnosed as paroxysmal atrial fibrillation, is granted.

The appeal of a July 2025 Department of Veterans Affairs (VA) notification letter to the Veteran that it could not process his March 2025 supplemental claim (VA Form 20-0995) as an application for special monthly compensation (SMC) on account of the need for the regular aid and attendance of another person (A&A) is dismissed.

FINDINGS OF FACT

1. In January 2026, prior to the promulgation of a decision in the appeal, the Board of Veterans' Appeals (Board) received written notification from the Veteran that it was his intent to withdraw his appeal seeking an initial compensable rating for service-connected bilateral carotid artery stenosis.

2. Since the effective date of service connection, the Veteran's supraventricular arrhythmia, diagnosed as paroxysmal atrial fibrillation, has required continuous use of oral medication for control; there have not been more than four episodes per year documented by ECG or Holter monitor, or more than four treatment interventions per year, of paroxysmal atrial fibrillation.

3. In a July 2025 letter, the VA notified the Veteran that it could not process his March 2025 supplemental claim (VA Form 20-0995) as an application for SMC (A&A) because he had to file his claim on the proper form (VA Form 21-526EZ); in October 2025, the Veteran filed VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement), listing the July 11, 2025 VA letter and arguing that he was appealing the VA's refusal to process the March 2025 supplemental claim.

4. In October 2025, the Board erroneously docketed the appeal seeking acceptance of the March 2025 supplemental claim as a valid application for SMC (A&A), which was a claims processing error.

CONCLUSIONS OF LAW

1. Regarding the claim seeking an initial compensable rating for service-connected bilateral carotid artery stenosis, the criteria for withdrawal of an October 2025 VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement) by the Veteran have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for a separate 10 percent, and no higher, rating for service-connected supraventricular arrhythmia, diagnosed as paroxysmal atrial fibrillation, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, Diagnostic Code (Code) 7010 (in effect prior to and from November 14, 2021).

3. As the July 2025 VA letter to the Veteran notifying him that it could not process his March 2025 supplemental claim (VA Form 20-0995) as an application for SMC (A&A) is not appealable to the Board, the criteria for dismissal of the appeal seeking acceptance of the March 2025 supplemental claim as a valid application for SMC (A&A) have been met as a matter of law. 38 U.S.C. §§ 511, 5104, 7104; 38 C.F.R. §§ 3.155, 3.160.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The appellant is a Veteran who served on active duty from November 1967 to July 1968. This case comes to the Board on appeal from an October 2024 rating decision of a VA Regional Office (RO), which is an agency of original jurisdiction (AOJ) that granted service connection for bilateral carotid artery stenosis and supraventricular arrhythmia. This case is also on appeal from a July 2025 VA notification letter informing the Veteran that it would not begin processing his claim for SMC (A&A), which was filed as a supplemental claim on VA Form 20-0995 in March 2025, until he submits it on the appropriate standardized form (VA Form 21-526EZ). The
who served on active duty from November 1967 to July 1968. This case comes to the Board on appeal from an October 2024 rating decision of a VA Regional Office (RO), which is an agency of original jurisdiction (AOJ) that granted service connection for bilateral carotid artery stenosis and supraventricular arrhythmia. This case is also on appeal from a July 2025 VA notification letter informing the Veteran that it would not begin processing his claim for SMC (A&A), which was filed as a supplemental claim on VA Form 20-0995 in March 2025, until he submits it on the appropriate standardized form (VA Form 21-526EZ). The Veteran appealed for higher ratings for the service-connected disabilities and for the VA to accept his March 2025 supplemental claim (VA Form 20-0995) as a valid application for SMC (A&A).

On his October 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran appealed the assigned initial ratings for the service-connected bilateral carotid artery stenosis and supraventricular arrhythmia and the VA's "refusal" to adjudicate his March 2025 supplemental claim for SMC (A&A). He elected the Hearing docket. On the day of the scheduled hearing on January 7, 2026, the hearing was canceled.

Therefore, the Board may only consider the evidence of record at the time of the respective July 11, 2025 VA notification letter and October 2024 AOJ decision on appeal, as well as any evidence submitted by the Veteran or representative within 90 days following the withdrawal (cancelation) of the hearing request on January 7, 2026. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801.

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 claim, 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 compensable rating for service-connected bilateral carotid artery stenosis

The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. Withdrawal may be made by the appellant or by his/her authorized representative. 38 C.F.R. § 20.205. In the present case, the Veteran sent written notification in January 2026, expressing his intent to withdraw his appeal seeking an initial compensable rating for service-connected bilateral carotid artery stenosis. As he has withdrawn his appeal, there remain no allegations of errors of fact or law for appellate consideration. Accordingly, the appeal is dismissed.

2. Entitlement to a separate compensable rating for service-connected supraventricular arrhythmia

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

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 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 of VA shall give the benefit of the doubt to the claimant. 38 U.S.C.
earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

The Veteran has continuously pursued the claim of service connection for atrial fibrillation since August 2, 2021. Historically, the Veteran's claim for service connection for atrial fibrillation, asserted as secondary to a heart disability, was received August 2, 2021. It was initially denied in a September 2022 rating decision, following which the Veteran filed VA Form 20-0996 (Decision Review Request: Higher-Level Review [HLR]), in March 2023. In a May 2023 HLR decision, the AOJ determined that duty-to-assist error had been identified because the VA failed to obtain a VA examination and opinion. Thus, the claim underwent further development, culminating in the October 2024 rating decision on appeal.

Notably, at the time of the filing of the service connection claim on August 2, 2021, service connection had already been established for ischemic heart disease, rated 60 percent, effective December 30, 2012, under 38 C.F.R. § 4.104, Diagnostic Code 7005, for arteriosclerotic heart disease (coronary artery disease). During the pendency of the claim, the Veteran underwent coronary artery bypass graft (CABG) surgery, and a July 2024 rating decision granted both a temporary total (100 percent) convalescent rating pursuant to 38 C.F.R. § 4.30, effective February 16, 2024, and a schedular 100 percent rating from June 1, 2024 under 38 C.F.R. § 4.104, Code 7017, for coronary bypass surgery. The Veteran did not appeal either of those rating assignments or effective dates.

Rather, the Veteran is appealing the October 2024 rating decision, which granted service connection for supraventricular arrhythmia, as associated with the service-connected coronary artery bypass graft (CABG) that was previously rated as ischemic heart disease, effective August 2, 2021. Specifically, the Veteran is seeking a higher initial rating for the newly established supraventricular arrhythmia from August 2, 2021. In the October 2024 decision, the AOJ in evaluating the new service-connected disability essentially combined it with his previously established heart disease, assigning a single 60 percent rating for both conditions from the effective date through February 15, 2024, and then from February 16, 2024 continuing the (maximum) 100 percent rating for the combined disabilities that were recharacterized as CABG to include paroxysmal atrial fibrillation, under 38 C.F.R. § 4.104, Diagnostic Codes 7011-7017. (The Veteran had atrial fibrillation, which is a type of supraventricular arrhythmia.)

As noted, the Veteran's CABG (previously rated as ischemic heart disease), separate and apart from the service-connected supraventricular arrhythmia, is evaluated at 60 percent prior to February 16, 2024, and at the maximum 100 percent from that date. (And when combined with supraventricular arrhythmia, those ratings did not change.) As the Veteran has not expressed any particular disagreement with the ratings assigned for his heart disease alone, the Board will only determine whether he warrants a higher initial rating in light of the newly service-connected supraventricular arrhythmia.

As will be discussed, the Board finds that for the appeal period beginning August 2, 2021, a 10 percent rating is appropriate for the disability, to be assigned separately from the service-connected heart disease. That is because the AOJ improperly combined the heart arrhythmia disability (paroxysmal atrial fibrillation) with his pre-existing heart disease when the rating criteria allows for separate evaluations for these two distinct cardiac disabilities with different manifestations.

Initially, it is noted
change.) As the Veteran has not expressed any particular disagreement with the ratings assigned for his heart disease alone, the Board will only determine whether he warrants a higher initial rating in light of the newly service-connected supraventricular arrhythmia.

Initially, it is noted that during the period of the appeal, VA amended the rating criteria for disabilities of the cardiovascular system, effective November 14, 2021. 86 Fed. Reg. 54089, 54093 (Sep. 30, 2021). This amended regulation applies to all applications for benefits received by VA or that are pending before the RO/AOJ on or after November 14, 2021. Claims pending prior to the effective date, as here, 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 February 16, 2024, the Veteran's ischemic heart disease is rated pursuant to 38 C.F.R. § 4.104, Code 7005, under arteriosclerotic heart disease (coronary artery disease), which is based on criteria involving congestive heart failure, estimated MET's (metabolic equivalent output) levels, left ventricular dysfunction, evidence of cardiac hypertrophy or dilatation, and requirement of continuous medication. From February 16, 2024, his CABG is rated pursuant to 38 C.F.R. § 4.104, Code 7017, in accordance with the General Rating Formula for Diseases of the Heart, which is based on much of the same criteria. Neither of these diagnostic codes contemplates supraventricular arrhythmia, or treatment interventions for it. The rating schedule, both prior to and from the effective date of the amendments to the criteria, in fact separately considers the number of treatment interventions required per year, or the type of treatment, for the Veteran's specific heart arrhythmia (atrial fibrillation). 38 C.F.R. § 4.104, Diagnostic Code 7010 (prior to and from November 14, 2021).

Throughout the appeal period, the VA examination reports and outpatient treatment records show diagnosis and treatment for atrial fibrillation, which is rated under 38 C.F.R. § 4.104, Code 7010, for supraventricular arrhythmias (prior to November 14, 2021) and supraventricular tachycardia (from November 14, 2021).

Under the pre-amended Code 7010, a 10 percent rating is warranted for permanent atrial fibrillation (lone atrial fibrillation), or: one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor. A maximum 30 percent rating is warranted for paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by ECG or Holter monitor.

Under the amended, current Code 7010, a 10 percent rating is warranted for supraventricular tachycardia confirmed by ECG, with one or more treatment interventions per year; or, confirmed by ECG with either continuous use of oral medications to control or use of vagal maneuvers to control. A maximum 30 percent rating is warranted for supraventricular tachycardia confirmed by ECG, with five or more treatment interventions per year.

Note 1 under the current Code 7010 provides that examples of supraventricular tachycardia include, but are not limited to, atrial fibrillation, atrial flutter, sinus tachycardia, sinoatrial nodal
current Code 7010, a 10 percent rating is warranted for supraventricular tachycardia confirmed by ECG, with one or more treatment interventions per year; or, confirmed by ECG with either continuous use of oral medications to control or use of vagal maneuvers to control. A maximum 30 percent rating is warranted for supraventricular tachycardia confirmed by ECG, with five or more treatment interventions per year.

Note 1 under the current Code 7010 provides that examples of supraventricular tachycardia include, but are not limited to, atrial fibrillation, atrial flutter, sinus tachycardia, sinoatrial nodal reentrant tachycardia, atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, atrial tachycardia, junctional tachycardia, and multifocal atrial tachycardia. Note 2 provides that for purposes of this diagnostic code, a treatment intervention occurs whenever a symptomatic patient requires intravenous pharmacologic adjustment, cardioversion, and/or ablation for symptom relief.

Turning to the evidence in this case, the Veteran's reports of VA examinations in November 2021, August 2023, March 2024, and September 2024, as well as his VA and private treatment records, reflect that he is on continuous oral medication (i.e., Eliquis, but at times propafenone, metoprolol, and amiodarone were also documented) for control of his atrial fibrillation, which has been confirmed by ECG. Moreover, such evidence shows that for the review period the Veteran has not undergone any treatment interventions such as cardioversion or ablation. Except for the questionable finding of the November 2021 examiner who noted that the Veteran's atrial fibrillation was "constant" rather than "intermittent (paroxysmal)," his atrial fibrillation has been characterized as paroxysmal. (The 2021 examiner does not explain the inconsistency of her finding that the Veteran's atrial fibrillation was "constant," as opposed to paroxysmal, when her physical examination disclosed that his heart rate was 62 and of a regular rhythm.) At no time has the Veteran experienced more than four episodes of paroxysmal atrial fibrillation per year as documented by ECG or Holter monitor.

After reviewing the pertinent records, the Board concludes that from the beginning of the period on appeal the evidence supports a separate 10 percent rating for the Veteran's paroxysmal atrial fibrillation under both the old and the revised Code 7010. This is based on the evidence demonstrating the presence of paroxysmal atrial fibrillation confirmed by ECG with continuous use of oral medications to control. However, the evidence does not support a rating in excess of 10 percent under either the old or revised Code 7010 because there are not more than four episodes per year documented by ECG or Holter monitor, or more than four treatment interventions per year.

As the evidence is persuasively in favor of the Veteran's claim, a separate 10 percent rating, but no higher, for paroxysmal atrial fibrillation under Code 7010 is warranted.

3. Whether a July 2025 VA notification letter to the Veteran that it could not process his March 2025 supplemental claim (VA Form 20-0995) as an application for SMC (A&A) is an appealable decision

By way of background, the Veteran was in pursuit of higher ratings for service-connected supraventricular arrhythmia and bilateral carotid artery stenosis when, in March 2025, he filed a supplemental claim (VA Form 20-0995), asserting entitlement to SMC (A&A) due to his cardiovascular disabilities. He noted that his wife was awarded VA caregiver benefits via VA's PCAFC (Program of Comprehensive Assistance for Family Caregivers) in December 2024 based on his cardiovascular disabilities. In a May 2025 letter, the VA acknowledged his "correspondence" indicating his intent to file a claim for SMC (A&A) but informed him that to begin processing his application for SMC (A&A) he had to file his claim on the proper form, specifically VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits.

In response to the VA's May 2025 letter, the Veteran in June 2025 re-submitted his March 2025 supplemental claim. In an attached statement, the Veteran's attorney argued that the Veteran's supplemental claim for SMC (A&A) was "valid" and met the requirements of 38 C.F.R. § 3.2501 for the submission of new and relevant evidence. In particular, the new and relevant evidence was the acceptance of the Veteran's wife into the PCAFC, which he maintained served as evidence of the Veteran's need for the regular aid and attendance of another person (A&A). He argued that the supplemental claim was "not a new claim, but a continuation of the Veteran's ongoing appeal" regarding the severity of his service-connected disabilities. He stated that A&A benefits were "directly tied" to the Veteran's functional limitations of his service-connected disabilities. (He reiterated his argument in correspondence received in April 2026, which he attached to extensive copies of VA treatment records dating back to 2008.)

In a July 11, 2025 letter, the VA acknowledged the Veteran's "correspondence" indicating his intent to file a claim for SMC (A&A) but again informed him that to begin processing his application for SMC (A&A) he had to file his claim on the proper form, specifically VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits.

In October 2025, the Veteran submitted VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), electing the Hearing docket. On the form, he sought Board review of the July 11, 2025 VA letter, asserting that he was appealing "VA's refusal to establish and adjudicate" the Veteran's March 2025 supplemental claim. After receiving the Veteran's October 2025 VA Form 10182, the Board erroneously docketed the appeal in October 2025, as will be explained.

In this case, the Veteran, with his filing of a VA Form 10182, is attempting to appeal an AOJ administrative notice letter regarding a claims-processing deficiency and not an AOJ decision on the merits of a claim that would be subject to review on appeal. See 38 U.S.C. § 511 (stating that the Secretary shall decide all questions of law and fact necessary to a decision under a law that affects the provision of benefits to veterans); 38 U.S.C. § 5104 (providing the requirements of a notice of a decision by the Secretary). The July 11, 2025 VA letter, which did not contain any notice of appellate rights, is not an appealable decision.

Furthermore, the VA notice letter of July 2025 was not analogous to a grant or denial of any benefits, and the Veteran has not alleged such. The AOJ merely informed him of what he must file to have his claim processed. The Board's dismissal of the appeal in this matter would not be tantamount to foreclosing an opportunity of the Veteran to seek SMC A&A benefits. In fact, he has been informed, not once but twice, of how to complete his claim by filing it on the proper form (via the postal service or online), yet he has still not done so. It is perplexing as to why the Veteran's attorney did not simply follow the AOJ's direction to submit a proper form.

The Veteran's attorney is essentially arguing that the claim for SMC (A&A) is contemplated within the scope of the claims for higher ratings for the cardiovascular disabilities (as decided hereinabove). The Board rejects this argument. A SMC (A&A) claim has not been reasonably raised through the appeal seeking higher ratings for the supraventricular arrhythmia and bilateral carotid artery stenosis. Nor is it reasonably raised in the Veteran's pursuit of other claims that resulted in an award of a 100 percent rating for CABG by a July 2024 rating decision. It is not implied that a veteran with a 100 percent schedular rating necessarily requires A&A. The Veteran did not assert a claim for SMC (A&A) when he was seeking a higher rating for ischemic heart disease that resulted in surgery (CABG) in February 2024, and the AOJ
The Board rejects this argument. A SMC (A&A) claim has not been reasonably raised through the appeal seeking higher ratings for the supraventricular arrhythmia and bilateral carotid artery stenosis. Nor is it reasonably raised in the Veteran's pursuit of other claims that resulted in an award of a 100 percent rating for CABG by a July 2024 rating decision. It is not implied that a veteran with a 100 percent schedular rating necessarily requires A&A. The Veteran did not assert a claim for SMC (A&A) when he was seeking a higher rating for ischemic heart disease that resulted in surgery (CABG) in February 2024, and the AOJ cannot be held to be a mind reader of the Veteran's intent with regard to whether he needs A&A. See Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (recognizing that the Secretary "has no duty to read the mind of the claimant").

Relatedly, the assertions of the Veteran's attorney to the effect that the award of benefits under the PCAFC was evidence of the Veteran's need for A&A does not relieve him of the need to file a claim for SMC (A&A) on the proper form, as he was repeatedly requested to do, before the AOJ may assist him in its development and adjudicate the matter. See 38 C.F.R. § 3.155 (describing the manner and methods in which a claim can be initiated and filed) and § 3.160 (explaining the requirements for a complete claim including on the appropriate application form prescribed by the Secretary). The Veteran has a duty to cooperate with VA in the development of his claim. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). While the Veteran has not complied with the VA's requests to file his SMC (A&A) claim on the appropriate application form, he is still within the one-year timeline of the July 11, 2025 VA letter to do so for the preservation of an effective date for any award granted based on a completed application.

For the reasons articulated above, the October 2025 appeal of the July 2025 VA letter, notifying the Veteran that it could not process his March 2025 supplemental claim as an application for SMC (A&A), is dismissed.

L. B. CRYAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Breitbeil, Debbie

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.

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