Citation Nr: 18147975 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 10-05 259 DATE: November 6, 2018 ORDER Entitlement to a disability rating in excess of 10 percent for supraventricular arrhythmias (claimed as paroxysmal supraventricular tachycardia) is denied. FINDING OF FACT The Veteran’s supraventricular arrhythmias (claimed as paroxysmal supraventricular tachycardia) is not manifested by paroxysmal atrial fibrillation or other supraventricular tachycardia with more than four episodes per year documented by electrocardiogram (ECG) or Holter monitor. CONCLUSION OF LAW The criteria for entitlement to a disability rating in excess of 10 percent for supraventricular arrhythmias (claimed as paroxysmal supraventricular tachycardia) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.104, Diagnostic Code (DC) 7010. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the Navy from September 1981 to September 1985 and May 1986 to May 2002. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2007 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In September 2011, the Veteran testified at a Travel Board hearing before a Veterans Law Judge (VLJ). A transcript of the proceeding has been associated with the claims file. Subsequently, the Veteran was notified in November 2012 that the VLJ was no longer employed with the Board, and he was offered the opportunity for a new Board hearing, which the Veteran declined in December 2012. The issue was previously remanded by the Board on December 2011, June 2015, and February 2017 for further development. In December 2011, the issue was remanded for an updated VA examination as the Veteran reported the condition had worsened since the last examination. In both June 2015 and February 2017, the case was remanded to give the Veteran the opportunity to complete a release of information for the RO to acquire cardiology records from Dr. J.P. to assist in substantiating the Veteran’s claim. However, as of the date of this decision, the Veteran has not provided the RO with an authorization to obtain the records nor has he provided the records to the RO. The last remand had also noted that an updated VA examination was to be conducted if and only if (emphasis added) records from Sarasota Cardiology were received. Since no such records were obtained, a VA examination at this time is not warranted. The Veteran is reminded that the “duty to assist is not a one-way street. If a Veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence.” Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). In the absence of the Veteran’s cooperation in obtaining pertinent medical evidence, VA has no further obligation to develop the record on appeal. Thus, the case was returned to the Board for further review. Entitlement to a disability rating in excess of 10 percent for supraventricular arrhythmias (claimed as paroxysmal supraventricular tachycardia) The Veteran contends that he has more than four episodes related to heart palpitations a year warranting an increase in rating for his service-connected heart issue. Disability ratings are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. In rating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). A claim for increased rating remains in controversy when less than the maximum available benefit is awarded. AB v. Brown, 6 Vet. App. 35 (1993). Reasonable doubt as to the degree of disability will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. In a decision, the Board shall consider all information and lay and medical evidence of record. 38 U.S.C. § 5107 (b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board shall resolve reasonable doubt in favor of the claimant. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Veteran’s paroxysmal supraventricular tachycardia disorder is currently assigned a 10 percent rating under DC 7010. Pursuant to DC 7010, a 30 percent rating is assigned when there is paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by ECG or Holter monitor. 38 C.F.R. § 4.104, DC 7010, General Rating Formula for Cardiovascular System. Here, there is no evidence that the Veteran has been examined using an ECG or Holter monitor to determine frequency and severity of episodes, or that such monitoring was indicated by the Veteran’s symptoms. The Veteran was afforded a VA examination on May 2007. The examiner continued the Veteran’s diagnosis of supraventricular tachycardia; nuclear stress and ECG testing were normal. The Veteran told the examiner that he had approximately six palpitations a year after separating from service. The Veteran was afforded another VA examination on August 2008 where the diagnosis was continued. The Veteran stated that he had an echocardiogram a month prior to the exam and that his last ECG and Holter monitor were a year prior. He further added that his last palpitations were three weeks ago and occur about every three to four weeks. In February 2009, the Veteran was afforded a third VA examination. It was noted by the examiner that the last ECG or Holter test was completed three years prior and the last cardiac catheterization was done three months prior; however, none of the records were available to the examiner to review. The Veteran told the examiner that he has heart palpitations about two to three times a month. The examiner found the Veteran’s pulse rate to be normal and heart sounds S1 and S2 without a murmur. The Veteran was afforded a fourth VA examination in January 2012. The examiner noted that the Veteran had more than four episodes of atrial fibrillation, atrial flutter, and atrial supraventricular tachycardia in the past 12 months and noted that the episodes were documented with the Holter. However, the last Holter monitor noted in the report was May 2006 and the last ECG noted was in April 2006. The examiner noted that he reviewed the C-File and CPRS. Testing conducted by the examiner showed his heart to be within the normal range. The examiner continued the Veteran’s previous diagnosis. During the September 2011 hearing, the Veteran testified that he sees a civilian practitioner to treat his supraventricular tachycardia. The Veteran was given the opportunity to authorize the release of these records through Board remands on June 2015 and February 2017. However, as previously noted, the Veteran failed to supply the RO with the release to request the private records and he did not provide the records to the RO. Additionally, during the September 2011 hearing, the Veteran himself testified that his episodes were only documented and tested once in the Navy and once or twice when he received surgery for his heart condition. Further, the Veteran testified that since his prescription of Toprol helps with his condition, the Veteran “sort of backed off” treatment with Dr. J.P. when the doctor discussed the possibility of a pacemaker. The Board also considered the Veteran’s lay statements to VA examiners and the September 2011 testimony indicating that he has episodes of the tachycardia or the atrial fibrillation about once or twice a week. As a lay person, however, the Veteran has not shown that he has specialized training sufficient to render such an opinion or diagnosis. See Jandreau v. Nicholson, 492 F. 3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this record, the diagnosis of paroxysmal supraventricular tachycardia is a matter not capable of lay observation, and requires medical expertise to determine an accurate diagnosis. Accordingly, the Veteran’s opinion as to the diagnosis of his heart episodes is not competent medical evidence. Further, the rating criteria specifically requires that the episodes of atrial fibrillation or supraventricular tachycardia be documented by an ECG or Holter monitor. In sum, the Board finds that the Veteran’s condition has remained consistent throughout the pendency of the appeal and a rating increase in excess of 10 percent is not warranted. The record does not show any evidence of paroxysmal atrial fibrillation or other supraventricular tachycardia with more than four episodes per year documented by an ECG or Holter monitor. The evidence provided only shows an ECG conducted in April 2006 and a Holter monitor in May 2006. There are no recent records from the Veteran’s private practitioner, Dr. J.P., documenting Holter monitors or ECGs, with the exception of records from 2006. In reaching the above decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran’s claim, the doctrine does not apply. Gilbert, 1 Vet. App. at 54; 38 U.S.C. § 5107; 38 C.F.R. § 3.102. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Hartford, Associate Counsel