Citation Nr: 18148490 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 09-46 670 DATE: November 8, 2018 ORDER Service connection for heart disease is denied. FINDING OF FACT The Veteran’s heart disease (coronary artery disease with history of myocardial infarction) did not have its clinical onset during active service, manifest within one year of service, nor is it otherwise related to service, to include as secondary to the Veteran’s service connected hiatal hernia. CONCLUSION OF LAW The criteria for service connection for heart disease are not met. 38 U.S.C. §§ 1110, 1131, 1132, 1133, 5107(b); 38 C.F.R §§3.102, 3.303, 3.307, 3.309(a); 3.309(f), 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Marine Corps from February 1982 to February 1985. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a December 2008 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. The Board remanded the claim for additional development in June 2014. Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. This means that the facts establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 U.S.C. §§ 1131; 38 C.F.R. 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). Service connection may also be granted through the application of statutory presumptions for chronic conditions. See 38 U.S.C. 1101(3), 1131, 1132, 1133; 38 C.F.R. 3.303(b), 3.307(a)(3), 3.307(a)(7), 3.309(a), 3.309(f). Coronary artery disease, is classified as a “chronic disease” under 38 C.F.R. 3.309(a); therefore, 38 C.F.R. 3.303(b) also applies. 38 C.F.R. 3.307; Walker v. Shinseki, 708 F.3d 1331, 1337 (Fed. Cir. 2013). Presumptive service connection for “chronic diseases” must be considered on three bases: chronicity during service, continuity of symptomatology since service, and manifestations within one year of the claimant’s separation from service. 38 C.F.R. 3.303(b); Walker, 708 F.3d at 1336-38. The application of these presumptions operate to satisfy the “in-service incurrence or aggravation” element and establish a nexus between service and a current disability, which must be found before entitlement to service connection can be granted. Further, service connection may be established on a secondary basis for a disability which was either caused or aggravated by a service-connected disability. 38 C.F.R. 3.310(a); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Applicable to claims received by VA on or after March 14, 2017, and to claims pending before VA on that date, a veteran, or former reservist or member of the National Guard, who had no less than 30 days (consecutive or nonconsecutive) of service at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987, shall be presumed to have been exposed during such service to the contaminants in the water supply, unless there is affirmative evidence to establish that the individual was not exposed to contaminants in the water supply during that service. See 38 C.F.R. § 3.307(a)(7)(iii); 82 Fed. Reg. 4173 (Jan. 13, 2017). For the purposes of this section, contaminants in the water supply means the volatile organic compounds trichloroethylene (TCE), perchloroethylene (PCE), benzene and vinyl chloride, that were in the on-base water-supply systems located at United States Marine Corps Base Camp Lejeune, during the period beginning on August 1, 1953, and ending on December 31, 1987. 38 C.F.R. § 3.307 (a)(7)(i). If an individual described in paragraph (a)(7)(iii) of this section develops a disease listed in §3.309(f), VA will presume that the individual concerned became disabled during that service for purposes of establishing that the individual served in the active military, naval, or air service. 38 C.F.R. § 3.307(a)(7)(iv). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical evidence. The VA must also consider all favorable lay evidence of record. See 38 U.S.C. 5107 (b); see also Layno v. Brown, 6 Vet. App. 465, 469-70 (1994) (a Veteran is competent to report on that of which he or she has actually observed and is within the realm of his or her personal knowledge). Entitlement to service connection for heart disease, to include as secondary to service connected hiatal hernia The Veteran contends that his heart disease is related to service due to his exposure to contaminated water at Camp Lejeune. Alternatively, the Veteran contends that he has heart disease secondary to his service connected hiatal hernia. As an initial matter, the Board must address whether service connection for the Veteran’s heart disease can be established on a direct basis. The Veteran’s medical records demonstrate that he has been diagnosed with coronary artery disease and that he has experienced a myocardial infarction. Therefore, it is accepted that the Veteran currently has heart disease. As such, the Board now turns to the question of whether there is an in-service incurrence and nexus. Here, the Veteran’s service treatment records do not document any complaints or treatment for a heart condition. The service treatment records show that the Veteran’s heart was normal prior to entry into the service, and the separation examination also indicates the Veteran did not have a heart condition. Post-service treatment records document the Veteran suffered a heart attack in December 1993, 8 years after his separation from the service. The Veteran was afforded a VA examination in June 2015. The June 2015 VA examiner opined that the Veteran’s current heart disease was less likely than not directly related to his active duty service. Because the Veteran was not diagnosed with a heart condition prior to entrance into the service, no heart condition was noted throughout his time in the service, and his separation examination demonstrated his heart was normal, there is no evidence that the Veteran’s heart disease was directly caused by his service. Accordingly, the Board finds that the preponderance of the evidence does not support a finding of an in-service incurrence and nexus, and service connection for heart disease cannot be granted on a direct basis. Although service connection of the Veteran’s heart disease cannot be established on a direct basis, the Board must consider whether service connection for the Veteran’s heart disease can be established on a presumptive basis. There is no evidence of a heart condition until many years after the Veteran’s separation from service. Thus, service connection on a presumptive basis as a chronic disease is also not warranted. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). It is the Veteran’s primary assertion that service connection for his heart disease is warranted on a presumptive basis due to his exposure to contaminants in the water supply at Camp Lejeune. Service connection can be established for diseases associated with exposure to contaminants in the water supply at Camp Lejeune for the following specified conditions: 1) Kidney cancer; 2) Liver cancer; 3) Non-Hodgkin’s lymphoma; 4) Adult leukemia; 5) Multiple myeloma; 6) Parkinson’s disease; 7) Aplastic anemia and other myelodysplastic syndromes; and 8) Bladder cancer. 38 C.F.R. 3.309(f). Heart disease is not one of the designated conditions under the Camp Lejeune presumption. Therefore, the Board finds that service connection for the Veteran’s heart disease is not established through application of the Camp Lejeune presumption. Id. Nevertheless, where presumptive service connection is not warranted because the claimed disability is not listed, the Board must consider whether there is competent evidence that shows that the claimed condition was actually caused by the Veteran’s active service, including contaminated water exposure. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007); Combee v. Brown, 34 F.3d 1039, 1042 (1994). Here, the June 2015 VA examiner addressed both the likelihood that the Veteran’s exposure to water contaminants at Camp Lejeune caused his heart condition, and, alternatively, that the heart disease was caused or aggravated by his hiatal hernia. The examiner opined that the Veteran’s heart disease was less likely than not caused by or the result of exposure to water contaminants at Camp Lejeune. The VA examiner explained that neither were the likely factor causing his heart disease, as it was much more likely that the factors causing the Veteran’s heart disease were his history of tobacco usage, obesity, hyperlipidemia, and hypertension, all of which are known, modifiable, risk facts for heart disease. The Board finds that the June 2015 VA opinion is highly probative because the reviewing clinician considered the Veteran’s relevant history, provided a sufficiently detailed description of the condition, provided analysis to support the opinion concerning the etiology of the condition, and considered the Veteran’s lay assertions. See Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). The VA examiner’s opinion regarding the Veteran’s cardiac symptoms during service is also validated by the evidence of record. The Veteran’s service treatment records document that the Veteran did not have a diagnosis of heart disease during service, and the Veteran’s post-service treatment records document the first instance of a heart condition 8 years after his separation from service. To the extent that the Veteran has stated that he has heart disease attributable to service, the Board finds that he is competent to report on his symptoms and that of which he has personal knowledge, but he is not competent to provide an opinion as to the diagnosis or etiology of his heart disease because such a question is not answerable by the application of knowledge within the realm of a lay person. See Layno, 6 Vet. App. at 469-70; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Accordingly, the Veteran’s opinion as to the diagnosis or etiology of his heart disease is not competent medical evidence. The Board finds the opinion of the VA examiner to be significantly more probative than the Veteran’s lay assertions. (Continued on the next page)   In short, the preponderance of the probative evidence indicates that the Veteran does not have heart disease which had its onset in service, or within one year of his discharge from active service, or is otherwise related to a period of active service, to include as secondary to a service-connected disability; therefore, service connection is not warranted. There is no doubt to be resolved in this case. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). S. C. KREMBS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Temple, Associate Counsel