Citation Nr: 1323070 Decision Date: 07/18/13 Archive Date: 07/24/13 DOCKET NO. 06-27 209 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUE Entitlement to service connection for a disorder causing chest pain. REPRESENTATION Appellant represented by: Texas Veterans Commission ATTORNEY FOR THE BOARD C. Lawson, Counsel INTRODUCTION The Veteran served on active duty from February 1979 to March 1994. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2005 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA). In June 2011, the Board reopened a previously denied claim of service connection for chest disability and remanded the matter to the RO for further development. In February 2013, the Board decided the issue of service connection for left ankle disability, and in May 2013, it decided the issue of entitlement to a compensable rating for bilateral hearing loss disability. The Board remanded the issue currently under consideration for further development at those times. FINDING OF FACT The Veteran's current disorder causing chest pain -- gastroesophageal reflux disease -- was not manifest in service and is unrelated to service. CONCLUSION OF LAW The criteria for service connection for a disorder causing chest pain are not met. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. §§3.303, 3.310 (2012). REASONS AND BASES FOR FINDING AND CONCLUSION Veterans Claims Assistance Act of 2000 (VCAA) Upon receipt of a complete or substantially complete application, VA must notify the claimant of the information and evidence not of record that is necessary to substantiate a claim, which information and evidence VA will obtain, and which information and evidence the claimant is expected to provide. 38 U.S.C.A. § 5103(a). The notice requirements apply to all five elements of a service connection claim: 1) Veteran status; 2) existence of a disability; (3) a connection between the Veteran's service and the disability; 4) degree of disability; and 5) effective date of the disability. Dingess v. Nicholson, 19 Vet. App. 473 (2006). The notice must be provided to a claimant before the initial unfavorable adjudication by the RO. Pelegrini v. Principi, 18 Vet. App. 112 (2004). The notice requirements may be satisfied if any errors in the timing or content of such notice are not prejudicial to the claimant. Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev'd on other grounds, 444 F.3d 1328 (Fed. Cir. 2006). The RO provided the Veteran pre-adjudication notice by a letter dated in April 2005. The notification complied with the requirements of Quartuccio v. Principi, 16 Vet. App. 183 (2002), identifying the evidence necessary to substantiate a claim and the relative duties of VA and the claimant to obtain evidence; and Pelegrini v. Principi, 18 Vet. App. 112 (2004). While the notification did not advise the Veteran of the laws regarding degrees of disability or effective dates for any grant of service connection, as is required by Dingess, the Board notes that the RO sent the Veteran a March 2006 correspondence that fully complied with Dingess. VA also has a duty to assist a claimant under the VCAA. VA has obtained service treatment records; assisted the Veteran in obtaining evidence; examined the Veteran for chest pain disability in August 2011, October 2012, March 2013, and May 2013; and afforded the Veteran the opportunity to give testimony before the Board. The examinations were adequate as they provide a fair and impartial basis upon which to decide the claim. All known and available records relevant to the issue on appeal have been obtained and associated with the Veteran's claims file; and the Veteran has not contended otherwise. The RO complied with the Board's May 2013 remand by obtaining an addendum to the March 2013 VA examination report and readjudicating the claims. VA has complied with the notice and assistance requirements and the Veteran is not prejudiced by a decision on the claim at this time. The Veteran is seeking entitlement to service connection for a disorder causing chest pain. He argues that he has chest pain, and has noted that he had it in service. Applicable law provides that service connection will be granted if it is shown that the Veteran suffers from disability resulting from an injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, 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 treatment records show complaints of chest pain, with costochondritis assessed in September 1979 and June 1983. On service discharge examination in December 1993, the Veteran's chest was normal, including by X-ray. Gastroesophageal reflux disease was not reported, suspected, or found. Post-service, there have been complaints of chest pain evaluated. On VA evaluation in February 2008, the Veteran reported that for the past few months, he had had gastroesophageal reflux disease symptoms and acid reflux at bedtime about 3-4 times a week. He had tried Tums and tried avoiding eating before bedtime. Gastroesophageal reflux disease was assessed and omeprazole was started. On VA evaluation in January 2009, the Veteran was assessed with atypical chest pain with likely muscle spasm. On VA examination in August 2011, the Veteran complained of shortness of breath and pain in the center of his chest. A stress test, pulmonary function test, and electrocardiogram had all been normal. He was never diagnosed with nor had any heart or lung problems. He stated that it was panic attacks and anxiety but that he felt that it was in his chest. He had reported an electrical pop in his right chest and had been diagnosed with psychosomatic complaints which were improved with psychiatric medication. There had been a diagnosis in February 2006, after a negative exercise treadmill test, of atypical chest pain. The examiner diagnosed atypical chest pain and opined that the current complaint of chest disability was not caused by or a result of service. In October 2012, the examiner stated that the Veteran does not carry a diagnosis of pulmonary or cardiac condition; and that he has diagnoses of gastroesophageal reflux disease, anxiety, and schizophrenia. He had a normal electrocardiogram in April 2006 and again in January 2009, which showed a normal sinus rhythm. He had a diagnosis of atypical chest pain in February 2006, after a negative exercise tolerance test. The examiner's opinion was that the Veteran did not have a current cardiac or pulmonary condition, and that the likely etiology of his chest discomfort is gastroesophageal reflux disease as diagnosed in February 2008. The Board remanded the case to the RO in February 2013, for an opinion as to whether it is at least as likely as not (a probability of at least 50 percent) that the Veteran's gastroesophageal reflux disease is causally related to any disease, injury, or incident of service, to include the chest pain complained of in service. On VA examination in March 2013, the examiner reviewed the Veteran's medical history, examined him, and diagnosed gastroesophageal reflux disease. The Veteran indicated to the examiner that in 1989, he was waking up all the time with symptoms of nausea and vomiting. These same symptoms would occur after he ate a meal. He went to sick call and was told he had indigestion. He was medically treated and sent back to duty. He was using antacids over the counter which did not work. His symptoms worsened. After he was discharged, he went to VA, where he was diagnosed with gastroesophageal reflux disease and treated with Omeprazole. Currently, he was having breakthrough symptoms with increased saliva and would occasionally have episodes of vomiting at night. The examiner then reviewed the Veteran's medical records. Service treatment records which were reviewed were noted to show abdominal complaints which were more consistent with reoccurring intestinal complaints rather than heartburn or reflux symptoms. The examiner felt that it was not at least as likely as not that the Veteran's current gastroesophageal reflux disease was connected to service because of this, and also because in 2008, the Veteran had reported reflux symptoms for only a few months. In May 2013, the Board remanded the case to the RO for an addendum to the March 2013 VA examination report, as the examiner in March 2013 had failed to consider treatment for chest pain assessed as costochondritis in September 1979 and June 1983, and for chest pain in June 1989. As a consequence of the Board's May 2013 remand, a May 2013 addendum to the March 2013 VA examination report was obtained. The May 2013 examiner considered the September 1973, June 1983, and June 1989 reports of service treatment mentioned above and was of the opinion that it was less likely than not that the referenced complaints of chest pain in September 1979, June 1983, and June 1989 had any relation to the Veteran's current gastroesophageal reflux disease. The reason for such opinion was that the complaints of chest pain in service in September 1979, June 1983, and June 1989 were actually due to costochondritis and musculoskeletal chest pain, rather than gastroesophageal reflux disease. Based on the evidence, the Board concludes that service connection is not warranted for a disorder causing chest pain. The only such disorder shown currently is gastroesophageal reflux disease, which was not manifest in service according to a review of the service treatment records and the VA examination reports from 2013. Additionally, no medical evidence relates it to service. To the contrary, the examiner in March 2013 reviewed the Veteran's medical record in detail, noted that he had been treated for symptoms in service which were more consistent with reoccurring intestinal complaints and that the Veteran had reported in 2008 that he had reflux symptoms for only a few months, and concluded that it was not at least as likely as not that his current gastroesophageal reflux disease was related to service. Moreover, the examiner in May 2013 specifically considered the September 1979, June 1983, and June 1989 service treatment records concerning chest pain, and found that the Veteran's current gastroesophageal reflux disease was unrelated to them as those service treatment records actually showed chest pain due to costochondritis and musculoskeletal chest pain. Moreover, there is no medical evidence of record showing that the Veteran's current gastroesophageal reflux disease had its onset in service or is related to service. The Veteran may be claiming that there has been continuity of symptomatology since service, and continuity of gastroesophageal reflux disease symptoms since service could establish service connection. However, the examiner in March 2013 reviewed his service treatment records and noted that his symptoms then were most consistent with reoccurring intestinal complaints, whereas gastroesophageal reflux disease symptoms had only been present for a few months when he was seen in 2008. The service symptoms the Veteran reported to the examiner, of nausea and vomiting after a meal, as well as a sick call visit for indigestion and the use of antacids in service, are not documented, which would be expected if they had occurred. Moreover, the examiner in May 2013 reviewed the Veteran's service treatment records and after doing so felt that the Veteran's chest pain symptoms in service were from costochondritis and musculoskeletal pain, rather than from gastroesophageal reflux disease. Continuity of gastroesophageal reflux disease symptoms since service is not shown. Accordingly, service connection for gastroesophageal reflux disease, including on a continuity of symptomatology basis, is not warranted. The preponderance of the evidence is against the claim and there is no doubt to be resolved. 38 U.S.C.A. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1991). ORDER Service connection for a disorder causing chest pain is not warranted. ______________________________________________ ALAN S. PEEVY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs