Citation NR: 9609243 Decision Date: 04/06/96 Archive Date: 04/16/96 DOCKET NO. 94-01 050 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to service connection coronary artery disease secondary to service connected depressive neurosis. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Daniel R. McGarry, Associate Counsel INTRODUCTION The veteran had active service from April 1951 to April 1953. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 1992 rating decision in which the regional office (RO) denied entitlement to service connection for coronary artery disease secondary to service connected depressive neurosis. The RO informed the veteran by a letter dated in January 1994 that his appeal was being place on the Board’s docket, and that any additional evidence should be submitted directly to the Board within 90 days. The Board has received additional evidence in June 1994, which the veteran’s representative submitted directly to the Board. The veteran did not waive RO consideration of any of this evidence, nor did he or his representative advanced an argument for “good cause” for the late submission of this evidence, as required by 38 C.F.R. § 20.1304 (1995). Although the Board has not considered such additional evidence, in light of its decision to grant entitlement to service connection for coronary artery disease, the evidence need not be referred to the RO for its consideration. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that he has disability from coronary artery disease which is proximately due to or the result of his service connected depressive neurosis, or was aggravated as a result of such service connected disability. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1995), 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 evidence supports the grant of entitlement to service connection for coronary artery disease secondary to service connected depressive neurosis. FINDING OF FACT The veteran has coronary artery disease which is proximately due to or the result of service connected disability from depressive neurosis, or which has been aggravated by such service connected disability. CONCLUSION OF LAW The requirements for a grant of service connection for coronary artery disease secondary to service connected disability from depressive neurosis are met. 38 U.S.C.A. §§ 1110, 5107 (West 1991 & Supp. 1995). 38 C.F.R. §§ 3.303, 3.310 (1995). REASONS AND BASES FOR FINDING AND CONCLUSION It is noted that the veteran’s claim is well grounded within the meaning of 38 U.S.C.A. § 5107 (West 1991 & Supp. 1995). The Board finds that he has presented a claim that is plausible. There is no indication of additional outstanding evidence. No further assistance to the veteran is required to comply with the duty to assist the veteran mandated by 38 U.S.C.A. § 5107. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. §§ 101(16), 1110 (West 1991 & Supp. 1995); 38 C.F.R. § 3.303 (1995). Further, disability which is proximately due to or the result of a service- connected disease or injury shall be service connected. 38 C.F.R. § 3.310. The United States Court of Veterans Appeals (Court) has held that when aggravation of a veteran’s nonservice connected condition is proximately due to or the result of service-connected condition, the veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to such aggravation. Allen v. Brown, 7 Vet.App. 439 (1995). The veteran was granted entitlement to service connection for anxiety reaction by a July 1953 rating decision. Since that action, the veteran’s neuropsychiatric disorder has been variously diagnosed as anxiety neurosis with hysteric features, anxiety state with schizoid impairment, schizophrenia, socioaffective type, and depressive neurosis, the last such diagnosis being noted in an October 1979 rating decision which increased the veteran’s disability rating to 50 percent. During VA outpatient treatment in 1991, the veteran complained of chest pain and dyspnea on exertion. In August 1991, the results of a Holter monitor were determined to be consistent with ischemia. In an October 1991 letter, Egerton K. van den Berg, Jr., M.D., advised that the veteran had significant single vessel coronary disease and a critical stenosis of the left anterior descending artery. Dr. van den Berg noted the patient’s history of depressive neurosis with obsessive features and stated that the veteran “ as a result, has been under significant stress, and these factors may have played a role in precipitating the development and progression of his atherosclerotic coronary artery disease.” In a January 1992 letter, Melvin L. Mayer, M.D., reported that the veteran had no family history of heart disease, was a nonsmoker, had never been obese, and never had significant elevation in his cholesterol. It was Dr. Mayer’s opinion that “...stress has been a major factor in his predisposition and development of this 95% stenosis of the coronary artery.” In a January 1996 letter, Norman H. Ertel, M.D., Chief, Medical Service of the VA medical center at East Orange, New Jersey, confirmed a relationship between chronic stress, depressive illness and other psychosocial factors and cardiovascular morbidity and mortality. According to Dr. Ertel There is at least reasonable support for the thesis that chronic depressive neurosis can cause coronary artery disease or accelerate underlying disease. There is even greater evidence that psychosocial factors can aggravate underlying coronary artery disease and that additional disability from coronary artery disease is fully attributable to such aggravation. The record contains evidence which supports a finding that the veteran’s disability from coronary artery disease is proximately due to or the result of his service connected depressive neurosis, or was aggravated to the full extent of the current disability therefrom, since disability from coronary artery disease was not shown to exist prior to the veteran’s disability from a neuropsychiatric disorder. The record contains no medical evidence that the veteran’s coronary artery disease is not causally related to his depressive neurosis. Accordingly, the Board concludes that entitlement to service connection for coronary artery disease secondary to depressive neurosis is established. ORDER Entitlement to service connection for coronary artery disease secondary to depressive neurosis is granted. JOAQUIN AGUAYO-PERELES 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 & Supp. 1995), 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. - 2 -