Citation Nr: 1007684 Decision Date: 03/02/10 Archive Date: 03/11/10 DOCKET NO. 06-08 045 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office and Insurance Center in Philadelphia, Pennsylvania THE ISSUE Entitlement to service connection for coronary artery disease. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Tahirih S. Samadani, Associate Counsel INTRODUCTION The Veteran served on active duty from January 1974 to June 1986. The Veteran also served in the U.S. Coast Guard Reserves beginning in 1986, which includes periods of active duty for training (ACDUTRA). This case comes before the Board of Veterans' Appeals (Board) on appeal from a July 2005 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) and Insurance Center in Philadelphia, Pennsylvania, which denied service connection for coronary artery disease. In March 2007, the Veteran testified at a personal hearing at the RO before a Decision Review Officer. A transcript of the proceeding is of record. FINDINGS OF FACT Resolving all doubt in the Veteran's favor, the evidence of record supports a finding that the Veteran's currently diagnosed coronary artery disease was first manifested during active duty for training. CONCLUSION OF LAW The criteria for service connection of coronary artery disease. 38 U.S.C.A. §§ 101, 106, 1110, 1131, 5107 (West 2002 & Supp. 2009); 38 C.F.R. §§ 3.6, 3.102, 3.303 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Duties to Assist and Notify The Veterans Claims Assistance Act of 2000 (VCAA) is not applicable where further assistance would not aid the veteran in substantiating his claim. Wensch v. Principi, 15 Vet App 362 (2001); see 38 U.S.C.A. § 5103A(a)(2) (Secretary not required to provide assistance "if no reasonable possibility exists that such assistance would aid in substantiating the claim"). In view of the Board's favorable decision in this appeal, further assistance is unnecessary to aid the Veteran in substantiating his claim. II. Entitlement to service connection for coronary artery disease Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Additionally, service connection may be granted for disability resulting from disease or injury incurred in or aggravated while performing active duty for training (ACDUTRA) or for injury incurred in or aggravated while performing inactive duty training (INACDUTRA). 38 U.S.C.A. §§ 101(24), 106 (West 2002 & Supp. 2009); 38 C.F.R. § 3.6 (2009). In order to establish service connection or service-connected aggravation for a present disability, the veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Shedden v. Principi, 381 F.3d at 1163, 1166-67 (Fed. Cir. 2004). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The term "veteran" means a person who served in the active military, naval, or air service and who was discharged or released therefrom under conditions other than dishonorable. 38 U.S.C.A. § 101(2) (West 2002). The term "active duty" includes full-time duty in the Armed Forces, other than ACDUTRA. 38 U.S.C.A. § 101(21) (West 2002). The term Armed Forces means the United States Army, Navy, Marine Corps, Air Force, and Coast Guard, including the reserve components thereof. 38 U.S.C.A. § 101(10) (West 2002). Active military, naval, or air service includes any period of ACDUTRA, during which the individual concerned was disabled or died from a disease or injury incurred in or aggravated in line of duty; or any period of INACDUTRA during which the individual concerned was disabled or died from injury incurred in or aggravated in line of duty. 38 U.S.C.A. § 101(21) and (24) (West 2002); 38 C.F.R. § 3.6(a) and (d). ACDUTRA is, inter alia, full-time duty in the Armed Forces performed by Reserves for training purposes. 38 C.F.R. § 3.6(c)(1). The line of duty includes the period during which the individual is proceeding directly to or returning directly from such ACDUTRA or INACDUTRA service. 38 C.F.R. § 3.6(e). VA will determine whether such individual was so authorized or required to perform such duty, and whether the individual was disabled or died from an injury or covered disease so incurred. In making such determinations, there shall be taken into consideration the hour on which the individual began to proceed or return; the hour on which the individual was scheduled to arrive for, or on which the individual ceased to perform, such duty; the method of travel performed; the itinerary; the manner in which the travel was performed; and the immediate cause of disability or death. Whenever any claim is filed alleging that the claimant is entitled to benefits by reason of this paragraph, the burden of proof shall be on the claimant. Id. For purposes of this section, the term covered disease means any of the following: (i) an acute myocardial infarction, (ii) a cardiac arrest, (iii) a cerebrovascular accident. Lay persons are not competent to opine as to medical etiology or render medical opinions. Barr v. Nicholson; see Grover v. West, 12 Vet. App. 109, 112 (1999); Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). Lay testimony is competent, however, to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Falzone v. Brown, 8 Vet. App. 398, 405 (1995) (lay person competent to testify to pain and visible flatness of his feet); Espiritu, 2 Vet. App. at 494- 95 (lay person may provide eyewitness account of medical symptoms). "Symptoms, not treatment, are the essence of any evidence of continuity of symptomatology." Savage v. Gober, 10 Vet. App. 488, 496 (citing Wilson v. Derwinski, 2 Vet. App. 16, 19 (1991)) (1997). Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted"). The Veteran has coronary artery disease and has been treated with a coronary angioplasty of the mid and distal right coronary artery. Therefore, it is clear from the record that the Veteran has a current heart disability. The question before the Board, then, is whether the currently diagnosed disorder is related to service. The Veteran does not contend nor does the record show that the Veteran's heart condition began during active military duty from January 1974 to June 1986. Instead, the Veteran argues that he had chest pains while coming home from active duty for training (ACDUTRA or "drilling") that took placed from July 6, 1996 to July 7, 1996. Accordingly, the questions in contention are whether: (a) the Veteran was on ACDUTRA for training from July 6, 1996 to July 7, 1996, and (b) whether he had symptoms of his heart condition during that time or when proceeding directly to or returning directly from such ACDUTRA. With regard to the first issue, the evidence establishes that the Veteran was on ACDUTRA on July 6, 1996 to July 7, 1996. In response to the RO's request for a list of the Veteran's drilling activity for 1996, the U.S. Coast Guard provided documentation showing active duty for training for July 6, 1996 and July 7, 1996. With regard to whether the Veteran had symptoms of his heart condition during training, there do not appear to be service treatment records for this drill period included in the claims file. Despite this, the Veteran alleges that he felt chest pains while coming home from the training, and therefore, there would be no record of the Veteran's complaints in his service treatment records. In addition, in March 2005, the Veteran stated that he was treated for a heart attack and his heart condition by civilian doctors, and he was not treated by any military healthcare provider. The private treatment records submitted by the Veteran show treatment for a heart attack on July 8, 1996. Medical documentation from Delaware Valley Medical Center show that the Veteran was admitted on July 8, 1996 complaining of mid epigastric discomfort which he attributed to his stomach. After getting sublingual nitroglycerin in the Emergency Room for epigastric discomfort, there was no change in the character of his pain. An electrocardiogram revealed minimal inferior ST elevation with some high lateral ST depression. He was diagnosed with acute inferior wall myocardial infarction, a history of hypertension, gastroesophageal reflux and hyperlipidemia. He was discharged July 11, 1996 and transferred to Hahnemann University Hospital for diagnostic cardiac catheterization to determine the extent of his coronary artery disease. On July 11, 1996, a combined right and left heart catheterization, left ventribulography and coronary arteriography was performed. On July 12, 1996, a percutaneous transluminal coronary angioplasty of the mid and distal right coronary artery was performed. The only evidence showing that the Veteran had symptoms of his heart disorder when leaving ACDUTRA is the Veteran's own lay statement. Although originally, the Veteran incorrectly stated that his heart attack occurred on July 5, 1996, the Veteran explained that he was simply mistaken about the date of the heart attack. Despite this inconsistency, the Veteran's reports that he experienced chest pain on the way home from ACDUTRA have been fairly consistent. In April 2005, the Veteran explained that his heart attack began on his way home from weekend drills. During the March 2007 hearing, the Veteran also testified that he had chest pain when coming home from the training. There is no evidence to the contrary. Furthermore, the medical evidence shows that he sought treatment the very next day and was diagnosed with acute inferior wall myocardial infarction. The Board finds that the Veteran is competent to provide statements as to how he felt when leaving his active duty for training. The Board also finds the Veteran's statement that he began experiencing chest pains on the way home from the drills are credible, as they have been consistent and the medical evidence corroborates that he sought treatment the day after feeling chest pain. Accordingly, with reasonable doubt resolved in favor of the Veteran, the Board finds that the Veteran has coronary artery disease as a result of his service, and service connection is granted for this disability. 38 U.S.C.A. § 5107(b). ORDER Service connection for coronary artery disease, claimed as cardiac condition and heart attack, is granted, subject to the laws and regulations governing payment of monetary benefits. ____________________________________________ CHERYL L. MASON Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs