Citation Nr: 1329617 Decision Date: 09/16/13 Archive Date: 09/20/13 DOCKET NO. 10-04 192 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUE Entitlement to service connection for a mini-stroke disability, to include as due to herbicide exposure or as secondary to service-connected disability, to include coronary artery disease (CAD). REPRESENTATION Appellant represented by: Tennessee Department of Veterans' Affairs ATTORNEY FOR THE BOARD T. Wishard, Counsel INTRODUCTION The Veteran had active military service from October 1966 to October 1968. This matter comes before the Board of Veterans' Appeals (Board) from a March 2009 rating decision of the Department of Veterans Affairs (VA), Regional Office (RO) in Nashville, Tennessee. This matter was previously before the Board in January 2012 and was remanded for further development. It has now returned to the Board for further appellate consideration. The Board finds that there has been substantial compliance with the mandates of its remand. In its January 2012 remand, the Board also remanded the issue of entitlement to service connection for hypertension, to include as due to herbicide exposure or as secondary to service-connected CAD. In an October 2012 rating decision, the Appeals Management Center (AMC) granted service- connection for hypertension; thus, that issue is no longer for appellate consideration. FINDINGS OF FACT 1. The competent medical evidence of record does not support a finding that the Veteran has a current mini-stroke disability. 2. The competent credible evidence of record is against a finding that the Veteran's arterial venous malformation (AVM), seizure disorder, and/or major hemorrhages, are causally related to, or aggravated by, service or a service- connected disability. CONCLUSION OF LAW The criteria for service connection for mini-stroke disability, to include as secondary to a service-connected disability, have not been met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310 (2013). REASONS AND BASES FOR FINDINGS AND CONCLUSION VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159 and 3.326(a). See also Pelegrini v. Principi, 18 Vet. App. 112 (2004); Quartuccio v. Principi, 16 Vet. App. 183 (2002); Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Dingess v. Nicholson, 19 Vet. App. 473 (2006). Notice was provided in April 2008 and January 2012. The claim was subsequently readjudicated in an October 2012 supplemental statement of the case. Mayfield, 444 F.3d at 1333. VA has a duty to assist the appellant in the development of the claim. The claim file includes service treatment records (STRs), VA and private medical records and correspondence, and the statements of the Veteran and others in support of the claim. The Board has considered the statements and perused the medical records for references to additional treatment reports not of record, but has found nothing to suggest that there is any outstanding evidence with respect to the Veteran's claim for which VA has a duty to obtain. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that an adequate opinion has been obtained. The claim file includes a May 2013 opinion with a July 2013 addendum. The opinion is predicated on consideration of the Veteran's disabilities and his medical history. Adequate rationale has been provided. The Board finds that all relevant facts have been properly and sufficiently developed in this appeal and no further development is required to comply with the duty to assist the Veteran in developing the facts pertinent to the claim. Essentially, all available evidence that could substantiate the claim has been obtained. Legal Criteria Service Connection Establishing service connection generally requires medical evidence or, in certain circumstances, lay evidence of the following: (1) A current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) nexus between the claimed in-service disease and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed.Cir.2007); Hickson v. West, 12 Vet. App. 247 (1999); Caluza v. Brown, 7 Vet.App. 498 (1995), aff'd per curiam, 78 F.3d 604 (Fed.Cir.1996) (table). For some "chronic diseases," presumptive service connection is available. 38 U.S.C.A. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. With "chronic disease" shown as such in service (or within the presumptive period under § 3.307), so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). For the showing of a '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. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. Id. If not manifest during service, where a veteran served continuously for 90 days or more during a period of war, or during peacetime service after December 31, 1946, and the 'chronic disease' became manifest to a degree of 10 percent within 1 year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307. The term "chronic disease," whether as shown during service or manifest to a compensable degree within a presumptive window following service, applies only to those disabilities listed in 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In each case where service connection for any disability is being sought, due consideration shall be given to the places, types, and circumstances of such Veteran's service as shown by such Veteran's service record, the official history of each organization in which such Veteran served, such Veteran's medical records, and all pertinent medical and lay evidence. 38 U.S.C.A. § 1154(a). Presumptive service connection - herbicide exposure VA regulations provide that certain diseases associated with exposure to herbicide agents may be presumed to have been incurred in service even if there is no evidence of the disease in service, provided the requirements of 38 C.F.R. § 3.307(a)(6) are met. 38 C.F.R. § 3.309(e). A Veteran who, during active service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307(a). The last date on which such a Veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the period beginning on January 9, 1962 and ending on May 7, 1975. If a Veteran was exposed to an herbicide agent during active service, the following diseases shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied: Chloracne or other acneform disease consistent with chloracne; Type 2 diabetes (also known as Type II diabetes mellitus or adult- onset diabetes); Hodgkin's disease; chronic lymphocytic leukemia; B cell leukemia, Parkinson's disease, multiple myeloma; non-Hodgkin's lymphoma; acute and subacute peripheral neuropathy; porphyria cutanea tarda; prostate cancer; respiratory cancers (cancer of the lung, bronchus, larynx or trachea); soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma); and ischemic heart disease, (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina), shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). The diseases listed at 38 C.F.R. § 3.309(e) shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne, porphyria cutanea tarda, and acute and subacute peripheral neuropathy shall have become manifest to a degree of 10 percent or more within a year after the last date on which the Veteran was exposed to an herbicide agent during active military, naval, or air service. 38 C.F.R. § 3.307(a)(6)(ii). Where the evidence does not warrant presumptive service connection, the United States Court of Appeals for the Federal Circuit has determined that an appellant is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Service Connection on a secondary basis Under 38 C.F.R. § 3.310, service connection may be granted for disability that is proximately due to or the result of a service-connected disease or injury, or for the degree of disability resulting from aggravation of a nonservice- connected disability by a service-connected disability. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Analysis The Board has reviewed all of the evidence in the Veteran's claims file, with an emphasis on the medical evidence pertinent to the claim on appeal. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. The Veteran contends that he has a "mini-stroke" disorder due to exposure to herbicides in service. The Veteran has not clearly stated the symptoms of his alleged mini-stroke disorder; thus, the Board has considered the Veteran's seizures in addition to other symptoms which the Veteran may feel are related to a mini-stroke disorder. The Veteran's DD 214 reflects that he served in Vietnam from March 1967 to March 1968 ; therefore, it is presumed that he was exposed to herbicides. Moreover, affirmative evidence does not exist to rebut that presumption. Despite presumed exposure to an herbicide agent, presumptive service connection under 38 C.F.R. § 3.307(a)(6) is not warranted. In the present case, a "mini-stroke" disability is not listed as a disability for which presumptive service connection is warranted. Even if the Veteran has a mini- stroke disorder, he does not have a diagnosed disability among the diseases recognized under 38 C.F.R. § 3.309(e) as a disease associated with exposure to certain herbicide agents; thus, presumptive service connection on the basis of herbicide exposure is not warranted. When a claimed disorder is not included as a presumptive disorder direct service connection may nevertheless be established by evidence demonstrating that the disease was in fact "incurred" during service. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). The Veteran's STRs are negative for any complaints of, or treatment for, a mini-stroke disorder. The earliest clinical evidence of a brain hemorrhage is in 1988, more than nine years after separation from service. The lapse of time between service separation and the earliest documentation of current disability is a factor for consideration in deciding a service connection claim. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Correspondence from Dr. P. McCombs to the Veteran, dated in May 2008, states in pertinent part as follows: "I am unaware that Agent Orange resulted in aneurysm or arterial venous malformations." The correspondence is negative for any opinion that the Veteran has a mini-stroke disability causally related to active service. In sum, there has been no demonstration by competent medical, nor competent and credible lay, evidence of record, that the Veteran has a mini-stroke disability causally related to, or aggravated by, active service, to include presumed exposure to herbicides. The Board has also considered whether the Veteran has a disability which is secondary to a service-connected disability. The Veteran is service-connected for CAD and hypertension. An October 1987 private record reflects that the Veteran presented with a seizure. Workup demonstrated a left temporal lobe arachnoid cyst, a right posterior arterial venous malformations (AVM) fed by the right posterior cerebral artery. The record reflects that the Veteran was hospitalized from April 1988 to June 1988. It was noted that he had a subarachnoid hemorrhage secondary to an AVM. June and July 1988 private medical records reflect that the Veteran had the onset of a seizure disorder the prior year which was worked up and demonstrated an AVN. The records reflect that he was placed on Phenobarbital for the seizure disorder and that he had a subarachnoid hemorrhage secondary to AVM. In addition, correspondence from Dr. V. Allen, dated in July 1988, reflects that the Veteran had "two very major intercerebral hemorrhages and subarachnoid hemorrhages secondary to a large arterial venous malformation." July 1996 private records reflect that the Veteran had had a cerebral aneurysm (subarachnoid hemorrhage, ruptured). They also reflect that he had a tumor. A September 1996 record reflects that the Veteran had a craniotomy "for what turned out to probably be a chronic subdural hematoma." A September 1996 record from Dr. V. Allen reflects that the Veteran has a "long history of neurological problems. He has some difficulty with arterial venous malformation. He was very sick. He was shunted, was treated with Gamma knife and immobilization and actually has done very well since that time. Over the last several months he has had increasing headaches, a little bit of dysphagia and a scan suggested questionably a small meningoma versus thickness in the dura but also suggest that the temporal tip of the left side as being compressed and pushed backward by a mass at the temple tip. This enhances somewhat and therefore it was our feeling that this was consistent with dysphagia and headaches and have elected to go on with surgical intervention." The Veteran was diagnosed with CAD in approximately 2003 or 2004. He was diagnosed with borderline hypertension in 2004 and with hypertension in approximately 2005. The evidence of record reflects that his hypertension is uniformly well controlled with medication. (See clinical records dated in February 2005, January 2009, December 2009, and March 2011.) A February 2005 record from The Heart Team reflects that the Veteran had a history of two cerebral hemorrhages, and a seizure disorder. It also notes that he had a tumor removed from his brain. (See also September 2007 record from The Heart Team.) An August 2005 record from The Heart Team reflects that the Veteran had seizures which were well controlled on Phenobarbital. It was noted that he had "not had a seizure in quite a while." A December 6, 2007 clinical record reflects as follows: He has a long history with Dr. Allen status post craniotomy for aneurysm and hemorrhage as well as ventriculoperitoneal shunt. He also had a coiling possibly of arteriovenous malformation versus aneurysm done in New York. He recently came to the emergency room because of some double vision and drooping of his left eyelid according to his son. A December 10, 2007 clinical record reflects that an MRI of the brain revealed the following: foci of T2 hyperintensity which display ill-defined enhancement within the left centrum semiovale and cerebral peduncle, and could represent regions of acute to subacute infarction, or metastases; ill -defined tangle of flow voids adjacent to the right occipital horn, suspicious for AVM; a prominent vessel adjacent to this region is noted which could represent a drain vein or hypertrophied feeder; diffusely thickened enhancing data; foci of T1 shortening along the tentorium, left greater than right. An April 2008 record from Affiliated Neurologists reflects that the Veteran had two brain hemorrhages in 1988. It noted that he had complaints of occasional hand shaking, left lower extremity numbness, and short term memory loss for twenty years. A January 2009 VA primary care initial evaluation record reflects that the Veteran has a history of seizures and has not had any seizures since being on Phenobarbital. The record also reflects an assessment of mild cognitive impairment and depression. The report is negative for any diagnosis of a mini-stroke disorder. A May 2009 VA clinical record reflects that the Veteran had a seizure disorder, which was treated with Phenobarbital. The Veteran reported that he had last had a seizure in October 2007. (This contention by the Veteran is contrary to the January 2009 noted above, as well as December 2009, August 2010, and September 2011 records which all reflect that the Veteran reported not having had a seizure since 1987). An August 2010 VA primary care record reflects that the Veteran had right lower radicular pain, lumbar degenerative disc disease/degenerative joint disease, spinal stenosis, seizure disorder with no seizures since 1987, hypertension, depression, history of stable rhinitis, personal history of cerebral hemorrhage with residual mild cognitive impairment post tumor removal (1990) and bleed (1998), left side intracranial shunt, status post cardiac valve replacement, and hyperlipidemia. The report is negative for any history of, or diagnosis of, a mini-stroke disorder. The Veteran's August 2011 VA Form 21-8940 (Application for Increased Compensation based on Unemployability) reflects his statement as follows: "In October 1987 I had seizure on my job and was hospitalized overnight for observation. In April 1988 I had two massive brain hemorrhage and had extensive rehabilitation that lasted nearly 12 months. Upon returning to work, I had problems with my short term memory and decided to retire." The Veteran did not report a "mini- stroke disorder." A September 2011 VA primary care note reflects that the Veteran had hyperlipidemia, a seizure disorder with no reported seizures since 1987, well-controlled hypertension, stable depression, a history of stable rhinitis, a personal cerebral hemorrhage with residual mild cognitive impairment post tumor removal and bleed, with intracranial shunt, lower back pain, DJD, and status post cardiac valve replacement. The report is negative for any history of, or diagnosis of, a mini-stroke disorder. A February 2012 VA examination report reflects that the Veteran had been diagnosed with a "mini-stroke disorder." The examiner opined that it is less likely as not that the Veteran's mini-stroke disorder is caused or aggravated by the Veteran's service-connected CAD. The examiner further noted that the Veteran had been diagnosed with a mini-stroke disorder in 1988. Notably, the February 2012 examiner did not checkmark that the Veteran had had a hemorrhage. The Board finds, as discussed in further detail below, that the February 2012 diagnosis of a mini-stroke disorder lacks probative value. The probative value of medical opinions is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches. As is true with any piece of evidence, the credibility and weight to be attached to these opinions are within the province of the adjudicator. Guarneri v. Brown, 4 Vet. App. 467, 470-71 (1993). The clams file includes October 2012 statements by friends of the Veteran. A.H. and B.W. stated that since the Veteran's "illness in 1988, his short term memory is very noticeable. He has problems remembering current events and oftentime [sic] forget when we last spoke." In an October 2012 statement, the Veteran contended that his Agent Orange exposure may have taken years to cause symptoms, such as his claimed mini-stroke disorder. He also stated that he may have heart irregularities and motor skills affected by Agent Orange, and that he had a brain tumor. The Veteran's claim for entitlement to service connection for a brain tumor was denied by the Board in a January 2012 decision. The Veteran is already service- connected for CAD. The clinical evidence of record does not support a finding that the Veteran has a mini-stroke disability which affects his motor skills, and which is causally related to, or aggravated by, active service or a service-connected disability. The Veteran and his friends have not been shown to have the experience, training, or education necessary to make a diagnosis of a "mini-stroke disorder" or an etiology opinion as to any such disorder, if diagnosed. Although lay persons are competent to provide opinions on some medical issues, the Board finds that a lay person is not competent to provide a probative opinion as to the specific issue in this case in light of the education and training necessary to make a finding with regard to the relationship and complexities of CAD, hypertension, brain tumors, strokes, and seizures. The Board finds that such etiology findings fall outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). A May 2013 VA clinical opinion Dr. W. Triggs, Chief, Neurology Service, is of record. He stated, in pertinent part, as follows: The appellant was determined to have a cerebral arteriovenous malformation (AVM) approximately 25 years ago. This congenital lesion caused the appellant to develop epileptic seizure. This lesion also caused the appellant to sustain brain injury (poor balance and cognitive impairment) caused by bleeding (subarachnoid hemorrhage and subdural hematoma) from the AVM. His treatment included several neurosurgical procedures, including placement of a ventriculoperitoneal shunt and embolization of the AVM. . . A brain MRI performed in December 2007 describes detailed pathological alteration consistent with the Veteran's history of AVM described above. In addition, small foci of abnormal signal were described in the left centrum semiovale, left cerebral pediuncle and posterior subinsular white matter. The radiologist speculated that the etiology of these lesions was unclear; a differential diagnosis included small areas of infarction and metastases. . . . . . . in my expert opinion, the [Veteran's] mini-stroke disorder and his seizure disorder are separable and completely unrelated problems. I am of the opinion that it is NOT at least as likely as not that the Veteran has a mini-stroke disorder due to his nonservice-connected AVM; rather I would relate the mini-stroke disorder to the service-connected hypertension, as hypertension, well-controlled or not, is a recognized primary contributing factor in the pathogenesis of the lesions detailed on the MRI (mini-stroke disorder). I am also of the opinion that it IS at least as likely as not that the Veteran has a seizure disorder due to his service-connected AVM. . . . I am of the opinion that the Veteran's well-controlled service-connected hypertension and/or service-connected coronary artery disease did NOT cause the Veteran's AVM to change it's [sic] natural course in any way, to include chronic worsening." In sum, the STRs are negative for complaints of, or treatment for, a seizure disorder. The clinical evidence reflects the onset of a seizure disorder in approximately 1987, nine years after separation from service. The clinical evidence is against a finding that the Veteran's seizure disorder is caused by, or aggravated by a service- connected disability. The Board will next discuss the Veteran's "mini-stroke" disorder. As noted above, the clinician opined that a "mini-stroke" disorder would be related to the Veteran's service-connected hypertension. However, the record does not reflect that the Veteran actually has a mini-stroke disability for VA purposes. Service connection claim requires, at a minimum, medical evidence of a current disability, Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). None of the clinical records from 1987 to 2012 reflect a history of a mini-stroke disorder. The Board acknowledges that the February 2012 VA examination report reflects a diagnosis of a mini-stroke disorder; however, the examiner also stated that this disorder was diagnosed in 1988. The February 2012 failed to note any hemorrhages in the examination report but checked "other" and noted "mini-stroke disorder." The clinical evidence of record does not support the February 2012 examiner's finding of a mini-stroke disorder; to the contrary, it supports a finding that the Veteran had two major hemorrhages in 1988. In addition, the Veteran had a seizure disorder that was noted in the 1988 medical records in the claims file, not a mini-stroke disorder. As noted by the 2013 VA clinician, a seizure disability is not the same as a mini-stroke disability. The Veteran's AVM is a congenital lesion which caused the Veteran to develop seizures (See May 2013 clinical opinion by Dr. W. Triggs) and also have two "very major" hemorrhages in 1988 (See correspondence from Dr. V. Allen, dated in July 1988). A congenital defect, such as AVM, is not a disability for which service connection can be granted. 38 C.F.R. §§ 3.303(c); 4.9. While a congenital defect which is aggravated by service, such that a superimposed disease or injury occurred during service, may warrant service connection, the evidence in this case does not reflect any superimposed disease or injury in service. Thus, service connection is not warranted for the Veteran's AVM or the resulting seizures, poor balance, cognitive impairment, subarachnoid hemorrhage, or subdural hematoma (strokes in 1988). With regard to whether the Veteran actually has a "mini- stroke disorder" as opposed to merely radiographic findings with no actual symptoms, the May 2013 clinician, Dr. W. Triggs, rendered a July 2013 addendum. He stated, in pertinent part, that "the lesions described in the left centrum semiovale and the left cerebral peduncle might well be associated with symptoms, predominantly with right sided weakness. I do not see this documented in the records provided. I do not see documented clinical evidence that the Veteran's mini-stroke disorder is ongoing." The Board finds that the term "might well be" is too speculative in nature to be probative. See Bostain v. West, 11 Vet. App. 124, 127-28, quoting Obert v. Brown, 5 Vet. App. 30, 33 (1993) (a medical opinion expressed in terms of "may" also implies "may or may not" and is too speculative to establish a causal relationship). In addition, an April 2008 private record reflects that the Veteran reported left lower extremity numbness. It is negative for complaints of the right side. In addition, upon clinical examination, muscle strength was normal, there was normal muscle bulk, normal tendon reflexes, normal gait, normal posture, and normal sensation on the right side. Thus, the August 2008 private clinical record, as well as the other clinical records in the claim file, support Dr. W. Trigg's findings that there is no clinical evidence that the Veteran has a right sided weakness which would be evidence of a mini- stroke disorder. In addition, the Veteran's cognitive impairment has been clinically related to his past cerebral hemorrhage. (See 2009 VA clinical records and May 2013 clinical opinion.) In sum, the most probative competent clinical evidence of record does not reflect that the Veteran has a current mini- stroke disorder, or that he has had one during the pendency of his claim. While the Veteran contends that he has such a disability, the competent credible evidence does not reflect any symptoms of such a disorder. The Court consistently has held that, under the law, a "determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service." Watson v. Brown, 4 Vet. App. 309, 314 (1993). The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 8 Vet. App. 208 (1995); 104 F.3d 1328, 1332 (1997). See also Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board finds that radiographic findings alone, of a past event, without any identifiable symptoms, do not constitute a disability for which service connection may be granted. Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999). The Board has considered the doctrine of giving the benefit of the doubt to the appellant, under 38 U.S.C.A. § 5107 (West 2002), and 38 C.F.R. § 3.102 (2012), but does not find that the evidence is of such approximate balance as to warrant its application. Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). ORDER Entitlement to service connection for a mini-stroke disability, to include as due to herbicide exposure or as secondary to service-connected disability, to include coronary artery disease (CAD) is denied. ____________________________________________ M. E. LARKIN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs