Citation Nr: 18160311 Decision Date: 12/26/18 Archive Date: 12/26/18 DOCKET NO. 16-40 334 DATE: December 26, 2018 ORDER Entitlement to service connection for ischemic heart disease to include residuals of an implanted pacemaker is denied. REFERRED ISSUE The clinical record raises a claim of entitlement to service connection for dizziness. This issue is not developed or certified for appellate review. Hence, it is referred to the RO for appropriate action. FINDING OF FACT The Veteran does not have ischemic heart disease, and a heart disorder leading to the need for a pacemaker implant was not demonstrated inservice. CONCLUSION OF LAW Neither ischemic heart disease nor a disorder requiring a pacemaker implant was incurred or aggravated inservice, and ischemic heart disease may not be presumed to have been so incurred. 38 U.S.C. §§ 1110, 1116, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from February 1961 to June 1970. He also served in the reserve. In September 1965 he underwent computer training in the Republic of Vietnam. These matters come before the Board of Veterans’ Appeals (Board) on appeal from July 2016 decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). To establish entitlement to service-connected compensation benefits, a veteran must show: (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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word chronic. When the disease identity is established, there is no requirement of evidentiary showing of continuity. 38 C.F.R. § 3.303. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. Id. For certain disabilities, such as cardiovascular disease service connection may be presumed when such disability is shown to a degree of 10 percent or more within one year of the Veteran's discharge from active duty. 38 U.S.C. § 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Such a presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. § 3.307. Veterans who served in the Republic of Vietnam during the Vietnam War are presumed to have been exposed to Agent Orange 38 C.F.R. § 3.307 (a)(6)(iii). Certain disabilities, such as ischemic heart disease, are presumed to be the result of such exposure, if they become manifest to a degree of 10 percent at any time after service. 38 U.S.C. § 1116; 38 C.F.R. § 3.309. The term "ischemic heart disease" includes, but is not limited to, acute, subacute and old myocardial infarction, atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina. 38 C.F.R. §§ 3.307, 3.309. The term does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke, or any other condition that does not qualify within the generally accepted medical definition of ischemic heart disease. Id. The foregoing regulations notwithstanding, service connection may be granted for any disease that is initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Ischemic heart disease to include residuals of a pacemaker implant The Veteran contends that he has ischemic heart disease, and residuals of an implanted pacemaker, as a result of being exposed to an herbicide agent while serving in Vietnam. A review of the service treatment records reveals no complaints, findings or diagnoses pertaining to any form of heart disease. No heart abnormality was claimed or diagnosed at his June 1970 separation examination. Private medical records, to include records from College Park Family Care do not reveal a diagnosis of ischemic heart disease. An August 2014 report from College Park Family Care includes a diagnosis of arteriosclerosis of the carotid arteries but no diagnosis of ischemic heart disease was noted. September 2014 electrocardiography, and rest and stress single proton emission computed tomography myocardial perfusion imaging was negative for any evidence of significant ischemia. Private medical records from Midwest Heart and Valvular Specialists include a notation that the appellant underwent a cardiac catheterization in 2009 which was normal. In December 2014, the appellant was noted to have a history of sinus node dysfunction, Mobitz II AV block, and nonsustained VT and rate dependent left bundle branch block. As a result, a pacemaker was implanted that month. Records from this provider do not, however, include a finding of ischemic heart disease. In March 2015 a physician from College Park Family Care noted that the appellant had cerebrovascular disease. Following a July 2016 VA examination, to include a review of all pertinent records, the examiner opined that the Veteran had never been diagnosed with ischemic heart disease despite numerous workups to include electrocardiograms, Holter monitoring, angiograms, echocardiograms, and stress testing. The examiner further found no evidence to link to his military service any disorder which caused the claimant to need a pacemaker. In this case the competent evidence shows that the appellant did not suffer from ischemic heart disease or any disorder necessitating a pacemaker during his active duty service. As such, there is no basis to grant direct service connection for either. Further, the competent evidence of record shows that cardiovascular disease was not compensably disabling within a year of the claimant’s separation from active duty. As such, there is no basis to grant service connection on a presumptive basis. Finally, despite numerous tests, studies and procedures the competent evidence of record shows that no examiner has ever diagnosed the claimant with ischemic heart disease to include coronary artery disease, any form of coronary spasm, coronary bypass surgery; and stable, unstable and Prinzmetal’s angina. Without evidence showing that the claimant actually has ischemic heart disease there is no basis to grant service connection notwithstanding his service in the Republic of Vietnam and his presumed exposure to herbicides. The claim is denied. As the preponderance of the evidence is against the claim the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Anthony L. Hines Associate Attorney