Citation Nr: 18159797 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 06-09 387 DATE: December 20, 2018 ORDER Entitlement to service connection for a heart disability, to include as secondary to service-connected disabilities is denied. FINDING OF FACT The most probative evidence of record does not establish that Veteran’s heart disabilities are not shown to be manifest in service or within one year of separation, or caused or aggravated by a service-connected disability. CONCLUSION OF LAW The criteria for service connection for a heart disability, to include as secondary to service-connected disabilities, have not been met. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5107 (West 2014); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.304, 3.310 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION 1. Entitlement to service connection for a heart disability, to include as secondary to service-connected disabilities The Veteran is seeking service connection for a heart disability, to include as secondary to his service connected disabilities. 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; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in-service. 38 C.F.R. § 3.303 (d). In order to establish service connection on a direct basis, the record must contain: (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). Under 38 C.F.R. § 3.303 (b), an alternative method of establishing the second and third Shedden element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309 (a); See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for a disability that is proximately due to, or the result of, a service-connected disability. See 38 C.F.R. § 3.310 (a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See id; Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In other words, service connection may be granted for a disability found to be proximately due to, or aggravated by, a service-connected disease or injury. To prevail on the issue of secondary service connection, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107 (b). The Veteran has asserted multiple theories for the origin of his heart condition. During his August 2010 Board hearing, the Veteran testified that he was electrocuted during service and this ultimately caused his heart condition. He has also asserted that his heart condition was evidenced by angina as early as 1989. Lastly, he has claimed that his heart condition is secondary to his service connected disabilities. During the Veteran’s 1968 enlistment examination, it was noted that the Veteran’s heart was normal. However, it was noted that he experienced pain or pressure in his chest. A June 1970 examination found the Veteran’s heart to be normal. Upon separation in August 1972, the Veteran’s heart was noted as normal. Prior to reenlistment, a June 1981 examination found the Veteran’s heart to be normal. The Veteran also denied shortness of breath, pain or pressure in chest, chronic cough, palpation or pounding heart, heart trouble and high or low blood pressure. An October 1988 radiologic report found that the Veteran had no active disease and his cardiac and mediastinal silhouettes were normal. However, there was mild apical pleural thickening. An April 1989 chest service treatment record (STR) noted that the Veteran’s heart had a regular rate and rhythm. The Veteran also denied shortness of breath, pain or pressure in chest, chronic cough, palpation or pounding heart, heart trouble and high or low blood pressure in April 1989. A May 1989 radiologic report found that the Veteran had a normal chest with no abnormalities of the heart. The Veteran’s June 1989 STRs show that he was treated following an electrical shock. However, it was specifically noted on the treatment record that the Veteran’s heart had a normal sinus rhythm and was negative for gallops. His STRs also show treatment for chest discomfort in February 1993, which was assessed as gastroesophageal reflux. In August 1994 the Veteran sought treatment for chest discomfort. The STR noted that the Veteran had a possible history of angina from 1988, but also found that he had a questionable cardiac history. The medical professional assessed the chest pain as a higher probability of gastric discomfort verus cardiac. During the Veteran’s October 1994 retirement examination, it was noted that the Veteran’s heart was normal. Following service, the Veteran’s treatment records reveal that he suffered a myocardial infarction in February 1997 and underwent a cardiac catheterization. The Veteran was also diagnosed with coronary artery disease and hyperlipidemia. A May 1999 treatment record noted that the Veteran had known coronary artery disease and had had a second stent placed in the right coronary in May 1999. The Veteran’s diagnoses included coronary artery disease and controlled hypertension. A February 2001 VA treatment record found that the Veteran’s coronary artery disease, status post coronary artery bypass graft, was present since 1990 when he presented with angina. In May 2003 the Veteran underwent a VA heart examination. The examiner conducted an in-person examination and reviewed the Veteran’s claims file. She also gave a detailed report of the Veteran’s medical history. Her assessment and plan found coronary artery disease status post two prior myocardial infarctions treated with stents and ultimately coronary artery bypass grafting. He continued to have angina. His hyperlipidemia contributed to his coronary artery disease. His diagnoses also included GERD, depression, anxiety, chronic back pain and possible diastolic dysfunction. In July 2003 the Veteran was afforded an addendum medical opinion to his May 2003 VA heart examination. The reviewing physician diagnosed the Veteran with hypercholesterolemia, coronary artery disease status post coronary artery bypass graft, myocardial infarction and peptic ulcer disease or gastroesophageal reflux disease. Based upon a review of the Veteran’s claims file, the VA physician found that the Veteran had extensive work-up while he was on active duty including a stress test and it was found that the Veteran had a non-cardiac origin of pain. He developed a heart attack in 1997. In the VA physician’s opinion, the Veteran’s coronary artery disease and his heart attack were not related to service. The Veteran was having hypercholesterolemia and smoking three packs per day which are the risk factors which present when he was on active duty and patient was treated with cholesterol lowering agent while he was on active duty and the Veteran chose to prove his last study might not have a heart attack in 1997, but the Veteran continued to smoke and also his cholesterol was still running high. Based on all the material facts, the VA physician did not think the Veteran’s myocardial infarction in 1997 was related to his service connected chest pain because he was extensively worked up at that time and stress test was negative. In May 2017 the Veteran was afforded an additional VA medical opinion. Based upon a review of the Veteran’s claim’s file, the VA medical professional determined that he could find no definitive objective evidence upon review, nor on a review of the medical literature, that would result in any specific nor definitive aggravation of his cardiac disability. Therefore, current service connected disabilities less likely than not aggravated his cardiac disability. Most recently, the Veteran was afforded a VA addendum opinion in January 2018. Upon a review of the Veteran’s claims file, the reviewing physician found that the Veteran’s cardiac condition was less likely than not related to any of his service-connected disabilities. The physician opined that the Veteran is not service connected for any condition that would increase the risk of coronary artery disease, status post stent and coronary artery bypass graft. He further wrote that the Veteran was service connected for various musculoskeletal, gastrointestinal and psychological conditions, none of which would predispose him to the development of his heart condition. Likewise, the medications, required for the treatment of these conditions would, in no way, increase the risk for development or aggravation of his heart condition. The Board places great weight on the opinions reached by this provider as the opinion is based on a complete review of the claims folder and considers the Veteran’s lay statements as well as the documented medical history both during and after service. Based on the above, the Board finds that the weight of the competent and credible evidence demonstrates that the Veteran’s heart disability was not incurred in or otherwise related to the Veteran’s active duty service or the presumptive period after discharge. The Board finds that the weight of the lay and medical evidence of record is against a finding of a causal relationship between the Veteran’s complaints of chest pain in service and his current heart disability. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim for service connection and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. In reaching this decision, the Board has considered the Veteran’s statements and belief that his current heart disability and his in-service diagnoses of angina. It is true that the Veteran’s lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of the disorder or symptoms of the disorder subject to lay observation. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disorder even where not corroborated by contemporaneous medical evidence). However, the etiology of his current heart disabilities is a complex question requires specialized training for a determination as to diagnosis and causation, and is therefore not susceptible to lay opinions on etiology. Furthermore, although a February 2001 VA treatment record related his heart disabilities to his in-service diagnosis of angina, there is no indication that the medical professional reviewed the Veteran’s claims file, nor did they provide a supporting rationale. Accordingly, the Board has placed greater probative weight on the opinions reached by the May 2003, July 2003, May 2017 and January 2018 examiners and medical opinions as discussed above. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Nelson, Associate Counsel