Citation Nr: 20022491 Decision Date: 04/01/20 Archive Date: 04/01/20 DOCKET NO. 15-08 259 DATE: April 1, 2020 ORDER Entitlement to service connection for a heart disorder other than coronary and ischemic heart disease, to include due to diabetes and coronary and ischemic heart disease, is denied. Entitlement to total disability evaluation based on individual unemployability due to service-connected disabilities is denied. FINDINGS OF FACT 1. The Veteran’s heart disorders, other than coronary and ischemic heart disease, are not caused by or aggravated by his service-connected diabetes and coronary and ischemic heart disease. 2. The Veteran is not rendered unable to obtain or maintain substantially gainful employment due to his service-connected disabilities alone. CONCLUSIONS OF LAW 1. The criteria for service connection for entitlement to service connection for a heart disorder other than coronary and ischemic heart disease, to include due to diabetes and coronary and ischemic heart disease, are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for entitlement to a total disability rating due to individual unemployability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.340, 3.341, 4.3, 4.16, 4.19. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1968 to November 1970. This matter is before the Board of Veterans’ Appeals (the Board) on appeal of a November 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Sioux Falls, South Dakota. The Veteran was provided a video conference hearing before a Veterans Law Judge (VLJ) in June 2018. A transcript is associated with the claims file. In February 2020, the Veteran was notified that the VLJ who conducted his June 2018 hearing was unavailable to participate in a decision on his appeal, his appeal would be reassigned to another VLJ, and he had the right to request another optional Board hearing before a different VLJ. The Veteran stated in writing that he did not wish to appear at another Board hearing. These claims were remanded in November 2018 for a follow up clarification addendum opinion. This opinion was obtained, and the Board finds it adequate because of its detailed background and comprehensive rational. With respect to the Veteran’s claim herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C.§§5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38C.F.R.§§3.102, 3.156(a), 3.159, 3.326. Entitlement to service connection for a heart disorder other than coronary and ischemic heart disease The Veteran seeks service connection for a heart disorder, to include a heart murmur and a need for a pacemaker, due to service, or in the alternative, due to include due to his service-connected diabetes and coronary and ischemic heart disease. He primarily contends that his service-connected diabetes and coronary and ischemic heart disease caused his heart murmur and need for a pacemaker. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran has an additional service-connected heart disorder other than his already service-connected coronary artery disease (CAD) and ischemic heart disease (IHD). The Board concludes that, while the Veteran has a current diagnosis of a heart murmur and requires a pacemaker, the preponderance of the evidence weighs against finding that these heart disorders began during service or are otherwise related to an in-service injury, event, or disease. The Veteran was provided VA medical opinion in February 2016. The examiner detailed the Veteran’s 2014 diagnosis of valvular heart disease involving multiple replacement valves. The examiner also listed paroxysmal atrial fibrillation with an implanted cardiac pacer that was unrelated to his IHD. The examiner’s rational for the heart valve condition was that it was related to the Veteran’s significant history of rheumatic fever as a child and not to his service-connected disabilities. The pacemaker was implanted following his postoperative complete heart block following multiple valve replacements and not due to his service connected IHD or CAD. In a March 2018 opinion and a May 2019 clarifying addendum opinion, a VA examiner opined that the Veteran’s heart murmur and need for a pacemaker are not at least as likely as not related to an in-service injury, event, or disease, including due to his already service-connected heart issues or his service-connected diabetes. Following a detailed overview of the Veteran’s medical history, the examiner opined that the Veteran’s heart murmur and pacemaker were not related to his service-connected disabilities. As rationale, the examiner stated A heart murmur is a symptom due to blood flow turbulence from inadequate opening or closing of a heart valve. The patient’s murmurs were due to the aortic valve inadequately opening and the mitral valve inadequately closing. Not caused or aggravated by diabetes. The patient does have non obstructive coronary disease that is asymptomatic. The development of complete heart block in this patient was highly likely to be from the surgical replacement of his aortic valve, his mitral valve, and repair of his tricuspid valve, all of which can lead to complete heart block during surgical repair. There is no data that shows diabetes can lead to complete heart block. The patient’s heart block later resolved but he continued to have chronotropic intolerance which is also not related to diabetes. The patient does have nonobstructive coronary disease that is asymptomatic. The examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). As an experienced cardiologist, the Board gives much probative weight to the May 2019 VA examiner’s opinion. Although the Veteran believes his heart murmur and pacemaker are related to an in-service injury, event, or disease, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships and the interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the May 2019 VA cardiologist’s opinion. Accordingly, the Board finds the Veteran’s heart murmur and pacemaker implant were not caused by service or any other service-connected disability. In reaching this conclusion, the Board considered the applicability of the benefit-of-the-doubt doctrine. However, the doctrine is not applicable because the evidence is not in a position of equipoise, equal positive and negative evidence, to otherwise grant the Veteran's claim. The appeal is denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Entitlement to total disability due to individual unemployability The Veteran also seeks entitlement to a total disability evaluation based on individual unemployability due to his service-connected disorders. To establish entitlement to a total disability evaluation based on individual unemployability due to service-connected disorders, there must be impairment so severe that it is impossible to follow a substantially gainful occupation. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.341, 4.16. In reaching such a determination, the central inquiry is whether the Veteran’s service-connected disabilities alone are of sufficient severity to produce unemployability. Hatlestad v. Brown, 5 Vet. App. 524 (1993). Unemployability is synonymous with an inability to secure and follow a substantially gainful occupation. VAOPGCPREC 75-91 (1991); 57 Fed. Reg. 2317 (1992). Consideration may be given to the Veteran's level of education, special training, and previous work experience in arriving at a conclusion, but not to his age or to impairment caused by non-service-connected disabilities. 38 C.F.R. §§ 3.341, 4.16, 4.19. When the Veteran’s schedular rating is less than total, a total rating may nonetheless be assigned for two or more disabilities, provided that at least one disability is ratable at 40 percent or more and that there is sufficient additional disability to bring the combined rating to 70 percent or more. In addition, the disabled person must be unable to secure or follow a substantially gainful occupation. 38 C.F.R. § 4.16(a). A total disability rating may also be assigned, for Veterans who are unemployable by reason of service-connected disabilities, but who do not meet the percentage standards of 38 C.F.R. § 4.16(a). 38 C.F.R. § 4.16(b). In such cases, the claim will be submitted to the Director of the VA, Compensation Service, for extra-schedular consideration. The Veteran has a combined 60 percent rating for the following service-connected disabilities: coronary artery disease with ischemic heart disease evaluated as 30 percent disabling; diabetes mellitus type II, evaluated as 20 percent disabling; a back scar, evaluated as 10 percent disabling; and a left hip residual scar, evaluated as 10 percent disabling. He is also service connected for a buttocks scar, a shell fragment wound to muscle group XX, bilateral hearing loss, periodontal disease, and left hip flexion as a residual of a shell fragment wound each evaluated as noncompensable. His combined rating does not meet the percentage rating criteria in 38 C.F.R. § 4.16(a). The Board has considered whether a TDIU is warranted under 38 C.F.R. § 4.16(b), but finds that the evidence does not show the Veteran’s service-connected disabilities are of such severity to warrant extraschedular consideration. The Veteran testified that he last worked for the National Park Service. Information received from this former employer indicates that the Veteran was let go from his position as a Park Ranger (Interpretation) in September 2013 due to a lack of funding. In this regard, the medical evidence fails to show that the Veteran’s service-connected CAD, diabetes, scar and muscle disabilities, hearing loss, dental disability, and left hip disability prevent him from securing and maintaining gainful employment. Notably, on a March 2018 VA examination of the left hip, the Veteran was noted to have minimal scarring without any fascial defect or cardinal signs or symptoms of a muscle disability; his demonstrated normal left hip muscle strength and was without any orthopedic impairments of the hip. The March 2018 examiner determined that the Veteran’s left hip disability did not impact his ability to work, as there were no employment limitations due to the condition. March 2018 examination of the back and buttocks scars revealed slight tenderness over the back scar, but no limitation of function or movement of either affected area. The examiner noted that the Veteran’s scar or residuals of the shell fragment wound did not cause any employment limitations. Although the examiner noted that the Veteran’s arthritic lumbar disorder limited employment requiring repeated bending and/or heavy lifting, sedentary employment was not a limiting factor. Here, the Board notes that the Veteran is not service-connected for lumbar arthritis. As for his diabetes mellitus, the March 2018 VA examiner noted on the clinical examination that the Veteran’s diabetes did not require a regulation of activities and that no complications of diabetes could be identified. Similarly, the medical evidence fails to show that the Veteran’s service-connected CAD prevents him from working. Indeed, a February 2016 VA examiner opined, following an examination of the Veteran, that the Veteran’s CAD did not impact his ability to work. The March 2018 VA examiner noted that Veteran remained physically active during good weather and determined that the Veteran’s heart disability result in any identified employment limitations. Following a review of the claims file and examination of the Veteran, the March 2018 VA examiner opined that the Veteran’s service-connected disabilities would not impact his work in a sedentary environment. There is also no evidence suggesting that the Veteran’s other service-connected disabilities (bilateral hearing loss and periodontal disease) impact his employability, and he does not claim otherwise. Although the Veteran’s service-connected disabilities likely impacts on his overall functioning to some degree, the probative evidence fails to show that his disabilities are of such a severity, singularly or in combination, to prevent him from performing any type of work whatsoever. The Veteran is already compensated at the appropriate level for his service-connected disabilities interference with his ability to work. Further the Veteran has not stated that his service-connected disabilities alone prevent him from working. Entitlement to total disability due to individual unemployability is denied. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Joseph Montanye, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.