Case A26040644

SHEREEN M. MARCUS · 2026 · Case ID: A26040644

MIXED

Summary

The veteran, who served in the United States Army from April 1966 through January 1968, appealed the denial of an earlier effective date for service connection of coronary heart disease and a compensable rating prior to February 10, 2021. The Board denied the earlier effective date, noting that the earliest claim for service connection was received on February 8, 2019, and the AOJ had already granted that date. The Board also denied a compensable rating prior to February 10, 2021, finding the evidence did not support the criteria for a rating at that time. However, the Board granted an increased rating of 30 percent for coronary heart disease, effective February 10, 2021. This rating was based on evidence showing mild left ventricular hypertrophy on a transthoracic echocardiogram on that date, which met the criteria for a 30 percent rating under 38 C.F.R. § 4.104, DC 7005. The Board found the evidence did not support a higher rating, as the veteran consistently denied heart failure symptoms and the echocardiogram showed normal left ventricular systolic function. The Board applied the benefit of the doubt in favor of the veteran for the 30 percent rating, as the evidence was in approximate balance.

Rationale

No formal or informal claim for service connection prior to February 8, 2019.; AOJ granted earliest possible effective date of February 8, 2019.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250807-573625

Full Decision Text

Citation Nr: A26040644
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250807-573625
DATE: April 30, 2026

ORDER

Entitlement to an effective date prior to February 8, 2019, for service connection of coronary heart disease is denied.

Prior to February 10, 2021, a compensable rating for coronary heart disease is denied.

Entitlement to an increased rating of 30 percent for coronary heart disease, but no higher, effective February 10, 2021, is granted.

FINDINGS OF FACT

1. The Veteran's intent to file a claim was received by the Department of Veterans Affairs (VA) on February 8, 2019, and his original service connection claim for coronary heart disease was filed within one year thereafter.

2. Prior to February 10, 2021, the Veteran's coronary heart disease did not manifest in a workload of 10.0 metabolic equivalents (METs) or less resulting in dyspnea, fatigue, angina, dizziness, syncope, or heart failure symptoms, or; continuous medication required, or; cardiac hypertrophy or dilatation, or; left ventricular dysfunction with an ejection fraction of 50 percent or less, or; acute congestive heart failure, or; chronic congestive heart failure

3. From February 10, 2021, the Veteran's coronary heart disease manifested in cardiac hypertrophy, but did not manifest in a workload of 5.0 METs or less resulting in dyspnea, fatigue, angina, dizziness, syncope, or heart failure symptoms, or; left ventricular dysfunction with an ejection fraction of 50 percent or less, or; acute congestive heart failure, or; chronic congestive heart failure.

CONCLUSIONS OF LAW

1. The criteria for an effective date prior to February 8, 2019, for service connection of coronary heart disease have not been met. 38 U.S.C. §§ 5107(b), 5110; 38 C.F.R. §§ 3.102, 3.155, 3.2500, 3.400.

2. The criteria for a compensable rating, prior to February 10, 2021, for coronary heart disease have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.100, 4.104, Diagnostic Code (DC) 7005.

3. The criteria for an increased rating of 30 percent for coronary heart disease, but no higher, effective February 10, 2021, have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.3, 4.100, 4.104, DC 7005.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from April 1966 through January 1968. The Veteran died in December 2024, and the Appellant is his surviving spouse.

These matters come to the Board of Veterans' Appeals (Board) on appeal from an October 2024 rating decision issued by a VA Regional Office, which was the agency of original jurisdiction (AOJ). In the August 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Appellant elected the Hearing docket. On December 29, 2025, the Appellant withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the October 2024 AOJ decision on appeal, as well as any evidence submitted by the Appellant or representative within 90 days following receipt of the withdrawal of the hearing request. 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 Appellant would like VA to consider any evidence that was submitted that the Board could not consider, the Appellant 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
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 Appellant would like VA to consider any evidence that was submitted that the Board could not consider, the Appellant 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.

This appeal has been advanced on the docket. 38 U.S.C. § 7107; 38 C.F.R. § 20.902(c).

In rendering this decision, the Board has reviewed all evidence of record whether discussed in detail. See Newhouse v. Nicholson, 497 F.3d 1298, 1302 (Fed. Cir. 2007) (holding the Board must only discuss the evidence which is relevant to the issues on appeal). To the extent the evidence is found in "approximate balance," the Board will afford the benefit of the doubt in favor of the Appellant. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (holding that exact equipoise is not required for the benefit of the doubt to be applied, but rather the veteran is entitled to the benefit of the doubt when the evidence is in approximate balance or "nearly equal").

1. Entitlement to an effective date prior to February 8, 2019, for service connection of coronary heart disease is denied.

The Appellant seeks an earlier effective date for coronary heart disease. See August 2025 VA Form 10182. For the following reasons, the Board finds there is no basis for an effective date of service connection prior to February 8, 2019.

In general, except as otherwise provided, the effective date of an evaluation based on an original claim will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400 (emphasis added).

Effective March 24, 2015, VA amended its adjudication regulations to require that all claims governed by VA's adjudication regulations be filed on standard forms prescribed by the Secretary. See 79 Fed. Reg. 57,660 (Sept. 25, 2014). These amendments are applicable with respect to claims and appeals filed on or after March 24, 2015.

The Veteran submitted an intent to file a claim, which VA received on February 8, 2019. See February 2019 Notification Letter. In December 2019, he submitted a formal claim for service connection for multiple conditions, including coronary heart disease. See December 2019 VA Form 21-526EZ.

Prior to February 8, 2019, the claims file does not contain any formal or informal service connection claims for coronary heart disease.

The Board granted service connection for coronary heart disease in an August 2024 decision. In an August 2024 rating decision, the AOJ implemented the Board's grant of service connection. The AOJ awarded a noncompensable rating under Diagnostic Code 7005, effective February 8, 2019, based on receipt of the intent to file.

As the AOJ has already granted the earliest possible effective date of February 8, 2019, there is no further benefit here that the Board can grant. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable. An effective date prior to February 8, 2019, is not warranted. The appeal is denied.

Increased Ratings

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.

Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approx
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.

In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991); Schafrath v. Derwinski, 1 Vet. App. 589 (1995).

Whether the issue is one of an initial rating or an increased rating, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007).

The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; separate ratings may be assigned for distinct disabilities resulting from the same injury only where the symptomatology for one condition is not duplicative or overlapping with the symptomatology of the other condition. See 38 C.F.R. § 4.14; see also Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

The "effective date for an increased rating, indeed, as well as for an initial rating or for staged ratings," depends on when the change in disability level can be "ascertained." Swain v. McDonald, 27 Vet. App. 219, 224 (2015). An effective date should not be "assigned mechanically" as of the date of an examination. Id.

2. Prior to February 10, 2021, a compensable rating for coronary heart disease is denied.

3. Entitlement to an increased rating of 30 percent for coronary heart disease, but no higher, effective February 10, 2021, is granted.

The Appellant seeks an increased rating for the Veteran's coronary heart disease. See August 2025 VA Form 10182. She continuously pursued the Veteran's initial rating, and therefore the appeal period begins on February 8, 2019.

The Veteran's coronary heart disease (also diagnosed as coronary artery disease) was rated under Diagnostic Code (DC) 7005 as noncompensable from February 8, 2019, and 30 percent disabling from September 3, 2024.

Effective November 14, 2021, VA amended the criteria for rating arteriosclerotic heart disease (coronary artery disease) under 38 C.F.R. § 4.104, DC 7005. 86 Fed. Reg. 54089 (Sep. 30, 2021). Where the rating criteria are amended during the course of an appeal, both the old and new versions of the rating criteria must be considered, and whichever is more favorable to the Veteran will be applied. However, should an increased rating be warranted under the revised criteria, the effective date of such award shall not be earlier than the effective date of the revision. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003).

Prior to November 14, 2021, a 10 percent rating is warranted where a workload of greater than 7.0 metabolic equivalents (METs) but not greater than 10.0 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication is required. 38 C.F.R. § 4.104, DC 7005.

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. Id.

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
pnea, fatigue, angina, dizziness, or syncope, or; continuous medication is required. 38 C.F.R. § 4.104, DC 7005.

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. For the purpose 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.

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. For the purpose 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 Otero-Castro, 16 Vet. App. at 382.

Under the pre-amendment rating criteria, one MET is the energy cost of standing quietly at rest and represented 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.

Effective November 14, 2021, arteriosclerotic heart disease (coronary artery disease) is rated in accordance with the General Rating Formula for Diseases of the Heart. 38 C.F.R. § 4.104, DC 7005. A 10 percent rating is warranted where a workload of 7.1 to 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 to 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 to 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. Id.

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).

Relevant Facts

Turning to the relevant evidence, the
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.

Relevant Facts

Turning to the relevant evidence, the Veteran's VA treatment records from 2019 through 2021 note that he had coronary artery disease. See August 2019 Vascular Surgery Consult; February 2021 Vascular Surgery Outpatient Note. At multiple appointments, he denied chest pain, palpitations, shortness of breath, and lightheadedness or dizziness. See February 2019 Nursing Note; July 2019 Primary Care Note; August 2020 Primary Care Note; February 2021 Vascular Surgery Outpatient Note; October 2021 Addendum; November 2021 Vascular Surgery Outpatient Note.

The Veteran was afforded a VA examination for heart conditions on February 4, 2021. The examiner indicated that the Veteran does not have a heart condition and does not have congestive heart failure. An EKG showed arrhythmia, specifically, occasional SVTs; however, the examiner noted that this was an incidental finding and does not warrant an official diagnosis. He had not been hospitalized for the treatment of any heart condition. The examination included an interview-based METs test, wherein the Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity. A stress test was not performed because exercise stress testing was not required as part of the Veteran's current treatment plan and the test was not without significant risk. The examiner noted that the Veteran's heart condition did not cause functional impact.

A transthoracic echocardiogram was performed on February 10, 2021. See The results included mild left ventricular hypertrophy. See February 2021 Transthoracic Echocardiogram Report. The left ventricular systolic function was noted as probably normal. Id.

In June 2022, the Veteran testified at a Board hearing before a Veterans Law Judge (VLJ) other than the undersigned. He stated that he does not believe he has coronary heart disease. See June 2022 Hearing Transcript.

The Veteran submitted an August 2022 private medical opinion, which noted that he has coronary artery disease. See August 2022 Dr. R.T. Medical Opinion.

A supplemental VA opinion was provided in December 2022, based on review of the Veteran's records. The examiner indicated that the Veteran does not have a currently diagnosed heart condition.

In May 2023, the Veteran's VA treatment records noted occasional PVCs and rare PACs, but no other arrhythmia. See May 2023 Cardiology Diagnostic Study Consult. At various medical appointments in 2024, he denied chest pain, dizziness, fatigue, heart arrhythmia, and shortness of breath. See January 2024 Risk Assessment Screening Note; June 2024 Audiology Diagnostic Study Note; June 2024 Care Management Note; September 2024 Vascular Surgery Consult; September 2024 Nursing Emergency Department Notes. He was noted to have no history of heart failure. See January 2024 Vascular Surgery Outpatient Visit Note; May 2024 Pharmacy Consult. In September 2024, his aortic root was moderately dilated and he had mild concentric left ventricular hypertrophy; however, his left ventricular systolic function was normal and his right ventricle was normal in size and function. See September 2024 Critical Care Unit Note.

The Veteran was afforded another VA examination for heart conditions in September 2024. The examiner confirmed diagnoses of arteriosclerotic heart disease (coronary artery disease) and hypertensive heart disease, and he clarified that "coronary artery disease" is the correct diagnosis rather than "coronary heart disease." At the examination, the Veteran denied having any heart symptoms and stated that he was not taking any medications for coronary artery disease. He had not been hospitalized for the treatment of any heart condition. Based on a September 2024 echocardiogram, the examiner noted that there was moderate left ventricular hypertrophy. An interview-based METs test was conducted, and the Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity. A stress test was not performed because exercise stress testing was not required as part of the Veteran's current treatment plan and the test
onary artery disease) and hypertensive heart disease, and he clarified that "coronary artery disease" is the correct diagnosis rather than "coronary heart disease." At the examination, the Veteran denied having any heart symptoms and stated that he was not taking any medications for coronary artery disease. He had not been hospitalized for the treatment of any heart condition. Based on a September 2024 echocardiogram, the examiner noted that there was moderate left ventricular hypertrophy. An interview-based METs test was conducted, and the Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity. A stress test was not performed because exercise stress testing was not required as part of the Veteran's current treatment plan and the test was not without significant risk. The examiner noted that the Veteran's heart condition did not cause functional impact.

Analysis

Prior to February 10, 2021, the evidence weighs persuasively against a compensable rating for coronary artery disease, under either the pre- or post-amended DC 7005. The record does not show that the Veteran's heart condition required continuous medication. Although the February 2021 VA examination found occasional SVTs, the examiner indicated that this was an incidental finding and did not warrant an arrhythmia diagnosis. Otherwise, the evidence does not show that he experienced heart failure symptoms, such as dyspnea, fatigue, angina, dizziness, or syncope, at any MET workload. Indeed, during the February 2021 VA examination, the Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity. In VA treatment records, he repeatedly denied experiencing chest pain, palpitations, shortness of breath, and dizziness. There is no indication that continuous medication was required to control his heart condition. There was no evidence of cardiac hypertrophy, dilatation, left ventricular dysfunction, or ejection fraction of 50 percent or less prior to February 10, 2021. The record does not reflect any episodes of acute congestive heart failure or chronic congestive heart failure, and the February 2021 VA examiner specifically indicated that the Veteran did not have congestive heart failure.

The first factually ascertainable date in which there was any evidence of cardiac hypertrophy, warranting a 30 percent rating (but no higher) was February 10, 2021, whereas on that date a transthoracic echocardiogram showed mild left ventricular hypertrophy. Albeit, the clinician also opined that the Veteran's left ventricular systolic function was noted as probably normal. Nonetheless, resolving any reasonable doubt, this is the first ascertainable date of meeting a compensable rating. Compare Swain, 27 Vet. App. at 224.

Thus, from February 10, 2021, the Board finds that the Veteran's coronary heart disease most closely approximates the criteria for a 30 percent rating under DC 7005. Specifically, on that date a transthoracic echocardiogram showed mild left ventricular hypertrophy. Later in 2024, he was again found to have left ventricular hypertrophy, and his aortic root was moderately dilated.

However, the evidence weighs persuasively against a rating in excess of 30 percent at any point from February 10, 2021. Again, he did not experience heart failure symptoms, such as dyspnea, fatigue, angina, dizziness, or syncope. He repeatedly denied chest pain, dizziness, fatigue, heart arrhythmia, shortness of breath, and difficulty breathing. Although PVCs and PACs were noted at one time in May 2023, these were indicated to be occasional and rare. Moreover, during an interview-based METs test in the September 2024 VA examination, the Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity. The record does not reflect any episodes of acute congestive heart failure or chronic congestive heart failure; on the contrary, VA treatment records specifically noted that he had no history of heart failure, and the September 2024 VA examiner did not diagnose him with congestive heart failure. The evidence does not show left ventricular dysfunction or ejection fraction of 50 percent or less; instead, his left ventricular systolic function was found to be normal.

The Board determines that the disability is fully capable of evaluation under the rating schedule.

Accordingly, the Board finds that the Veteran's coronary artery disease did not warrant a compensable rating prior to February 10, 2021, but that the evidence supports a higher rating of 30 percent, effective February 10, 2021, but no higher and no earlier. The appeal is, therefore, granted in part as outlined above. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4
. The evidence does not show left ventricular dysfunction or ejection fraction of 50 percent or less; instead, his left ventricular systolic function was found to be normal.

The Board determines that the disability is fully capable of evaluation under the rating schedule.

SHEREEN M. MARCUS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board S. Harris, Associate Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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