Citation Nr: 18106949
Decision Date: 06/01/18	Archive Date: 05/31/18

DOCKET NO. 13-21 709A
DATE:	June 1, 2018
ORDER
Entitlement to service connection for a heart disability to include coronary artery disease is granted.
FINDING OF FACT
The Veteran’s heart disability was incurred in service. 
CONCLUSION OF LAW
The criteria for service connection for a heart disability are met. 38 U.S.C. § 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303.
REASONS AND BASES FOR FINDING AND CONCLUSION
Entitlement to service connection for a heart disability
The Veteran contends that his heart disability incurred in service and should be service connected.  The Board upon review of the evidence finds that the Veteran heart disability was incurred in service and the presumption of soundness attached when the Veteran was processed for activation in his pre-deployment physical.  The Board could find no evidence in the file that would clearly and unmistakably demonstrate that the Veteran’s coronary artery disease existed prior to March 2003. With the question of soundness settled, the Board turns to whether the elements of service connection.  There is not dispute that the Veteran has a current diagnosis of coronary artery disease most recently documented in a May 2015 VA treatment record or that he experienced coronary artery disease in service in April 2003.  
In terms of the relationship, the Board observes that with chronic disease shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. This rule does not mean that any manifestation of joint pain, any abnormality of heart action or heart sounds, any urinary findings of casts, or any cough, in service will permit service connection of arthritis, disease of the heart, nephritis, or pulmonary disease, first shown as a clearcut clinical entity, at some later date. 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 (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. 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. See 38 C.F.R. § 3.303(b).  Here, the Veteran was diagnosed with coronary artery disease in service and has continued to carry the diagnosis to the present time.
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Considering the foregoing, the evidence supports the fact that the Veteran has been diagnosed in service with coronary artery disease and has continued to suffer under the disease.  As such, the Board finds that service connection for coronary artery disease is warranted.

 
PAMELA TOTTEN-BROWNING
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J. Acosta, Associate Counsel