Citation Nr: 1320114	
Decision Date: 06/21/13    Archive Date: 07/02/13

DOCKET NO.  07-17 038	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in Montgomery, Alabama


THE ISSUE

Entitlement to service connection for coronary artery disease, to include as secondary to service-connected disabilities.


REPRESENTATION

Appellant represented by:	The American Legion


WITNESS AT HEARING ON APPEAL

Appellant


ATTORNEY FOR THE BOARD

Christopher Murray, Counsel

INTRODUCTION

The Veteran had active military service from March 1981 to July 1981 and from January 1991 to May 1991.  He also served with the Alabama Army National Guard from 1981 to 2003, with various periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA).

This case comes before the Board of Veterans' Appeals (Board) on appeal of a June 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama.

The Veteran testified before the Board at a November 2008 hearing conducted via videoconference.  A transcript of the hearing is of record.

The Board previously referred the issue of entitlement to service connection for sleep apnea.  However, no action has been taken on the Veteran's claim.  As such, this issue is again REFERRED to the RO for its consideration.  See Godfrey v. Brown, 7 Vet. App. 398 (1995).

This case was previously before the Board in September 2011, at which time the claim was remanded to the Agency of Original Jurisdiction (AOJ) for further development.  The requested development having been completed, the case is once again before the Board for appellate consideration of the issue on appeal.


FINDING OF FACT

Resolving all doubt in favor of the Veteran, coronary artery disease is caused by his service-connected hypertension.





CONCLUSION OF LAW

Coronary artery disease is proximately due to a service-connected disability.  38 U.S.C.A. §§ 1110, 5107(b) (West 2002); 38 C.F.R. § 3.310 (2012).


REASONS AND BASES FOR FINDING AND CONCLUSION

Duties to Notify and Assist

Since the entire benefit sought on appeal has been granted, no purpose would be served by undertaking an analysis of whether there has been compliance with the notice and duty to assist requirements set out at 38 U.S.C.A. §§ 5100, 5102-5103A, 5106, 5107, 5126 (West 2002).  See, e.g., Bernard v. Brown, 4 Vet. App. 384 (1993); VAOPGCPREC 16-92, 57 Fed. Reg. 49,747 (1992).

Analysis

Under 38 U.S.C.A. § 7104, Board decisions must be based on the entire record, with consideration of all the evidence.  In Timberlake v. Gober, 14 Vet. App. 122 (2000), the Court held, in pertinent part, that the law requires only that the Board address its reasons for rejecting evidence favorable to the claimant.  The Board must review the entire record, but does not have to discuss each piece of evidence.  Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000).

It is VA's defined and consistently applied policy to administer the law under a broad interpretation, consistent, however, with the facts shown in every case.  When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant.  By reasonable doubt it is meant that an approximate balance of positive and negative evidence exists which does not satisfactorily prove or disprove the claim.  Reasonable doubt is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility.  See 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102 (2012).

The Veteran initially asserted entitlement to service connection for coronary artery disease as directly related to his service in the Gulf War.  Though not raised by the Veteran, as discussed in detail below, the record supports entitlement to service connection on a secondary basis.  As such, the Board will not discuss direct service connection in the instant case.  See generally Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994).

Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury.  38 C.F.R. § 3.310(a) (2012).  Establishing service-connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability.  See 38 C.F.R. § 3.310(a); see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc).  When aggravation of a Veteran's non-service-connected condition is proximately due to or the result of a service-connected condition, the Veteran shall be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation.  Allen, supra.

The Veteran has submitted both private and VA treatment records related to his initial diagnosis of coronary artery disease in approximately November 2001 and its subsequent treatment.  Significantly, in conjunction with the instant claim, the Veteran was awarded service connection for hypertension.  See September 2011 Board decision; September 2011 rating decision.  Following the award of service connection for hypertension, the Veteran was provided a VA examination in November 2011.  After reviewing the claims file and physically examining the Veteran, the VA examiner noted several recordings of very high blood pressure while in the National Guard.  The VA examiner opined that these levels put significant stress on the arterial wall, producing microscopic cracks which lead to scarring.  This scarring in turn traps lipid particles, accelerating the atherosclerotic process.  Ultimately, the VA examiner concluded that this was the Veteran's only risk factor for coronary artery disease at the time, so it is therefore at least as likely as not that hypertension is the major etiologic factor in the development of his current heart disease.

A Veteran need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail.  Entitlement need not be established beyond a reasonable doubt, by clear and convincing evidence, or by a fair preponderance of the evidence.  When the evidence is in "relative equipoise, the law dictates that the Veteran prevails."  Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

In light of the November 2011 VA examiner's opinion, identifying the Veteran's now service-connected hypertension as "the major etiologic factor" in the development of his current heart disease, and resolving all doubt in favor of the appellant, the Board concludes that service connection is warranted for coronary artery disease as proximately due to service-connected hypertension.  38 C.F.R. § 3.310; Allen, 7 Vet. App. at 439.


ORDER

Service connection for coronary artery disease is granted, subject to the laws and regulations governing the payment of monetary benefits.




____________________________________________
D. MARTZ AMES
Acting Veterans Law Judge, Board of Veterans' Appeals



Department of Veterans Affairs