Citation Nr: 18152999 Decision Date: 11/27/18 Archive Date: 11/26/18 DOCKET NO. 16-56 646 DATE: November 27, 2018 ORDER Service connection for heart disability, to include valvular heart disease with status post mitral valve replacement, claimed as ischemic heart disease (IHD) due to exposure to herbicide agents, is denied. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of IHD; valvular heart disease is not shown in service or within the initial post separation year, and is not otherwise related to in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a heart disability are not met. 38 U.S.C. §§ 1101, 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a), (e). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from November 1966 to September 1968. VA has conceded that the Veteran had service in the Republic of Vietnam. This matter comes before the Board of Veterans Appeals (Board) on appeal from a January 2016 rating decision of a Department of Veterans’ Affairs (VA) Regional Office (RO). In a November 14, 2016 Substantive Appeal (VA Form 9), the Veteran requested a hearing before a Member of the Board relating to his claim. In December 2016, the Veteran submitted an additional Form 9 withdrawing his hearing request in this matter. There are no other hearing requests of record. Accordingly, the Veteran’s hearing request is deemed withdrawn. See 38 C F R § 20.704(e). Entitlement to service connection heart disability. The Veteran contends that he has a heart disability that should be considered IHD, for the purpose of presumptive service connection based on herbicide exposure. He argues that valve disorders should be treated the same as IHD since it involves the same organ. The Board concludes that the preponderance of the evidence is against service connection for heart disability, to include valvular heart disease with status post mitral valve replacement and IHD due to exposure to herbicide agents. The Veteran’s valvular heart disorder is not shown in service or within the initial post separation year, and it is not otherwise related to service. IHD is not shown during the pendency of the appeal or prior thereto. 38 U.S.C. §§ 1101, 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a), (e). Compensation may be awarded for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131. Service connection basically means that the facts, shown by evidence, establish that an injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303. Service connection may be granted for any disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in- service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a), (d). For endocarditis, which covers all forms of valvular heart disease, the disability is considered to have been incurred in or aggravated by service although not otherwise established during the period of service if manifested to a compensable degree within one year following service in a period service. 38 U.S.C. §§ 1101, 1131; 38 C.F.R. §§ 3.307(a) (3), 3.309(a). This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Unlike IHD and coronary artery disease, valvular heart disease is not a disease presumptively associated with herbicide exposure. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307 (a)(6), 3.309(e). Notwithstanding, service connection may be established with proof of direct causation. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); see also McCartt v. West, 12 Vet. App. 164, 167-68 (1999) (providing that the provisions set forth in Combee are equally applicable in cases involving claimed Agent Orange exposure). In this case, service treatment records (STRs) reflect no complaints or findings for abnormal heart pathology. Decades after active service, in 2003, private medical record reflect that the Veteran had heart valve problems based on diagnostic testing to include an echocardiogram. At this time, mitral valve regurgitation was diagnosed. The Veteran underwent heart valve repair in January 2004 due to severe mitral insufficiency. VA received the Veteran’s claim for service connection for IHD in June 2015. A November 2015 VA examination reflects that the Veteran had been diagnosed with valvular heart disease in 2004 and had been symptom-free since the 2004 repair. The examiner also found the Veteran’s heart condition did not qualify within the generally accepted medical definition of IHD. The Board has considered Veteran’s argument that, since IHD is described as an “abnormality” of the arteries of the heart that supply oxygen and blood to the heart, heart valves should be included in the description of related conditions because arteries cannot function properly without valves. See Form 9 (December 2016). However, the Board finds that the Veteran is not competent to opine that valvular disease is part-and-parcel of IHD as he lacks the requisite medical training and expertise. The matter of whether valvular disease is a form of IHD is complex medical question that requires knowledge of the mechanisms of the heart, diseases of the heart, and the ability to distinguish between diseases caused by defective valve versus narrowed heart arteries and their underlying causes. The Veteran does not possess the training, credentials, or other expertise to formulate an opinion that is of comparable probative value to that of a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Therefore, his medical opinion has no probative value. The Board assigns greater probative value to the November 2015 VA medical opinion that the Veteran’s heart disability was not IHD as this was prepared by a skilled, neutral medical professional after review of the claims file and examination of the Veteran. The Veteran has not presented a favorable medical opinion to weigh in this matter. 38 U.S.C. § 5107(a) (claimant bears responsibility to support a claim for VA benefits). The Board further assigns greater probative value to the STRs and the many decades intervening service and the first documented findings for abnormal heart pathology, which was not IHD. Buchanan v. Nicholson, 451 F.3d 1331, 1337 (2006); see also Maxson v. West, 12 Vet. App. 453, 459 (1999), aff'd sub nom., Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (holding that the Board may take into consideration the passage of a lengthy period of time in which the Veteran did not complain of the disorder at issue); Forshey v. West, 12 Vet. App. 71, 74 (1998), aff'd sub nom., Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (finding that the definition of evidence encompasses "negative evidence" which tends to disprove the existence of an alleged fact). On balance, the weight of the evidence is against the claim. Accordingly, the claim is denied. There is no doubt to resolve. 38 U.S.C. § 5107(b). C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. E., Associate Counsel