Citation Nr: 1007459 Decision Date: 03/01/10 Archive Date: 03/11/10 DOCKET NO. 08-14 924 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in New York, New York THE ISSUE Entitlement to service connection for claimed heart condition, to include as secondary to right pneumonectomy due to cancer. REPRESENTATION Appellant represented by: New York State Division of Veterans' Affairs ATTORNEY FOR THE BOARD N. Rippel, Counsel INTRODUCTION The Veteran served on active duty from June 1962 to August 1968. He performed active service in the Republic of Vietnam. This case comes before the Board of Veterans' Appeals (Board) on appeal of an April 2007 rating decision of the RO. FINDING OF FACT The currently demonstrated coronary artery disease with ischemic cardiomyopathy is shown as likely as not to be aggravated by the service-connected residuals of the right pneumonectomy due to lung cancer. CONCLUSION OF LAW By extending the benefit of the doubt to the Veteran, his disability manifested by coronary artery disease and ischemic cardiomyopathy is proximately due to or the result of service-connected disability manifested by the absence of the right lung. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310 (2009). REASONS AND BASES FOR FINDING AND CONCLUSION As a preliminary matter, the Board notes that the Veteran has been provided all required notice, to include notice pertaining to the effective-date element of his claim. In addition, the Board has determined that the evidence currently of record is sufficient to substantiate the Veteran's claim. Therefore, no further development is required under 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2009) or 38 C.F.R. § 3.159 (2009). I. Legal Criteria Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1110. Service connection may 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 C.F.R. § 3.303(d). Service connection may also be granted for disability which is proximately due to or the result of service-connected disability. 38 C.F.R. § 3.310(a). Additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability is also compensable under 38 C.F.R. § 3.310(a). Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). During the pendency of the Veteran's service connection claim, 38 C.F.R. § 3.310 was amended, effective October 10, 2006. The amendments to this section are not liberalizing. Therefore, the Board will apply the former version of the regulation. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C.A. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. II. Analysis Service connection is in effect for the residuals of a right pneumonectomy due to cancer that was determined to be the result of herbicide exposure, with lung cancer diagnosed and right pneumonectomy performed in 1999, and service connection being awarded in March 2002. The Veteran was diagnosed with coronary disease and ischemic cardiomyopathy in 1998. He had a myocardial infarction at that time and underwent cardiac catheterization in 1998, 1999 and 2004. Although a heart murmur was noted on both the service entrance and separation examination reports, the coronary artery disease and ischemic cardiomyopathy are not shown to be due to any event or incident of his active service. Nonetheless, the Veteran has presented medical opinion evidence that the current heart disease is medically related to the service-connected right pneumonectomy due to lung cancer. A VA examination report dated in December 2006, with addendum dated in February 2007, reflects an opinion that the combination of heart and lung disease caused dyspnea rendering the Veteran unemployable. Neither the report nor the addendum; however, fully addressed the etiology of the current heart disease or its relationships to the service- connected right lung pneumonectomy. Nonetheless, in June 2007, the Veteran's treating cardiologist opined that his coronary artery disease was at least as likely as not related to lung disease. The physician related the Veteran's history of multiple heart and lung problems. He explained that the heart problems, coronary artery disease, remote myocardial infarction, coronary artery stent and re-stenosis, defibrillator placement due to LV dysfunction, and compensated congestive heart failure, combine with his lung cancer and right pneumonectomy to produce fairly significant dyspnea. Noting various factors, the treating cardiologist provided his clinical opinion that the Veteran's heart and lung disease interacted with each other. He noted that certain treatments for the heart disability were hard to undertake because of the lung disability. In addition, the treating cardiologist explained that the cardiac condition was aggravated by the lung condition and vice versa. His conclusion was that both conditions impacted each other and were involved in his overall disability. The private treatment records dated from 1998 through December 2006 show describe the findings of his heart disease and lung disability. While the medical evidence in this case does not directly address the etiology of the Veteran's coronary artery disease with ischemic cardiomyopathy, the opinions of record do tend show that the degree of functional impairment caused by the Veteran's serious heart disease is to some extent related to and impacted by the service-connected right lung pneumonectomy, The Veteran's treating cardiologist described this as being aggravated, and the VA examiner identified the combination as producing an increased degree of dyspnea. Thus, on this record, the Board finds the evidence to be in relative equipoise in showing that the currently demonstrated coronary artery disease as likely as not is aggravated by the service-connected residual of the right pneumonectomy. In addition, the Board notes that the Veteran performed active duty in the Republic of Vietnam and, by law, is presumed to have been exposed to Agent Orange based on this service. VA in this regard has been tasked with identifying the various diseases that are causally linked to Agent Orange exposure. While heart disease is not currently included in this group, the listing is subject to periodic change and updating on the basis of new information and study. Accordingly, in resolving all reasonable doubt in the Veteran's favor, secondary service connection for coronary heart disease and ischemic cardiomyopathy on the basis of aggravation is warranted. ORDER Secondary service connection for coronary artery disease and ischemic myopathy on the basis of aggravation is granted. ____________________________________________ STEPHEN L. WILKINS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs