Citation Nr: 0811152 Decision Date: 04/04/08 Archive Date: 04/14/08 DOCKET NO. 05-01 075 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUE Entitlement to service connection for a heart disorder. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD M. Katz, Associate Counsel INTRODUCTION The veteran served on active duty from January 2000 to April 2000. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2003 rating decision by the Department of Veterans Affairs (VA) Regional Office in Indianapolis, Indiana (RO). FINDING OF FACT The veteran does not have a current diagnosis of a chronic heart disorder related to military service. CONCLUSION OF LAW A heart disorder was not incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1110, 5103A, 5107 (West 2002); 38 C.F.R. § 3.303 (2007). REASONS AND BASES FOR FINDING AND CONCLUSION VA has certain notice and assistance requirements. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (West 2002 & Supp. 2005); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326 (2007). Upon receipt of a substantially complete application for benefits, VA must notify the veteran of what information or evidence is needed in order to substantiate the claim, and it must assist the veteran by making reasonable efforts to obtain the evidence needed. 38 U.S.C.A. §§ 5103(a), 5103A; 38 C.F.R. § 3.159(b); see Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002). Prior to the initial adjudication of the veteran's claim, the RO's letter dated in May 2003 advised the veteran of the foregoing elements of the notice requirements. Further, the purpose behind the notice requirement has been satisfied because the veteran has been afforded a meaningful opportunity to participate effectively in the processing of his claim, to include the opportunity to present pertinent evidence. Thus, the Board finds that the content requirements of the notice VA is to provide have been met. See Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004). The duty to assist the veteran has also been satisfied in this case. The RO has obtained the veteran's service medical records and his identified private treatment records. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159. The Board notes that VA did not provide the veteran with a medical examination, but finds that an examination was not required in this case. VA is only required to provide medical examinations or obtain medical opinions in certain circumstances. 38 U.S.C.A. §5103A(d); 38 C.F.R. § 3.159(c)(4). Finally, there is no indication in the record that additional evidence relevant to the issue being decided herein is available and not part of the record. See Pelegrini, 18 Vet. App. at 112. As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of this case, the Board finds that any such failure is harmless. See Mayfield v. Nicholson, 20 Vet. App. 537 (2006); see also Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). 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. § 1110; 38 C.F.R. § 3.303. Service connection for certain chronic diseases, including arteriosclerosis, will be presumed if they are manifest to a compensable degree within the year after active service. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2007). Service connection may also be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b); 38 C.F.R. § 3.303(d); Cosman v. Principi, 3 Vet. App. 503, 505 (1992). In order to establish service connection for a claimed disorder, the following must be shown: (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Hickson v. West, 12 Vet. App. 247, 253 (1999). The veteran's service medical records reveal that he was treated for chest pain inservice. A March 2000 Emergency Medical Services (EMS) record notes the veteran's complaints of a dull throbbing pain in his left chest cavity without radiation. A March 2000 Naval Hospital report reveals the veteran's complaints of sudden sharp, burning, and stabbing pain in the left chest while performing marching drills. The report noted that the veteran's chest pain seemed to be exacerbated by being emotionally upset after someone was yelling. There was associated shortness of breath and a clammy feeling that resolved with the chest pain. The veteran reported that he had a similar episode the morning before his admission to service, during which he felt nauseous and vomited. Physical examination revealed the veteran to be alert and oriented with a somewhat depressed affect and in no apparent distress. His temperature was 99.1 degrees, his pulse was 82, his respiratory rate was 20, and his blood pressure was 114/61. The veteran was 5'7" tall and weighed 74 kilograms. Cardiovascular examination revealed a regular rate and rhythm without murmur, gallop, or rub. His chest was without tenderness to palpation. Laboratory tests showed CPK 251, LDH 701, AST 34, and a CK/MV percent of 4.7. Myoglobin was 43 and troponin was 13.9. A chest x-ray was within normal limits, and an initial electrocardiogram (EKG) showed decreased R waves in V1 and V2 with prominent R waves in V3- V6 with probable strain pattern T-wave inversion V3-V6. Subsequent EKGs showed intermittent T-wave inversion inferior lateral leads. No ST elevation, depression, or Q waves were noted. A treadmill test was performed which showed no evidence of ischemia. The veteran exercised at 76% maximum predicted heart rate without chest pain or EKG changes. He achieved 10.1 METS. An echocardiogram was also performed, and the results were normal. The diagnosis was "rule out myocardial infarction." The physician noted that the veteran's chest pain was associated with an elevated troponin and CK, but normal MB fraction. The veteran had no further similar significant chest pain or other symptoms during his hospital stay. The physician ultimately found the veteran unfit for military service given his "possible history of myocardial infarction" and his "refusal to undergo cardiac cathertization to rule out significant heart disease." The veteran's service personnel records reveal that in March 2000, he was discharged to a medical holding company with a discharge diagnosis of "possible myocardial infarction." Private medical treatment records from October 2004 reveal the veteran's complaints of chest pain. The veteran reported a history of chest pain on and off in the past. The veteran also stated that he has done relatively well with his chronic chest pains over the last four years, and described them as a prickling sensation in his chest with occasional sharp qualities. The veteran reported that he was a smoker, but that he intended to quit. He stated that he occasionally uses alcohol, he drinks eight cups of caffeine per day, and he rarely exercises. The veteran denied a family history for premature coronary artery disease. Physical examination revealed that the veteran's blood pressure was 117/70, his heart rate was 66, his respiratory rate was 14, and his weight was 168 pounds. His skin was well-perfused, and his neck was supple. Carotid upstrokes were brisk and there were no carotid bruits. His lungs were clear. A cardiovascular examination revealed a regular rate and rhythm with a normal S1 and S2 without rubs or gallops. His chest had normal contour and was non-tender. His abdomen was soft and bowel sounds were present. No masses or bruits were noted. The veteran's extremities demonstrated no edema, and his distal pulses were 2+/4 at the radials and dorsalis pedis bilaterally. An EKG was performed, which demonstrated normal sinus rhythm, normal conduction interval, and no ST/T- wave abnormalities of significance. The physician diagnosed chest pain. A December 2004 private hospital treatment record revealed that the veteran underwent an x-ray of the chest. The x-ray revealed no acute cardiopulmonary disease. In a July 2004 statement and a January 2005 substantive appeal, the veteran contended that, because his heart problems started during service, his heart disorder must be service-connected. The Board finds that the medical evidence of record does not support a finding of service connection for a heart disorder. Although the veteran's service medical records reveal complaints of chest pain and a diagnosis of "rule out myocardial infarction" inservice, there is simply no medical evidence that the veteran has a current heart disorder. Degmetich v. Brown, 104 F.3d 1328, 1333 (1997) (holding that the existence of a current disability is the cornerstone of a claim for VA disability compensation). In October 2004, the veteran underwent a private examination performed by a cardiologist. A physical examination performed at that time was normal, and an EKG was also normal. As such, the diagnosis was chest pain. In addition, a December 2004 chest x-ray was normal. The Board acknowledges that the veteran can provide competent evidence about what he experienced; for example, his statements are competent evidence as to what symptoms he experiences. See, e.g., Layno v. Brown, 6 Vet. App. 465 (1994). Competency, however, must be distinguished from weight and credibility, which are factual determinations going to the probative value of the evidence. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). The Board notes that the veteran has alleged that his history of chest pain warrants service-connection. However, while the veteran is competent to testify to his symptoms of chest pain, as a lay person, he is not competent to diagnose a current disability or to assert that a relationship exists between his period of service and his chest pain. See Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). In addition, it is important for the veteran to understand that pain alone, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability for which service connection may be granted. Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999), appeal dismissed in part, and vacated and remanded in part sub nom. Sanchez-Benitez v. Principi, 239 F.3d 1356 (Fed. Cir. 2001). Thus, in the absence of competent medical evidence showing a known clinical diagnosis of a heart disorder, the claim must be denied. See Degmetich, 104 F.3d at 1332 (holding that compensation may only be awarded to an applicant who has a disability existing on the date of the application, and not for a past disability); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (in the absence of proof of the presently claimed disability, there can be no valid claim). Accordingly, service connection for a heart disorder is not warranted. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as there is no medical evidence of the disorder at issue, the preponderance of the evidence is against the veteran's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Service connection for a heart disorder is denied. ____________________________________________ JOY A. MCDONALD Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs