BVA9504478 DOCKET NO. 92-08 451 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to a disability evaluation greater than 60 percent for arteriosclerotic heart disease with hypertension. 2. Entitlement to a disability evaluation greater than 30 percent for an anxiety disorder. 3. Entitlement to a total disability evaluation based upon individual unemployability due to service-connected disabilities. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD R. J. Rolfsen, Jr., Counsel INTRODUCTION The veteran served on active duty from May 1943 to January 1944. This appeal stems from an October 1991 decision of the Montgomery, Alabama, Department of Veterans Affairs (VA) Regional Office (RO). The Board of Veterans' Appeals (Board) remanded the case in April 1993 for evidentiary development. The requested development has been completed and the case is now ready for further appellate review. In view of the Board's decision concerning the claim for an increased rating for arteriosclerotic heart disease with hypertension, the issue of entitlement to a total rating based on individual unemployability is moot. The veteran has requested service connection for glaucoma secondary to his service-connected arteriosclerotic heart disease with hypertension and service connection for diabetes mellitus. The RO most recently denied service connection for these disabilities by rating decision in October 1994. A notice of disagreement with this decision has not been received. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his service-connected arteriosclerotic heart disease with hypertension and anxiety disorder are more disabling than recognized by the evaluations currently in effect. He maintains that he has shortness of breath with bending over or walking two blocks. He also contends that he is unable to work due to the severity of his service-connected arteriosclerotic heart disease. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against granting an increased disability evaluation for the veteran's anxiety disorder and that a 100 percent evaluation for arteriosclerotic heart disease with hypertension is warranted.. FINDINGS OF FACT 1. All relevant evidence necessary for the disposition of the veteran's appeal has been obtained. 2. The veteran's arteriosclerotic heart disease with hypertension is primarily manifested by complaints of shortness of breath, angina with exertion and occasionally at rest, and congestive heart failure; more than sedentary employment is precluded. 3. The veteran's anxiety disorder is manifested by anxiety, difficulty getting along with people, bad dreams, and a need for daily psychotropic medication and regular mental health therapy; definite impairment of social and industrial adaptability has been demonstrated. CONCLUSIONS OF LAW 1. The schedular criteria for a 100 percent for arteriosclerotic heart disease with hypertension are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, Part 4, Codes 7005, 7101 (1993). 2. The schedular criteria for a disability evaluation greater than 30 percent for anxiety disorder are not met. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. § Part 4, Code 9400 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, the Board finds that the veteran's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107. The Board is also satisfied that all relevant evidence has been properly developed. The case has been remanded and additional evidence has been obtained. Under these circumstances, the Board finds that there is no further duty to assist the veteran in order to comply with the duty to assist him as mandated by 38 U.S.C.A. § 5107. A review of the service medical records reveals that the veteran was seen in December 1943 with complaints of tachycardia, pain in his chest, nervousness and intolerance to exercise. The diagnosis was mild neurocirculatory asthenia. In January 1944, he was diagnosed with psychoneurosis, hypochondriacal type. Elevated blood pressure readings were also shown. By rating decision in September 1954, service connection was established for a psychophysiological cardiovascular reaction and a disability evaluation of 10 percent was assigned. This disability was subsequently reclassified as an anxiety neurosis and increased to 30 percent. By decision in January 1971, the Board granted service connection for hypertension and the RO subsequently assigned a disability evaluation of 20 percent, reclassifying the veteran's cardiovascular disorder as generalized arteriosclerosis with hypertension. This disability evaluation was then subsequently increased to 30 percent. The Board remanded the case in April 1993. While on remand, an increased disability evaluation of 60 percent was granted for the veteran's arteriosclerotic heart disease with hypertension. Disability evaluations are based upon the average impairment of earning capacity resulting from a disability. 38 U.S.C.A. § 1155. A. Arteriosclerotic Heart Disease with Hypertension The veteran's arteriosclerotic heart disease with hypertension is currently evaluated as 60 percent disabling under the provisions of 38 C.F.R. § Part 4, Code 7101-7005. This evaluation contemplates hypertensive vascular disease with diastolic pressure readings of predominately 130 or more and severe symptoms, 38 C.F.R. § Part 4, Code 7101, or arteriosclerotic heart disease following a typical history of acute coronary occlusion or thrombosis or with a history of substantiated repeated anginal attacks and more than light manual labor is precluded. 38 C.F.R. § Part 4, Code 7005. A 100 percent disability evaluation is available under the Schedule during and for 6 months following acute illness from coronary occlusion or thrombosis, with circulatory shock, etc. A 100 percent disability evaluation is also available under the Schedule after the above referenced 6 month period where there are chronic residual findings of congestive heart failure or angina on moderate exertion or more than sedentary employment is precluded. 38 C.F.R. § Part 4, Code 7005. Applying these laws and regulations to the particular facts of this case, it is apparent that an increased rating is not warranted. The veteran was examined by the VA in September 1991. At this examination, he complained of pain in his chest and left arm with exertion and, occasionally, with rest. He stated that the pain was usually relieved with Nitroglycerin and that he became short of breath if he bent over to tie his shoes or slowly walked two blocks. Physical examination noted that his chest was hyperresonant with distant, harsh breath sounds. The heart was noted to be borderline enlarged with a regular rhythm and no murmur; his blood pressure was 152/78. The diagnoses included arterioscleriotic heart disease with angina and hypertension. VA hospitalization reports concerning a period of hospitalization at a VA Medical Center in February 1992, reflect that the veteran presented with complaints of substernal chest pain and increasing shortness of breath. Physical examination noted a Grade III/VI systolic ejection murmur at the lower left sternal border. An echocardiogram revealed an ejection fraction of 65 percent and a hypercontractile left ventricle. The veteran was re-hospitalized at AMI Brookwood Medical Center later in February 1992 due to recurrent sharp chest pain and shortness of breath. Coronary catheterization showed diffuse coronary atherosclerosis. The discharge diagnoses included angina pectoris, congestive heart failure, and coronary artery disease. Accordingly, after reviewing all the evidence of record, the Board finds that an increased disability rating of 100 percent is warranted. The veteran is able to walk only two blocks without becoming short of breath. He has recurrent angina with exertion and occasionally at rest, and most recently has developed congestive heart failure. Given the severity and chronicity of his symptoms, more than sedentary employment is out of the question due to his service-connected arteriosclerotic heart disease. The benefit of the doubt has been resolved in the veteran's favor. 38 U.S.C.A. § 5107; 38 C.F.R. §§ 4.7, Part 4, Code 7101-7005. B. Anxiety Disorder The veteran's anxiety disorder is currently evaluated as 30 percent disabling under the provisions of 38 C.F.R. § Part 4, Code 9400. This evaluation contemplates a definite impairment in the ability to establish or maintain effective and wholesome relationships with people. The psychoneurotic symptoms must result in such reduction in initiative, flexibility, efficiency and reliability levels so as to produce definite industrial impairment. In order to be entitled to an evaluation greater than 30 percent, the veteran must demonstrate that the ability to establish or maintain effective or favorable relationships with people is considerably impaired. Also, by reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels must be so reduced so as to result in considerable industrial impairment. Applying these laws and regulations to the particular facts of this case, it is apparent that an increased rating is not warranted. In Hood v. Brown, 4 Vet.App. 301 (1993), the Court of Veterans Appeals stated that the term "definite" in 38 C.F.R. § 4.132 was "qualitative" in character, whereas the other terms were "quantitative" in character, and invited the Board to "construe" the term "definite" in a manner that would quantify the degree of impairment for purposes of meeting the statutory requirement that the Board articulate "reasons and bases" for its decision. 38 U.S.C.A. § 7104(d)(1)(West 1991). In a precedent opinion, dated November 9, 1993, the General Counsel of the VA concluded that "definite" is to be construed as "distinct, unambiguous, and moderately large in degree." It represents a degree of social and industrial inadaptability that is "more than moderate but less than rather large." O.G.C. Prec. 9-93 (Nov. 9, 1993). The Board is bound by this interpretation of the term "definite." 38 U.S.C. § 7104(c). With these considerations in mind, the Board will address the merits of the claim at issue. The veteran was examined by the VA in September 1991. At this examination, he reported that his last inpatient psychiatric hospitalization for his nerves had been in the early 1970's. He had retired from the U.S. Postal Service in 1985. He complained of chronic difficulty getting along with people, adding that he got mad and upset easily. He also reported sometime hearing "weird voices" in his dreams, but he indicated that the frequency of his bad dreams has diminished with medication. He also indicated that he still feet anxious or nervous most of the time. On mental status examination, his mood was described as anxious and his affect was relaxed. Although there was a past history of suicidal ideation, there was no history of suicidal attempts and no history of recent suicidal ideations; there were no idiosyncratic behaviors noted. Also, other than "weird voices," there were no auditory or visual hallucinations and he was not delusional. Furthermore, his behavior was appropriate, his judgment was intact and his insight was good. The pertinent diagnosis was generalized anxiety disorder or anxiety neurosis. The veteran was admitted to a VA Medical Center in February 1992 for an unrelated disorder. During this period of hospitalization it was noted that he had been maintained on his psychiatric medication without any acute problems. Accordingly, after considering all the evidence of record, the Board finds that the disability evaluation currently in effect adequately contemplates all disability resulting from the veteran's service-connected anxiety disorder. When examined by the VA in September 1991, although his mood was anxious, his affect was relaxed, his behavior was appropriate and his judgment was intact. Also, February 1992 VA hospitalization reports note that he had been maintained on psychiatric medication without problems. Therefore, an increased disability evaluation is not warranted. In reaching its decision, the Board has considered the complete history of the disability in question as well as the current clinical manifestations and the effect they may have on the earning capacity of the veteran . 38 C.F.R. §§ 4.1, 4.2, 4.41 (1993). Furthermore, the Board finds that in this case the disability pictures are not so exceptional or unusual so as to warrant an evaluation on an extraschedular basis. It has not been shown that the veteran's anxiety disorder has caused marked interference with employability or necessitated frequent periods of hospitalization beyond that contemplated by the evaluations currently in effect. 38 C.F.R. § 3.321(b)(1) (1993). The criteria for an evaluation greater than the 30 percent currently assigned have not been met or approximated as explained above. 38 C.F.R. § 4.7 (1993). ORDER Entitlement to a disability evaluation of 100 percent for arteriosclerotic heart disease with hypertension is granted, subject to the law and regulations governing the payment of monetary benefits. Entitlement to a disability evaluation greater than 30 percent for anxiety disorder is denied. WAYNE M. BRAEUER Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.