BVA9501212 DOCKET NO. 92-23 103 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to an increased rating for the veteran's service- connected coronary artery disease with myocardial infarction, status post-coronary artery bypass graft, currently rated 60 percent disabling. 2. Entitlement to an increased rating for the veteran's service- connected peripheral vascular disease, currently rated 20 percent disabling. 3. Entitlement to an increased (compensable) rating for the veteran's service-connected bilateral thrombophlebitis with left phlebectomy. 4. Entitlement to a total disability evaluation for compensation based on individual unemployability. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD L. J. Vecchiollo, Associate Counsel INTRODUCTION The veteran served on active duty in the Armed Forces from April 1945 to August 1975. This matter came before the Board of Veterans' Appeals (Board) on appeal from a March 1991 rating decision from the St. Petersburg, Florida, Department of Veterans Affairs (VA) Regional Office (RO). A notice of disagreement was received in May 1991. A statement of the case was issued in June 1991. A substantive appeal was received in July 1991. An October 1991 rating decision granted an increase from 30 percent to 60 percent for the veteran's service-connected coronary artery disease with myocardial infarction, status post-coronary artery bypass graft. The Board notes that June 1992 rating decision denied service connection for a hiatal hernia. The veteran was informed of his procedural and appellate rights regarding this issue in July 1992. The veteran withdrew his claim regarding this issue in a statement in support of claim, received in October 1992. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his service-connected coronary artery disease with myocardial infarction, status post-coronary artery bypass graft, should be rated more than 60 percent disabling; peripheral vascular disease, should be rated more than 20 percent disabling; and bilateral thrombophlebitis with left phlebectomy; as the symptoms and manifestations of the disabilities from which he suffers have increased in severity. The veteran also maintains that the bilateral factor should be applied to his thrombophlebitis. The veteran contends that his service- connected disabilities prevent gainful employment. 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 disability ratings of more than 60 percent for the veteran's coronary artery disease with myocardial infarction, status post-coronary artery bypass graft; more than 20 percent for the peripheral vascular disease; and a compensable rating for bilateral thrombophlebitis with left phlebectomy; are not warranted. Further, it is the decision of the Board that a total disability evaluation for compensation based on individual unemployability is warranted. FINDINGS OF FACT 1. The medical evidence reflects that the veteran's service- connected coronary artery disease with myocardial infarction, status post-coronary artery bypass graft is manifested by a regular heart rate and rhythm without murmur, rub or gallop and chest pain once a week during exercise which is relieved by medication. 2. The medical evidence reflects that the veteran's service- connected peripheral vascular disease is manifested by occasional leg cramping but no clubbing, cyanosis or edema of the lower extremities. 3. The medical evidence reflects that the veteran's service- connected bilateral thrombophlebitis with left phlebectomy is asymptomatic as evidenced by the absence of cyanosis or swelling of the lower extremities. 4. The record reflects that the veteran completed high school and two years of college. The veteran had 5 years occupational experience from November 1985 to November 1990 as an education specialist. He reported in January 1991, that he was last employed on a full-time basis in November 1990 and is currently retired. 5. Service connection is in effect for coronary artery disease with myocardial infarction, status post-coronary artery bypass graft, currently rated 60 percent disabling, peripheral vascular disease, currently rated 20 percent disabling, hearing loss, rated 20 percent disabling; and a noncompensable rating for bilateral thrombophlebitis with left phlebectomy. The veteran's combined evaluation is 70 percent. 6. The veteran's service-connected disabilities preclude him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. A disability rating higher than 60 percent for the veteran's service-connected coronary artery disease with myocardial infarction, status post-coronary artery bypass graft is not warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.3, 4.104, Diagnostic Codes 7017-7005 (1994). 2. A disability rating higher than 20 percent for the veteran's service-connected peripheral vascular disease is not warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.3, 4.104, Diagnostic Codes 7114, 7116 (1994). 3. A disability rating higher than zero percent for the veteran's service-connected bilateral thrombophlebitis with left phlebectomy is not warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.3, 4.104, Diagnostic Code 7121 (1994). 4. The veteran is individually unemployable by reason of his service-connected disabilities. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.340, 4.16(a) (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The evaluations assigned for the veteran's service-connected disabilities are established by comparing the manifestations indicated in his medical records with those manifestations described in the prior medical findings, and with the criteria in the VA's Schedule for Rating Disabilities, 38 C.F.R. Part 4 (1994). 38 U.S.C.A. § 1155 (West 1991). When there is a question as to which of two evaluations should be applied to a disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1994). The veteran suffered from three attacks of thrombophlebitis of the left leg from 1971 to 1973 in service. In 1973, he underwent phlebectomy of the superficial veins of the left lower extremity. Left ventricular hypertrophy was discovered in 1975. In a March 1976 rating decision, the veteran was granted service connection for peripheral vascular disease, rated 20 percent disabling under DC 7114; prominent left ventricle, rated zero percent disabling under DC 7099; and high frequency hearing loss rated zero percent disabling under DC 6279. The veteran was granted entitlement to service connection for peripheral vascular disease (bilateral arteriosclerosis obliterans, claimed also as thrombophlebitis with left phlebectomy), rated zero percent disabling in a March 1976 rating decision. The veteran sustained two myocardial infarctions in 1986 requiring cardiac catheterizations. In a September 1986 decision, the RO separated the veteran's peripheral vascular disease rating into two disabilities, peripheral vascular disease, rated 20 percent disabling, and bilateral thrombophlebitis with left phlebectomy rated zero percent disabling. The veteran's prominent left ventricle rating was changed to myocardial infarction, severe coronary artery disease under DC 7006-7005, rated 30 percent disabling from January 1987. The veteran's service-connected hearing loss rating was increased to 20 percent from July 1988. The veteran sustained two more myocardial infarctions in 1989 and underwent coronary artery bypass graft surgery. The veteran's myocardial infarction, severe coronary artery disease rating was changed to coronary artery disease with myocardial infarction, status post-coronary artery bypass graft under DC 7005-7017 and increased to 60 percent disabling. The veteran's current combined rating is 70 percent. A VA examination was conducted in January 1991. The cardiac examination was normal. The veteran had no trouble walking, however, he did get leg cramps, particularly in the calves. A diagnosis, in part, of early bilateral peripheral arteriosclerosis obliterans was given. Reports of outpatient visits from David A. Miles, M.D., from October 1989 to January 1991 revealed that the veteran had no episodes of angina or signs or symptoms of congestive heart failure. In a letter, dated in June 1991, Dr. Miles stated that due to the veteran's history of severe coronary artery disease, the physician recommended that he retire. In August 1991, the veteran was hospitalized due to chest pain which, the examiner "felt ... in all likelihood" was unstable angina. A VA examination was conducted in August 1991. A chest examination revealed regular rate and rhythm without murmur, rub or gallop. An extremity evaluation indicated that no clubbing, cyanosis or edema was present. In a VA progress note, dated in November 1991, the veteran stated that he only has chest pain once a week during exercise which is relieved by medication. I. Entitlement to an Increased Rating for the Veteran's Coronary Artery Disease with Myocardial Infarction, Status Post- Coronary Artery Bypass Graft Coronary artery bypass is rated 100 percent disabling for the first year following surgery and, thereafter, is rated as arteriosclerotic heart disease. 38 C.F.R. § 4.104, Diagnostic Code 7017. Arteriosclerotic heart disease is rated 100 percent disabling when, after six months, there are chronic residual findings of congestive heart failure or there is angina on moderate exertion or more than sedentary employment is precluded. When there is a history of substantiated repeated angina attacks and more than light manual labor is not feasible, arteriosclerotic heart disease is rated 60 percent disabling. 38 C.F.R. § 4.104, Diagnostic Code 7005. First, there is no finding of congestive heart failure. Second, there is no definite finding of angina on moderate exertion besides the one episode of angina noted in August 1991. Finally, there is no evidence that more than sedentary employment is precluded on the basis of this disability alone. See Part IV, infra. Therefore, a rating higher than 60 percent under this diagnostic code is not warranted. II. Entitlement to an Increased Rating for the Veteran's Peripheral Vascular Disease 38 C.F.R. § Part 4, Diagnostic Code 7116 provides that where there are severe arteriosclerosis obliterans, manifested by marked circulatory changes that produce total incapacity or require house or bed confinement, a 100 percent disability rating is warranted. When the disease is manifested by coldness of extremity with claudication on minimal walking, a 60 percent disability rating is assigned. A 40 percent evaluation is provided for well-established cases, with intermittent claudication or recurrent episodes of superficial phlebitis. Minimal circulatory impairment, with paresthesia, temperature changes or occasional claudication warrants a 20 percent disability rating. In this case, there is no evidence of intermittent claudication or recurrent episodes of superficial phlebitis. Therefore, a rating higher than 20 percent under this diagnostic code is not warranted. III. Entitlement to an Increased Rating for the Veteran's Bilateral Thrombophlebitis with Left Phlebectomy. VA Schedule for Rating Disabilities provides that thrombophlebitis will be assigned a 10 percent disability evaluation where there is persistent moderate swelling of the leg that is not markedly increased on standing or walking. To warrant the next higher disability evaluation of 30 percent, there must be persistent swelling of the leg or thigh that is increased on standing or walking 1 or 2 hours and is readily relieved by recumbency as well as moderate discoloration, pigmentation or cyanosis. 38 C.F.R. § 4.104, Diagnostic Code 7121 (1994). In every instance where the schedule does not provide a zero percent rating for a diagnostic code, a zero percent rating shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31 (1994). In this case, there is no evidence that the veteran suffers from persistent moderate swelling. Therefore, a rating higher than zero percent under this diagnostic code is not warranted. See 38 C.F.R. § 4.31 (1994). In addition, the bilateral factor was considered. However, it is not for application in this case as the veteran does not have a partial disability of compensable degree in each of 2 paired extremities. 38 C.F.R. § 4.26(c) (1994). IV. Entitlement to a Total Disability Evaluation for Compensation Based on Individual Unemployability. The record reflects that the veteran completed high school and two years of college. The veteran had 5 years occupational experience from November 1985 to November 1990 as an education specialist. He reported in January 1991, that he was last employed on a full-time basis in November 1990 and is currently retired. Total disability ratings for compensation may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more, or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. §§ 3.340, 4.16(a) (1994). In this case, we note that the schedular criteria pursuant to 38 C.F.R. § 4.16(a) (1994), have been met. It is significant to note that 38 C.F.R. § 4.16(a) (1994) further provides that nonservice- connected disabilities and their degree of impairment or previous unemployability status are to be disregarded where the service- connected disabilities render the veteran unemployable. Service connection is in effect for coronary artery disease with myocardial infarction, status post-coronary artery bypass graft, currently rated 60 percent disabling, peripheral vascular disease, currently rated 20 percent disabling, hearing loss, rated 20 percent disabling; and a noncompensable rating for bilateral thrombophlebitis with left phlebectomy. The veteran's combined evaluation is 70 percent. The veteran contends that his service-connected disabilities prevent gainful employment. The Board has reviewed numerous clinical records of the veteran revealing treatment for numerous service-connected disabilities. In addition to the medical evidence of record, in a letter from Dr. Miles, dated in June 1991 stated that due to the veteran's history of severe coronary artery disease, the physician recommended that he retire. The Board notes that the medical evidence demonstrates that the combination of the veteran's service-connected disabilities prevents employment involving any physical activity including employment as an education specialist, which is an area that the veteran has had prior employment experience. The Board notes the overwhelming medical evidence that the veteran is unable to secure or follow a substantially gainful occupation as the result of severe coronary artery disease, the circulatory disabilities of his lower extremities, and his hearing loss. The Board finds that upon a review of the entire record that the evidence demonstrates that the veteran is unable to secure or follow a substantially gainful occupation solely due to his service-connected disabilities. Therefore, a total disability rating for compensation based on individual unemployability is warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.340, 4.16(a) (1994). ORDER The appeals regarding entitlement to increased ratings for coronary artery disease with myocardial infarction, status post- coronary artery bypass graft, peripheral vascular disease bilateral thrombophlebitis with left phlebectomy are denied. Entitlement to a total disability evaluation for compensation based on individual unemployability is granted, subject to the law and regulations governing the award of monetary benefits. EUGENE A. O'NEILL 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. (CONTINUED ON NEXT PAGE) 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.