Citation Nr: 18146599 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 17-64 739 DATE: October 31, 2018 ORDER Service connection for a heart condition, claimed as open-heart surgery and heart attacks, is denied. Service connection for the residuals of a cerebrovascular accident, claimed as stroke, is denied. FINDINGS OF FACT 1. The Veteran’s heart condition developed many years after his separation from service and is not related to service or to any incident therein. 2. The Veteran’s cerebrovascular accident occurred many years after his separation from service and is not related to service or to any incident therein. CONCLUSIONS OF LAW 1. The criteria for service connection for a heart condition are not met. 38 U.S.C. §§ 1110, 5103, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. 2. The criteria for service connection for a cerebrovascular accident are not met. 38 U.S.C. §§ 1110, 5103, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1966 to February 1967. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a June 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in the 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. § 1110. 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). To establish service connection for a disability resulting from a disease or injury incurred in service, or to establish service connection based on aggravation in service of a disease or injury which pre-existed service, there must be (1) competent evidence of the current existence of the disability for which service connection is being claimed; (2) competent evidence of incurrence or aggravation of a disease or injury in active service; and (3) competent evidence of a nexus or connection between the current disability and the disease or injury incurred or aggravated in service. Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009); cf. Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). A layperson is generally not capable of opining on matters requiring medical knowledge. Routen v. Brown, 10 Vet. App. 183, 186 (1997). See also Bostain v. West, 11 Vet. App. 124, 127 (1998). 1. Entitlement to service connection for a heart condition. 2. Entitlement to service connection for a cerebrovascular accident. In his April 2017 application for benefits, the Veteran asserted that service connection was warranted for a heart condition and the residuals of a cerebrovascular accident. However, in his November 2017 substantive appeal, the Veteran reported that none of his conditions are related to service but that his doctors at VA encouraged him to file a claim for service connection. Service treatment records are absent complaints, treatment, or diagnoses related to a heart condition or cerebrovascular accident; on examination in December 1966, prior to separation from service, no abnormalities of the cardiovascular or vascular systems were noted. Post-service treatment records document diagnoses and treatment for coronary arteriosclerosis, coronary artery bypass, a myocardial infarction, and a cerebrovascular accident as early 2006. The Veteran was afforded a VA examination in February 2009, in conjunction with his 2009 claim for non-service-connected pension. The Veteran at that time reported that he had a cardiac catheterization done in May 2008 and three blockages were found. He also reported that he had a stroke in September 2006. The examiner determined that the Veteran had a history of congestive heart failure with angina, since 2008, and a history of a left-sided cerebrovascular accident with no residuals. The Board is cognizant that the duty to assist includes providing an examination when one is required by law. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In this case, the Veteran has not been afforded an examination in connection with his claims for service connection for his heart condition or cerebrovascular accident. A medical examination is required only where there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service; (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service; and (4) insufficient competent medical evidence on file for VA to make a decision on the claim. See McLendon, 20 Vet. App. at 83. Here, although the evidence shows a current diagnosis of a heart condition and a history of a cerebrovascular accident, there is no evidence that even suggests an etiological relationship between these conditions and the Veteran’s active duty service. Indeed, the Veteran does not even contend that his heart condition or cerebrovascular accident are related to service. Rather, he asserts that these conditions are not related to service but he was told to apply for service connection anyway. As such, the Veteran’s statements do not raise any obligation on the part of VA to afford the Veteran a medical examination or obtain a medical opinion at this time. 38 C.F.R. § 3.159(c)(4). (Continued on the next page)   In the absence of evidence, there cannot be equipoise, and there can be no resolution of doubt. The appellant still ultimately bears some burden of production. 38 U.S.C. § 5107(a); Cromer v. Nicholson, 455 F.3d 1346 (Fed. Cir. 2006). As there is no evidence to support any finding of a nexus between service, service connection for a heart condition and for a cerebrovascular accident is not warranted. S. C. KREMBS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Bilstein, Associate Counsel