Citation Nr: 18145195 Decision Date: 10/30/18 Archive Date: 10/26/18 DOCKET NO. 09-42 292 DATE: October 30, 2018 ORDER Entitlement to service connection for a cardiovascular disability is denied. FINDING OF FACT A cardiovascular disability was not incurred in service, did not manifest to a compensable degree within a year of service separation, has not been chronic since service, and is not due to or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for entitlement to service connection for a cardiovascular disability have not been met. 38 U.S.C. §§ 1110, 1112, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from August 1970 to August 1972. The Veteran testified before the undersigned Veterans Law Judge in October 2012. A written transcript of this hearing has been added to the claims file. The Board notes the Veteran has also perfected appeals of the issues of entitlement to service connection for neuropathy of the right upper extremity and entitlement to an increased rating for right shoulder impingement syndrome. As the Veteran testified on these other matters before a different Veterans Law Judge, they will be the subject of a separate Board action. Entitlement to service connection for a cardiovascular disability The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). In the present case, there is no indication in this record of a failure to notify. See Scott v. McDonald, 789 F.3rd 1375 (Fed. Cir. 2015). Likewise, there is no indication in the record of a failure to assist the Veteran in the development of his claim. See Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to VA’s duty to assist). The Veteran seeks service connection for a cardiovascular disability. He asserts that he has a cardiovascular disability, claimed as coronary artery disease with a history of myocardial infarction and coronary artery bypass graft surgery, due to service, or as due to or aggravated by a service-connected disability. He has been granted service connection for posttraumatic stress disorder (PTSD), bilateral hearing loss, tinnitus, and right shoulder impingement syndrome. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may 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). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d, 78 F.3d 604 (Fed. Cir. 1996). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. 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. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of “continuity of symptoms” after service is required for service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from 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 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. Finally, service connection may be awarded for any disability which is proximately due to or the result of, or is otherwise aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. In the present case, the Veteran’s service treatment records are negative for any diagnosis of, or treatment for, a cardiovascular disability. On examination for service separation in July 1972, his heart and vascular systems were within normal limits, and on his report of medical history, he denied any history of heart trouble. Thus, based on this competent evidence, the Board is unable to conclude that the Veteran experienced in-service onset of a cardiovascular disease or injury. Likewise, he did not seek and was not treated for a cardiovascular disability for many years after service. His first diagnosis of a cardiovascular disability dates to 2008, when he experienced a myocardial infarction, and was afforded a coronary artery bypass graft and stent placement. Coronary artery disease was diagnosed at that time. This lengthy period without complaint or treatment is one piece of evidence that there has not been ongoing symptomatology, and weighs heavily against the claim. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Thus, service connection on a direct basis is not warranted, as such a disability was not incurred in service, did not manifest to a compensable degree within a year thereafter, and has not been chronic and continuous since service separation. Regarding the issue of service connection on a secondary basis, the Veteran asserts his service-connected PTSD has caused or aggravated his coronary artery disease. The Veteran was afforded a February 2017 VA examination on this issue, at which time current diagnoses of coronary artery disease, stable angina, and a history of myocardial infarction were confirmed. After examination of the Veteran and review of the claims file, the VA examiner, a physician, opined that, while some studies have shown a possible correlation between cardiovascular outcomes and psychosocial factors, a direct causal association has not established in the medical literature. The examiner noted that the Veteran had multiple risk factors for cardiovascular disease, including smoking history, age over 50, hypertension, obesity, and hyperlipidemia. The examiner opined that these risk factors greatly outweighed any potential contribution purportedly resulting from PTSD. Thus, in the examiner’s medical opinion, it was less likely than not that this Veteran’s cardiovascular disability was proximately due to, the result of, or aggravated by, his PTSD. Based on this competent evidence, uncontroverted in the record, the Board finds the preponderance of the evidence to be against the award of service connection on a secondary basis for a cardiovascular disability. The Board also notes the Veteran claims to have served in Vietnam. For veterans with established Vietnam service, service connection for certain disabilities, including ischemic heart disease, may be presumed. See 38 C.F.R. § 3.309(e). In the present case, however, the Veteran’s DD-214 does not reflect any foreign service or awards or decorations for service in Vietnam. Likewise, his service personnel records do not reflect such service. The Board does not accept the Veteran’s own contentions regarding his Vietnam service, as he is not considered to be a credible historian. He has in the past both claimed and denied combat participation. He has also reported being an excellent student in high school and a high school dropout, as having an active social life and being a loner as a child, and as having avoided sports and being a star athlete. As such, the Veteran’s reports of service in Vietnam are not, in and of themselves, considered credible. The Veteran himself asserts his coronary artery disease is due to service, or a service-connected disability. As a layperson, however, the Veteran is not capable of making medical conclusions; thus, his statements regarding causation are not competent evidence. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. Id; see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). However, cardiovascular disorders are complex disorders which require specialized training for a determination as to diagnosis and causation, and they are therefore not susceptible of lay opinions on etiology, and the Veteran’s statements therein cannot be accepted as competent medical evidence. The Veteran is also not reporting an expert opinion as told to him, and his lay contentions have not later been confirmed by a competent expert. In conclusion, the preponderance of the evidence is against the claim of service connection for a cardiovascular disability, as such a disability was not incurred in service, did not manifest to a compensable degree within a year of service, has not been chronic since service separation, and is not due to an incident of service. Additionally, a current cardiovascular disability is not due to or aggravated by a service-connected disability. As a preponderance of the evidence is against the award of service connection, the benefit of the doubt doctrine is not applicable in the instant appeal. 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Thomas D. Jones, Counsel