Citation Nr: 18155854 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 16-50 297 DATE: December 6, 2018 ORDER Reopening of a previously denied claim of entitlement to service connection for a heart condition, previously claimed as atypical chest pain, is granted. Entitlement to service connection right ventricular dysplastic syndrome, previously claimed as atypical chest pain, is granted. FINDINGS OF FACT 1. In an unappealed May 2006 rating decision, the RO denied service connection for a heart condition (previously claimed as atypical chest pain) because no current disability was shown. 2. Evidence obtained since the unappealed May 2006 rating decision that denied service connection for a heart condition (previously claimed as atypical chest pain) is neither cumulative nor redundant of other evidence of record, and raises a reasonable possibility of substantiating the claim. 3. The evidence of record reasonably shows that the Veteran has right ventricular dysplastic syndrome that began in active service. CONCLUSIONS OF LAW 1. The May 2006 rating decision denying service connection for a heart condition (previously claimed as atypical chest pain) is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2018). 2. The criteria for reopening the previously denied claim of entitlement to service connection for a heart condition (previously claimed as atypical chest pain) have been satisfied. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2018). 3. The criteria for entitlement to service connection for right ventricular dysplastic syndrome have been met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served active duty service with the United States Air Force from January 1986 to January 2006. This case comes before the Board of Veteran’s Appeals (Board) on appeal from a February 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Although the RO reopened the Veteran’s claim, the Board must independently decide whether the Veteran has submitted new and material evidence to reopen the claim. Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). 1. Reopen Claim Rating actions from which an appeal is not timely perfected become final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. The Veteran did not appeal the May 2006 decision, nor did he submit relevant evidence within a year thereof. The decision became final. A final decision cannot be reopened unless new and material evidence is presented. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The May 2006 rating decision denied service connection for a heart condition (previously claimed as atypical chest pain) because the Veteran did not have a current diagnosis attributed to atypical chest pain. Service treatment records and VA treatment records documented the Veteran complaints of chest pain and a diagnosis of atypical non-cardiac chest pain. Since that time, the Veteran has submitted a private cardiology consult evaluation and VA examination report which found a recent diagnosis consistent with the myocardial perfusion study during the Veteran’s service and a diagnosis of right ventricular dysplastic syndrome. This is both new and material, and reopening is warranted. As such, the records relate to the previously unestablished current disability element of the claim. See Shedden, supra. Thus, a reasonable possibility of substantiating the claim has been raised. 38 C.F.R. § 3.156 (a); see also Shade, supra. 2. Service Connection Service connection will be granted if it is shown that the Veteran suffers from a 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 the line of duty, during active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. In order to establish service connection, the record must contain competent evidence of: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Some chronic diseases may be presumed to have been incurred in service, if they become manifest to a degree of ten percent or more within the applicable presumptive period. 38 U.S.C. §§ 1101(3), 1112(a); 38 C.F.R. §§ 3.307(a), 3.309(a). For those listed chronic conditions, a showing of continuity of symptoms affords an alternative route to service connection. 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F. 3d 1331 (Fed. Cir. 2013). Heart disease is a listed condition. Service treatment records (STRs) document complaints of recurrent chest pain toward the end of service. Testing did not explain the complaints; no arrhythmias were identified, though the left ejection fraction was low. Testing immediately post service showed recovery to normal ranges, and the initial claim was denied for lack of a current disability. Subsequently, supraventricular tachycardia was detected. At a February 2014 VA examination, implantation of an automatic implantable cardioverter-defibrillator (AICD) in August 2013 was noted. The examiner, a physician’s assistant, felt that there was insufficient evidence to diagnose a current arrhythmia condition, but she did identify current right ventricular dysplastic syndrome. She also indicated that, based on the current medical evidence and the chronicity and continuity of in-service and post-service complaints from the Veteran, it was at least as likely as not that the current disability was related to the in-service complaints. In an addendum opinion issued later that month, a VA doctor opined that the right-side heart condition was less likely than not related to the chest pains in service, as such are nonspecific and not considered diagnostic. The cause of right ventricular dysplastic syndrome is unknown. Although the VA physician is more qualified than a physician’s assistant to render a nexus opinion, in this instance the latter contains a far stronger rationale, as it refers to the evidence of record, particularly the competent, credible, and documented lay evidence of a chronic disease from the Veteran. Importantly, it is not vital that the actual cause be identified so long as the date of onset be established as during active duty, as the initial February 2014 VA examiner has done. The Board finds it is entitled to greater probative value, and therefore the preponderance of the evidence favors the claim. Service connection for right ventricular dysplastic syndrome is warranted. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Baxter, Associate Counsel