Citation Nr: 18158585 Decision Date: 12/17/18 Archive Date: 12/17/18 DOCKET NO. 16-05 702 DATE: December 17, 2018 ORDER Service connection for a heart disability is denied. FINDINGS OF FACT 1. In February 2001, during an examination by the Army National Guard (ARNG), the Veteran was found to have a systolic murmur. 2. Throughout 2001, the Veteran only served periods of inactive duty for training (INACDUTRA) with the ARNG. CONCLUSION OF LAW The criteria for entitlement to service connection for a heart disability have not been met. 38 U.S.C. §§ 101, 1110 (2012); 38 C.F.R. §§ 3.6, 3.303, 3.304 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from June 1978 to February 1979. Additionally, he served in the Massachusetts ARNG from May 1991 to May 2003. Service Connection 1. The issue of entitlement to service connection for a heart disability. The Veteran contends that he has a heart disability which manifested during service in the ARNG. During the October 2017 hearing, the Veteran testified that that an ARNG examination revealed several abnormal findings related to his heart. Service connection may be granted for disability resulting from disease or injury incurred or aggravated while performing active duty for training (ACDUTRA), or from an injury incurred or aggravated while performing inactive duty for training (INACDUTRA). 38 U.S.C. §§ 101, 106, 1131. ACDUTRA is, among other things, full-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. 38 U.S.C. § 101. INACDUTRA is part-time duty in the Armed Forces performed by Reserves for training purposes or by members of the National Guard of any state. Id. ACDUTRA and INACDUTRA also includes authorized travel to or from such duty or service. 38 U.S.C. § 106(d). There is a distinction between the terms “disease” and “injury” for VA compensation purposes. “Disease” is defined as harm resulting from some type of internal infection or degenerative process. VAOPGCPREC 4-2002; see also Brooks v. Brown, 5 Vet. App. 484, 487 (1993). Whereas, “injury” is defined as harm resulting from some type of external trauma. VAOPGCPREC 4-2002. The Veteran’s service personnel records indicate that he served multiple periods of INACDUTRA during 2001. As relevant to the current appeal, the Veteran had INACDUTRA on February 3 – 4, 2001. On February 4, 2001, the Veteran underwent an examination which identified a grade 1-2 systolic murmur and an abnormal EKG. The examination report indicates that it was scheduled based on the Veteran’s age and not because of an injury or pre-existing medical condition. As noted above, the Veteran may establish service connection for the claimed heart disability demonstrating that he was disabled from an injury incurred or aggravated in the line of duty. In this case, although the record indicates that a heart murmur and abnormal EKG were noted while the Veteran was on INACDUTRA, there is no evidence that the Veteran experienced an injury during this period. Moreover, the Veteran does not allege that he experienced a cardiac injury while on INACDUTRA. Instead, the February 4, 2001 examination is the date that these conditions were first identified during a routine examination. Accordingly, because the record does not indicate, and the Veteran does not allege, that he was disabled due to an injury incurred or aggravated during INACDUTRA, service connection must be denied. The Board notes that in October 2018, the Veteran’s representative identified five different VA facilities at which the Veteran has received treatment; the VA Boston Healthcare System, Bedford VA Medical Center (VAMC), Charleston VA Clinic, Hershel Woody Williams VAMC and Beckley VAMC. A review of the claims file shows only treatment records from the VA Boston Healthcare System have been associated with the same. Nevertheless, the Board finds a remand to obtain further outstanding treatment records is unnecessary because the claim is being denied based on the lack of an INACDUTRA injury. Post-service treatment records would have no bearing on this issue. Although the claim is being denied based on the lack of an injury while on INACDUTRA, the Board notes that this case was previously remanded in order to schedule the Veteran for a VA examination to determine the nature and etiology of his claimed heart condition. The Veteran underwent a VA examination in August 2018 which revealed that he was diagnosed with a cardiac arrhythmia, specifically, an incomplete right bundle branch block, in 2001. The examiner noted the following history: In 2001 the Veteran had a routine examination done for the indication of being over 38 years of age. The Veteran was in good health and did not have any heart-related symptoms. Abnormalities were noted on the examination. The medical examiner noted a heart murmur. An electrocardiogram was required because of the individual’s age at the time. The electrocardiogram was read as abnormal. An abnormality of the conduction system was noted. (The conduction system is the electrical system that controls the beating of the heart.) The size of one aspect of the electrocardiogram raised concern as to whether the individual had developed left ventricular hypertrophy. [The Veteran] was referred to a cardiologist by his PCP. … The cardiologist noted that there was no personal history of heart-related symptoms. There was no family history of heart disease. The individual was normotensive on examination (that is, he did not have hypertension). No murmur was noted. No heart-related abnormality was noted on the physical examination. The electrocardiogram was read by the cardiologist as showing incomplete right bundle branch block and ‘percordial voltage for left ventricular hypertrophy.’ The cardiologist stated . . . ‘in the absence of symptoms of heart disease I think it is unlikely that [the Veteran] has a cardiac problem.” The VA examiner further noted that a heart murmur was heard and recorded by a single examiner, but such a finding does not establish the existence of a heart problem or condition. He explained that “innocent murmurs can be transient and can be caused by non-cardiac factors such as anxiety or fear. Examiners can be mistaken in labeling the sounds that they hear. Of note in this case, the presence of a murmur was not confirmed by the consulting cardiologist or by subsequent examiners.” The examiner reported that there is no evidence of structural heart disease in this case and it was his opinion that “the weight of the evidence argues against including a heart murmur as a heart condition in this case.” With respect to the incomplete right bundle branch block, the examiner noted that this “is an abnormality that is not a problem or condition.” Instead, it is “an ECG finding” which “represents a minor slowing of a small part of the electrical network that controls the beating of the heart and firing of the heart muscle. The abnormality is minor, described as benign and inconsequential in the literature. It does not indicate underlying disease, does not cause functional disability, is not progressive, and does not put an individual at risk for arrhythmias. It is an abnormality that is not a problem.” With respect to the finding that the Veteran’s electrocardiograph was consistent with left ventricular hypertrophy (LVH), the VA examiner explained that it meant he had a large left ventricular muscle. A larger left ventricular muscle led to more electrical activity, which in turn is represented by taller waves of activity on an ECG. However, taller waves are not solely attributable to LVH. Consideration must be given to the habitus of the individual, specifically the thickness of the individual’s chest wall over the heart. The thickness of the individual chest wall over the heart affects the voltage that reaches the electrodes, thereby the height of the waves on an ECG. Again, the VA examiner referenced the cardiologist’s findings shortly following the in-service examination who determined that he had a relatively thin chest wall, which led to the increased voltage and that he did not have LVH. The examiner noted that “the fact that [the Veteran] did not have a cardiac problem was communicated to him and to his military superiors.” His service treatment records include the paperwork that documents his return to full duty with no limitations. It was noted that the Veteran accepted this conclusion and a repeat examination was done in October 2001 wherein he denied medical problems. Although a complete set of the Veteran’s post-service VA treatment records have not been associated with the claims file, the August 2018 VA examiner noted that the findings contained in the February 4, 2001 examination were not indicative of a cardiac disability. The examiner noted that the Veteran was returned to full duty and a repeat examination noted that he was in good health. As discussed above, the record does not indicate that the Veteran incurred a cardiac injury while on INACDUTRA that resulted in a disability. The criteria for service connection have not been met. The preponderance of the evidence is against the claim and, therefore, service connection is not warranted. M. Donohue Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Suh, Associate Counsel