Citation Nr: 0004307 Decision Date: 02/17/00 Archive Date: 02/23/00 DOCKET NO. 97-01 970 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston- Salem, North Carolina THE ISSUES 1. Entitlement to an increased evaluation for coronary artery disease with a history of hypertension, previously diagnosed as hypertension, currently evaluated as 30 percent disabling. 2. Entitlement to a total disability evaluation based on individual unemployability due to the veteran's service- connected disabilities. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD M. L. Wright, Counsel INTRODUCTION The veteran had active service from November 1976 to November 1979. This appeal arises from a July 1996 rating decision of the Winston-Salem, North Carolina, Regional Office (RO) which denied an increased evaluation for the veteran's service- connected coronary artery disease and hypertension. The evaluation for these disorders was confirmed and continued at 30 percent disabling. It was also determined by the RO that the veteran was not entitled to a total disability evaluation for individual unemployability due to his service-connected disabilities (TDIU). The veteran appealed these determinations. In January 1998, the Board of Veterans' Appeals (Board) remanded this case for development of the medical evidence. It has now returned for further appellate review. FINDINGS OF FACT 1. All evidence required for equitable decisions of the issues on appeal has been obtained. 2. The veteran's coronary artery disease with a history of hypertension is characterized by mild and moderate physical disability. 4. The veteran's current combined service-connected disability evaluation is 30 percent disabling. There is no objective evidence of record to indicate that the veteran's service-connected heart disease has precluded him from substantially gainful employment. CONCLUSIONS OF LAW 1. An evaluation in excess of 30 percent is not warranted for the veteran's service-connected coronary artery disease with a history of hypertension. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.2, 4.14, 4.104, Diagnostic Code 7005, 7101 (Effective prior to, and on, December 12, 1998). 2. A TDIU is not warranted. 38 U.S.C.A. §§ 1155, 5107, 7104 (West 1991 & Supp. 1999); 38 C.F.R. §§ 3.340, 3.341, 4.16 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Factual Background. By rating decision of April 1980, the RO granted service connection for the veteran's hypertension. This disorder was evaluated under the U. S. Department of Veterans Affairs (VA) Schedule for Rating Disabilities, 38 C.F.R. Part 4, Diagnostic Code (Code) 7101 as noncompensable. The award was made effective from November 1979. In a rating decision of February 1995, the RO expanded the grant of service connection to include the veteran's coronary artery disease with a history of hypertension. This disorder was evaluated as 30 percent disabling under Code 7005 effective from April 1994. A private medical report dated in 1990 reflects a history of intermittent hypertension, treated with medication. A VA cardiovascular examination was provided to the veteran in June 1994. He reported employment as a city warehouse worker since 1991. He stated that he had lost 15 days of work during the past year due to complaints (which he continued to have) of pain, numbness, and pressure in his chest, back, shoulders, and arms. The veteran also complained of headaches and tiring easily. He claimed that sometimes at night it felt like his heart would stop. On examination, the veteran's heart was not enlarged. His heart had a regular rhythm with no murmurs. The first heart sound was split at the apex. The veteran had adequate pulses to the extremities and peripheral pulses were normal. His blood pressure was recorded as 130/80, 130/85 and 130/90. A chest X-ray noted an increase in the transverse diameter of the cardiac silhouette which the radiologist commented may be secondary to the veteran's failure to take a deep breath rather than cardiac enlargement. However, the radiologist noted that cardiac enlargement could not be ruled out. All other findings on the X-ray were noted to be normal. At the time of that examination, an exercise/stress test reported that the veteran obtained a maximum workload of 3.5 metabolic equivalent (METs). Noted blood pressure readings during the testing ranged from a high of 157/102 to a low of "66/45." An attached outpatient record reported that during the veteran's stress test he was unable to walk on the treadmill more than 1 1/2 minutes due to "exercise de- conditioning." The tester reported that no acute changes were seen in the veteran and he did not want to participate in any further stress testing. An electrocardiogram (EKG) noted that the veteran had a normal sinus rhythm, but had a T wave abnormality suggestive of inferior ischemia. The conclusion was an abnormal EKG. After reviewing the above test results, the examiner provided a diagnosis of hypertension not found on examination, a history of easy fatigability, chest discomfort, and occasional irregular pulse with an EKG consistent with coronary artery disease. It was noted by the examiner that he did not have access to the veteran's prior medical records for review of the medical history. In May 1996, the veteran filed claims for an increased evaluation for his coronary artery disease and TDIU. He indicated that he last worked in October 1995 as a laborer for a city government. He reported having a high school education and no other training. The veteran claimed that when he applied for other jobs with the same city government he had been told he could not be employed due to his heart condition. His last employer responded in June 1996 and reported that the veteran's employment had ended in October 1995 due to a "lay-off." The veteran's VA medical records dated from 1994 to 1996 were received in July 1996. An outpatient record of October 1994 noted the veteran's complaint of occasional chest wall pain that was relieved by pain medication. He denied symptoms of shortness of breath, abdominal pain, nausea, or vomiting. On examination, his heart had a regular sinus rhythm with no rubs or murmurs. The veteran's blood pressure was 118/70. By April 1995, the veteran denied any problems with chest, abdominal pain, or shortness of breath. His blood pressure was 114/58 and his heart had a regular sinus rhythm with no rubs or murmurs. In April 1996, it was noted that the veteran continued to smoke cigarettes. His blood pressure was 116/72 and his heart had a regular sinus rhythm with no rubs or murmurs. The assessment was improved hypertension with the use of medication. By rating decision of July 1996, the RO denied an increased evaluation for the veteran's coronary artery disease on the basis that his current symptomatology did not warrant a higher evaluation under the scheduler criteria. It was also determined that the veteran was not entitled to TDIU on the basis that his disability evaluations did not meet the rating criteria. The veteran submitted an notice of disagreement (NOD) in August 1996. He claimed that he was required to take prescribed medication in order to control his angina pectoris. The veteran asserted that his visits to VA outpatient treatment did not convey the true nature of his coronary artery disorder. He alleged that he had time to relax during his four or more hours waiting for his VA appointment. The veteran also claimed that he had told his VA examiner that he experienced chest pain when lifting and bending and shortness of breath when walking. In a letter of November 1997, the veteran claimed that he had recently visited his physician at the VA and was prescribed additional medication to control his heart disease. He alleged that this medication required him to limit all his activities and he was now unable to maintain substantially gainful employment due to his heart disorder. The Board remanded this case in January 1998 for additional development of the medical evidence and the status of the veteran's employment. By letter of February 1998, the RO requested that the Social Security Administration (SSA) submit the veteran's medical records in its possession. In a separate letter of the same date, the RO requested that the veteran provide information and release forms for the healthcare providers that had treated his heart disorder. He was also requested to submit information about his current employment status. The veteran was informed that his medical records with the SSA and his local VA Medical Center were also being requested. He was asked to help obtain copies of this evidence in order to expedite his claim. The veteran was informed that his failure to provide this evidence to the VA could have an adverse effect on his claims. VA medical records dated from 1996 to 1997 were associated with the claims file in March 1998. An outpatient record of November 1996 noted follow-up for the veteran's coronary disorder. His blood pressure was reported as 136/94 and 130/85. The veteran's heart had a regular sinus rhythm with no rubs or murmurs. The assessment was hypertension improved with the use of medication. In May 1997, the veteran's blood pressure was 136/88 and 130/85. His vital signs were stable. The veteran's heart had a regular sinus rhythm with no rubs or murmurs. The assessment was improved hypertension with the use of medication. An outpatient record of June 1997 noted the veteran's complaint of chest pain that radiated into his upper back. The diagnosis was ischemic angina. The veteran was again seen on a regular appointment in October 1997. He acknowledged that he continued to smoke cigarettes. His blood pressure was 144/78 and his vital signs were stable. The veteran's heart had a regular sinus rhythm with no rubs or murmurs. The assessment was hypertension improved with the use of medication. In April 1998, the veteran complained of occasional chest pain relieved by medication. He denied any shortness of breath or edema. The examiner noted the veteran's claimed history of hypertension and an old myocardial infarction. On examination, his blood pressure was 124/77. He heart had a regular sinus rhythm without any obvious murmurs. The veteran was seen in May 1998 for genitourinary complaints. His blood pressure was 159/69. It was noted that the veteran had a history of coronary artery disease. On examination, he had a regular heart rhythm with no murmurs. A letter was sent to the veteran by the RO in April 1998. He was informed that the RO had not received a responses from either the SSA or his private physician. The RO asked the veteran to obtain copies of the pertinent medical records held by the SSA and his physician and submit them directly to the VA. The RO also sent letters to the private physician and the SSA again requesting the veteran's medical records. In May 1998, the veteran submitted his private medical records to the VA. This consisted of a single outpatient record dated in late April 1993. This treatment was for the veteran's urinary complaints. On examination, the veteran had a regular cardiac rhythm without murmurs, rubs, or gallops. The assessment was controlled paroxysmal atrial tachycardia. Another letter was sent to the veteran from the RO in June 1998. He was informed that the RO had again requested his medical records from his private physician and the SSA without any response. The veteran was again asked to obtain this evidence and submit it to the VA. He was informed that if this evidence was not received within 60 days, the RO would make a decision on his claim without it. The SSA responded to the RO's request for records in September 1998. This response consisted of a copy of a December 1997 decision that denied the veteran's claim for SSA disability benefits. In that determination it was noted that he was found capable of performing "light" or "sedentary" work and that there was no reason he could not work in his former job of driving a van for the disabled. In October 1998, the veteran submitted a letter indicating that he currently was still unemployed due to his service- connected disabilities. The veteran was afforded a VA cardiovascular examination in January 1999. It was noted by the examiner that he had reviewed the available medical records and history. The veteran complained of atypical (sharp, stabbing) chest pain with movement or when bending or lifting. He claimed that he had very poor effort tolerance and could not walk due to his bad legs, weakness, and tiredness. The veteran denied symptoms of dyspnea, orthopnea, and dizziness. After a review of the available medical evidence, the examiner commented that it was revealed the veteran had a history of hypertension. However, there was no objective confirmation of coronary artery disease except for symptoms of recurrent pain and abnormal EKG. On examination, the veteran's blood pressure was 130/88 and 132/90. The veteran had carotid pulses with no bruits and there was no evidence of jugular venous distention. His heart had a regular rhythm and the point of maximal impulse was inside the mid-clavicular line. The veteran's heart sounds were normal with no murmur or gallop detected. Pedal pulses were unremarkable and there was no postural hypertension detected. An EKG noted abnormal findings, however, the examiner reported that there were no significant changes when compared with prior EKG's. The assessment was a history of chronic hypertension and symptoms of recurrent chest pain of uncertain etiology. It was noted that the veteran had been scheduled for a chest X-ray and an echocardiogram, but had failed to report to these tests. The examiner made the following comments: [The veteran] has been suspected and treated for coronary artery disease. I find no objective evidence of coronary artery disease in the medical record. EKG changes may be related to hypertension...[The veteran's] functional capacity and classification could not be adequately judged as [he] stated to me multiple symptoms of aches and pains, [the veteran has] a limited effort tolerance by his history. A letter was received from the veteran in March 1999. He claimed that because of the January 1999 examiner's comment that there was no objective evidence of coronary artery disease in his records, he obviously did not have access to all of the medical records. He contended that the RO had failed to comply with the Board's remand of January 1998 by not obtaining his private medical evidence. In a separate letter of March 1999, the veteran asserted that he had reported and received all scheduled VA testing to include an examination, EKG, chest X-ray, and echocardiogram. Attached to this letter was a copy of his VA echocardiogram taken in February 1999 which noted that the veteran's left ventricle was of normal size and contractility. There was no regional wall motion abnormalities and the left ventricle had normal function with an ejection fraction of 55 percent. The left antrium, aortic valve, and mitral valve were all normal. The pericardium had no effusion. The RO requested that the VA Medical Center provide a copy of the report of the veteran's chest X-ray claimed to have been taken sometime in January or February 1999. In June 1999, the VA Medical Center responded that the veteran had declined to have this X-ray performed. A written statement was received from the veteran in June 1999. He reported that the January 1999 VA examiner had performed an EKG that resulted in abnormal readings. It was contended by the veteran that "it is known" that abnormal findings on an EKG will result in abnormal findings on an echocardiogram. He claimed that after reviewing the January 1999 EKG results, the VA examiner had him rescheduled for an echocardiogram the following month. The veteran alleged that the VA examiner rescheduled this examination so that it would not reveal the abnormality. He asserted that he had a chest X-ray performed in January 1999 at a VA outpatient clinic. However, he had requested a copy of this X-ray report from the clinic but was told it could not be located. The veteran contended that his claim should not be adversely effected based on the error of the VA outpatient clinic. Attached to the veteran's statement was a letter from the VA informing him that it had been unable to locate the "EKG and Chest X- ray you requested." In a separate statement received in June 1999, the veteran asserted that the SSA had not performed an examination of him and that his SSA disability was determined based solely on his VA medical records. A report of contact dated in early August 1999 noted the veteran's concerns about the delay in forwarding his claim to the Board. He was informed by the RO that his case was being held while the RO attempted to locate his alleged January 1999 chest X-ray. It was suggested to the veteran that if this X-ray could not be located he would be given the opportunity to have another X-ray taken. In a letter sent to the veteran in late August 1999, the RO informed him that multiple attempts to retrieve the January 1999 chest X-ray had been to no avail and the VA Medical Center maintain that he had declined such an examination. The veteran was asked to respond on whether or not he would be willing to undergo another chest X-ray. He was warned that if he did not respond in the affirmative in 30 days, his case would be forwarded to the Board. The veteran submitted a written statement in September 1999. He accused the RO and the VA Medical Center of conspiring against his claim and tampering with the medical evidence. He again asserted that he had undergone a chest X-ray in January 1999. It was further alleged by the veteran that the February 1999 echocardiogram had noted results that indicated his injection fraction was not greater than 55 percent. He requested that his case be expeditiously returned to the Board. II. Applicable Criteria. Under the applicable criteria, disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1999). Separate diagnostic codes identify the various disabilities. The VA has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). These regulations include, but are not limited to, 38 C.F.R. §§ 4.1 and 4.2 (1999). The requirements for evaluation of the complete medical history of the claimant's condition operate to protect claimants against adverse decisions based upon a single, incomplete, or inaccurate report, and to enable the VA to make a more precise evaluation of the level of the disability and of any changes in the condition. Schafrath, 1 Vet. App. at 594. The evaluation of the same disability or manifestations under different diagnoses is to be avoided. 38 C.F.R. § 4.14 (1999). Rather, the veteran's disability will be rated under the diagnostic code, which allows the highest possible evaluation for the clinical findings shown on objective examination. The rating criteria for evaluating cardiovascular disabilities was effectively changed on January 12, 1998. See 61 Fed. Reg. 65207-65224 (1997). The United States Court of Appeals for Veterans Claims (hereafter the Court) has held that when a law or regulations change during the pendency of a veteran's appeal, the version most favorable to the veteran applies, absent congressional or Secretarial intent to the contrary. Karnas v. Derwinski, 1 Vet. App. 308, 312-13 (1991). In this case, the RO has considered the veteran's claim under both the former and the revised scheduler criteria; hence, there is no prejudice to the veteran in the Board doing likewise. See Bernard v. Brown, 4 Vet. App. 384 (1993); see also Robinette v. Brown, 8 Vet. App. 69 (1995). The applicable rating criteria is noted below: Code 7005. Arteriosclerotic heart disease (Coronary artery disease): >During and for 6 months following acute illness from coronary occlusion or thrombosis, with circulatory shock, etc.; rate as 100 percent disabling. >After 6 months, with chronic residual findings of congestive heart failure or angina on moderate exertion or more than sedentary employment precluded; rate as 100 percent disabling. >Following typical history of acute coronary occlusion or thrombosis as above, or with history of substantiated repeated anginal attacks, more than light manual labor not feasible; rate as 60 percent disabling. >Following typical coronary occlusion or thrombosis, or with history of substantiated anginal attack, ordinary manual labor feasible; rate as 30 percent disabling. Code 7101. Hypertensive vascular disease (essential arterial hypertension). >Diastolic pressure predominately 130 or more and severe symptoms; rate as 60 percent disabling. >Diastolic pressure predominately 120 or more and moderately severe symptoms; rate as 40 percent disabling. >Diastolic pressure predominately 110 or more with definite symptoms; rate as 20 percent disabling. >Diastolic pressure predominately 100 or more; rate as 10 percent disabling. * Note 1: For the 40 percent and 60 percent ratings under Code 7101, there should be careful attention to diagnosis and repeated blood pressure readings. * Note 2: When continuous medication is shown necessary for control of hypertension with a history of diastolic blood pressure predominately 100 or more, a minimum rating of 10 percent will be assigned. 38 C.F.R. § 4.104 (Effective prior to January 12, 1998). Code 7005. Arteriosclerotic heart disease (Coronary artery disease): With documented coronary artery disease resulting in: >Chronic congestive heart failure, or; workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent; rate as 100 percent disabling. >More than one episode of acute congestive heart failure in the past year, or; workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent; rate as 60 percent disabling. >Workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray; rate as 30 percent disabling. Code 7101. Hypertensive vascular disease (hypertension and isolated systolic hypertension): >Diastolic pressure predominantly 130 or more; rate as 60 percent disabling. >Diastolic pressure predominantly 120 or more; rate as 40 percent disabling. >Diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more; rate as 20 percent disabling. >Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control; rate as 10 percent disabling. * Note (1): Hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90mm. or greater, and isolated systolic hypertension means that the systolic blood pressure is predominantly 160mm. or greater with a diastolic blood pressure of less than 90mm. * Note (2): Evaluate hypertension due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, as part of the condition causing it rather than by a separate evaluation. 38 C.F.R. § 4.104 (Effective on January 12, 1998). 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. 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. 38 C.F.R. § 4.104, Note 2 (Effective on January 12, 1998). A total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. Total disability may or may not be permanent. Total ratings will not be assigned, generally, for temporary exacerbations or acute infectious diseases except where specifically prescribed by the schedule. 38 C.F.R. § 3.340(a)(1) (1999). Total ratings are authorized for any disability or combination of disabilities for which the Schedule for Rating Disabilities prescribes a 100 percent evaluation or, with less disability, where the requirements of 38 C.F.R. § 4.16 of the rating schedule are present. 38 C.F.R. § 3.340(a)(2) (1999). Total disability compensation ratings may be assigned under the provisions of 38 C.F.R. § 3.340. However, if the total rating is based on a disability or combination of disabilities for which the Schedule for Rating Disabilities provides an evaluation of less than 100 percent, it must be determined that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age. 38 C.F.R. § 3.341(a) (1999). Total disability ratings for compensation may be assigned, where the scheduler rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities: provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. It is provided further that the existence or degree of nonservice-connected disabilities or previous unemployability status will be disregarded where the percentages referred to in this paragraph for the service- connected disability or disabilities are met and in the judgment of the rating agency such service-connected disabilities render the veteran unemployable. Marginal employment shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a) (1999). III. Analysis. The first responsibility of a claimant is to present a well- grounded claim. 38 U.S.C.A. § 5107(a) (West 1991). A claim for an increased evaluation is well grounded if the claimant asserts that a disorder for which service connection has been granted has worsened. Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). In this case, the veteran asserted that his service-connected coronary artery disease and hypertension are worse than currently evaluated, and he has thus stated a well-grounded claim. In addition, the undersigned finds that the VA has conducted all development required in this case to comport with the requirements of 38 U.S.C.A. § 5107(a). The Board's remand of January 1998 required that the RO request information from the veteran on his healthcare providers, request his medical records from the appropriate SSA and VA facilities, and conduct a thorough compensation examination based on the veteran's entire medical history. These actions were carried out by the RO and do not require any further development. See Stegall v. West, 11 Vet. App. 268 (1998). While the veteran has claimed that the January 1999 examiner did not have all available medical records for review, the development noted in the claims file indicates otherwise. Regarding the veteran's SSA records, the RO has on a number of occasions requested these records directly from the agency and informed the veteran of his responsibility in submitting this evidence. The agency did provide a copy of its decision denying the veteran's claim. More significant is the veteran's own admission in June 1999 that the SSA relied solely on his VA medical records and had not conducted any independent medical examination in connection with his SSA claim. Based on this information, any further development of the SSA records would be futile. Regarding the veteran's private medical records, the RO has also directly requested these from the identified physician to no avail. Again, the veteran was informed of his responsibility in submitting this evidence to the VA. The one outpatient record from this physician that the veteran did submit indicates that the veteran was being seen for treatment of his genitourinary complaints. Thus, these records do not appear to be pertinent to his service-connected heart disorder. It is also found that the veteran has been adequately informed of the requirements for an increased evaluation of his coronary disability, to include both the former and revised criteria at 38 C.F.R. § 4.104, in the RO's the statement of the case and SSOC's of recent years and the Board's remand of January 1998. As the veteran has been provided with the opportunity to present evidence and arguments on his behalf and availed himself of those opportunities, appellate review is appropriate at this time. See Robinette v. Brown, 8 Vet. App. 65 (1995); Bernard v. Brown, 4 Vet. App. 384 (1993). Turning to the evaluation of the veteran's coronary artery disease, the veteran has claimed that he is significantly disabled due to this disorder. His predominate complaints are chest pain and shortness of breath with exertion. It is alleged that his physical activities are so limited by his disease that he cannot maintain gainful employment. While the veteran is competent to provide evidence on symptomatology, he not competent to provide a diagnosis, etiology, or any matter requiring a professional medical opinion. Zang v. Brown, 8 Vet. App. 246 (1995). The latter opinions can only be provided by a competent medical professional. Evaluating the evidence of record under the former criteria at Code 7005 indicates that the veteran is not entitled to an increased evaluation. There is no evidence that the veteran has ever suffered a coronary occlusion or thrombosis. In fact, his coronary artery disease was solely based on suggested findings from the veteran's 1994 EKG. There is only one diagnosis for coronary artery disease of record and the January 1999 examiner suggested there was significant objective evidence of record to place this diagnosis in doubt. While the veteran has claimed repeated problems with chest pain, the only substantiated anginal attack of record was reported in the outpatient record of June 1997. Finally, the veteran has not submitted any evidence except his own unsubstantiated assertions that his heart disease precludes him from manual labor. None of the examiners of record has indicated that the veteran's coronary artery disease prohibited from such labor. Based on this evidence, an increased evaluation to 60 percent disabling is not warranted under the former criteria at Code 7005. The revised criteria at Code 7005 also do not provide a basis for an increased evaluation. There is no objective evidence of record to indicate that the veteran suffered any episode of congestive heart failure in recent years. The echocardiogram of February 1999 has found no abnormality with the veteran's left ventricle functioning and, in any event, his ejection fraction was noted to be in excess of 50 percent. It is alleged by the veteran that the report of the February 1999 indicated that his ejection fraction was less than 55 percent. However, a review of this report does not indicate such a finding and, as noted above, the veteran is not a competent medical professional who could provide the appropriate interpretation of the raw test data. On the exercise/stress test of 1994, the veteran was only able to reach a METs of 3.5 before stopping. However, the report of this examination does not indicate that the veteran stopped the test due to dyspnea, fatigue, angina, dizziness, or syncope. The tester reported that there were no acute changes noted in the veteran during the test and he declined further evaluation. As the veteran was not prevented by the noted symptomatology from reaching a higher METs score, this evidence does not meet the scheduler criteria for a 60 percent evaluation. Therefore, an increased evaluation cannot be awarded under the revised criteria of Code 7005. Turning to the evaluation of hypertension under Code 7101, both the former and revised criteria require a diastolic reading predominately at or above 120 for an evaluation in excess of 30 percent disabling. There is no evidence of record that the veteran has maintained a diastolic reading this high for any period of time and an increased evaluation under Code 7101 is therefore not authorized. It was argued by the veteran's representative in a September 1999 brief submitted to the Board, that that the veteran is entitled to a separate evaluation for his hypertension under the Court's precedent in Esteban v. Brown, 6 Vet. App. 259 (1994). In Esteban, the Court ruled that a veteran could receive separate evaluations for the similar service- connected disabilities if the rating criteria of the different diagnostic codes did not contain overlapping symptomatology. However, prior to reaching the issue of whether separate evaluations could be assigned in the present case, it must be shown that the evidence supports a compensable rating for hypertension. The facts of the present case do not support such a finding. There is no evidence in recent years that the veteran's diastolic reading has stayed predominately 100 or more, or that his systolic reading is predominately 160 or more. A review of the historical evidence also fails to show that his diastolic readings have ever been predominately 100 or more prior to the use of medication to control his hypertension. Based on these facts, the veteran would not be entitled to a compensable evaluation for hypertension and, therefore, the issue of a separate evaluation for this disorder is moot. Likewise the assertion by the service representative that the veteran's disability, which is productive of chest pain, should be evaluated under the provisions of 38 C.F.R. § 4.40 (1999) has been carefully considered. That regulation addresses functional loss and disability of the musculoskeletal system. There has been presented no medical evidence linking any musculoskeletal system dysfunction to the service-connected disorder. On the other hand, the relevant diagnostic code, 7005, includes disability due to angina as a factor in rating arteriosclerotic heart disease/coronary artery disease. The veteran's complaints of chest pain have been the primary basis for his rating of 30 percent, especially in view of the fact that clinical examination reveals little objective data to confirm the presence of coronary artery disease. Assigning an increased rating under 38 C.F.R. § 4.40 would not be proper, in the Board's view. Finally, the veteran has claimed that his service-connected heart disease has prevented him from obtaining or maintaining substantially gainful employment. However, the only evidence he has submitted in support of this claim is his own unsubstantiated assertions. Evidence from his employer does not indicate that he lost his last job due to his heart disease nor has any medical professional provided an opinion that this disease has significantly interfered with his industrial adaptability. The report from the Social Security Administration reflects that the claim was denied because the veteran was felt (on the basis of all disabilities, service- connected and nonservice-connected) to be capable of performing work, including his former employment driving a van. In any event, the veteran's service-connected disability evaluation is only 30 percent disabling. Without the service-connected disability evaluation required by 38 C.F.R. § 4.16, that is, a single disability evaluated as 60 percent disabling, the veteran is prohibited as a matter of regulation from eligibility for TDIU. See Sabonis v. Derwinski, 6 Vet. App. 426 (1994). Based on the above analysis, the preponderance of the evidence does not warrant an increased evaluation for the veteran's service-connected heart disease. It is also determined that the veteran is not entitled to TDIU based on the regulatory criteria. ORDER An increased evaluation in excess of 30 percent disabling for coronary artery disease with a history of hypertension is denied. A total evaluation for individual unemployability due to service-connected disability is denied. N. R. ROBIN Member, Board of Veterans' Appeals