Citation Nr: 18147996 Decision Date: 11/07/18 Archive Date: 11/06/18 DOCKET NO. 16-40 247 DATE: November 7, 2018 ORDER Service connection for sinus tachycardia, claimed as a heart condition, as secondary to a service-connected disability is granted. FINDING OF FACT The probative medical evidence of records establishes that it is more likely than not that the Veteran’s current sinus tachycardia, claimed as a heart condition, was caused by his service-connected posttraumatic stress disorder (PTSD) with anxiety and depression. CONCLUSION OF LAW With resolution of reasonable doubt in the Veteran’s favor, the criteria for entitlement to service connection for sinus tachycardia, claimed as a heart condition, as secondary to a service-connected disability have been met. 38 U.S.C. §§ 5107(b), 7104; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty with the United States Army from August 1968 to March 1970, to include service in the Republic of Vietnam. The Veteran earned a Purple Heart and Bronze Star during his active duty service. Board decisions must be based on the entire record, with consideration of all the evidence. 38 U.S.C. § 7104. The law requires only that the Board address its reasons for rejecting evidence favorable to the veteran. Timberlake v. Gober, 14 Vet. App. 122 (2000). The Board must review the entire record, but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a “competent” source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence in light of the entirety of the record. While the Veteran is competent to report (1) symptoms observable to a layperson; (2) a diagnosis that is later confirmed by clinical findings; or (3) a contemporary diagnosis, he is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition. See Davidson v. Shinseki, 581 F.3d 1313 (2009). Because there is no universal rule as to competence, the Board must determine on a case-by-case basis whether a particular condition is the type of condition that is within the competence of a lay person to provide an opinion as to etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24 Vet. App. 428 (2011). Contemporaneous records can be more probative than history as reported by a veteran. See Curry v. Brown, 7 Vet. App. 59, 68 (1994). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). 1. Entitlement to service connection for sinus tachycardia, claimed as a heart condition, to include as secondary to service-connected disabilities The Veteran claims entitlement to service connection for a heart condition, to include as secondary to his service-connected PTSD with anxiety and depression, as raised in the August 2016 substantive appeal. Service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995). The Board acknowledges the Veteran has a current diagnosis of a heart condition during the appeal period. The Veteran submitted a May 2015 disability benefits questionnaire (DBQ) for heart conditions completed by his private treatment provider. The May 2015 DBQ documents the Veteran’s diagnosis of sinus tachycardia. The sinus tachycardia diagnosis is confirmed in a May 2016 VA medical opinion. Further, the Board acknowledges that the Veteran is service connected for PTSD with anxiety and depression. In a September 1970 rating decision, the Veteran was granted service connection for anxiety and depression and assigned a 10 percent disability rating. In a May 1997 rating decision, the Veteran’s anxiety and depression was re-characterized by VA as PTSD with anxiety and depression and his 10 percent disability rating was continued. Finally, the Board finds that the probative medical evidence of record establishes that it is more likely than not that the Veteran’s current sinus tachycardia was caused by his service-connected PTSD with anxiety and depression. In a May 2016 VA medical opinion, the VA physician explained: After review of all of [the Veteran’s] provided vitals and EKGs in [the Veteran’s electronic claims file]: it appears his sinus tachycardia is intermittent… Per his records, [the Veteran] also has a generalized anxiety disorder. It is my opinion that this is the more likely cause of his intermittent sinus tachycardia, along with his deconditioning. For the reasons and bases discussed above and after resolving all reasonable doubt in favor of the Veteran, the Board finds that service connection is warranted for the Veteran’s sinus tachycardia as secondary to his service-connected PTSD with anxiety and depression. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.310. T. Blake Carter Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Riordan, Associate Counsel