Citation Nr: 20048045 Decision Date: 07/17/20 Archive Date: 07/17/20 DOCKET NO. 13-32 300 DATE: July 17, 2020 ORDER Entitlement to service connection for a cardiac disability diagnosed as idiopathic cardiomyopathy, atrial flutter, slow AV nodal re-entry, and supraventricular tachycardia, as secondary to diabetes mellitus, type II, (diabetes mellitus), is granted. FINDING OF FACT The evidence is in relative equipoise as to whether the Veteran’s cardiac disability was caused by his service-connected diabetes mellitus. CONCLUSION OF LAW The criteria for entitlement to service connection for a cardiac disability, as secondary to service-connected diabetes mellitus, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1967 to December 1972. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In December 2016, the Veteran testified at a video-conference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing has been associated with the claims file. In November 2017 and July 2019, the Board remanded this matter for further development. That development having been completed, this matter has returned to the Board for further appellate review. Entitlement to service connection for a cardiac disability, to include as secondary to diabetes mellitus Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent medical or lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service connection may also be granted on a secondary basis for a disability which is proximately due to, or the result of, a service connected disability. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists; and (2) that the current disability was either: (a) proximately caused by; or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (providing, in pertinent part, that reasonable doubt will be resolved in favor of the claimant). When the evidence supports the claim or is in relative equipoise, the claim will be granted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990); see also Wise v. Shinseki, 26 Vet. App. 517, 532 (2014). If the preponderance of the evidence weighs against the claim, it must be denied. See id.; Alemany v. Brown, 9 Vet. App. 518, 519 (1996). The Veteran asserts that his cardiac disability is secondary to his service-connected diabetes mellitus. See October 2013 VA Form 9. In this regard, the Veteran has been diagnosed with idiopathic cardiomyopathy, atrial flutter, slow AV nodal re-entry, and supraventricular tachycardia. See October 2019 Novant Health Heart and Vascular Inst. Statement. Accordingly, he has a current cardiac disability. Davidson, 581 F.3d 1313. In support of his claim, the Veteran submitted multiple statements from his private physicians. An October 2010 statement found that the Veteran had cardiovascular complications that are directly due to his diabetes mellitus, or likely to be caused in part and/or aggravated by his diabetes mellitus. See October 2010 Physician’s Statement for Diabetes. An October 2019 statement related the Veteran was diagnosed with atrial flutter and supraventricular tachycardia. An electrophysiologic study found atrial flutter and slow AV nodal re-entry as an underlying arrhythmia with His-Purkinje dysfunction, for which the Veteran received a pacemaker. The physician opined that these electrical abnormalities were the result of the Veteran’s long-standing diabetes. He further opined that the electrical abnormalities were also aggravated beyond their natural progression by the Veteran’s diabetes mellitus. See October 2019 Novant Health Heart and Vascular Inst. Statement. A February 2018 VA medical opinion report opined, in pertinent part, that the Veteran’s paroxysmal supraventricular tachycardia associated with AV nodal re-entry was not caused by his diabetes mellitus, as there is no known association between diabetes and AV nodal re-entry tachycardia. See February 2018 Medical Opinion Disability Benefits Questionnaire (DBQ). An October 2019 VA opinion found that the Veteran’s cardiomyopathy was caused by his adrenal tumor, which has since resolved, therefore an opinion on causation aggravation was moot. See October 2019 Medical Opinion DBQ. A March 2020 VA addendum opinion found there was no causal relationship between cardiac dysrhythmia and diabetes mellitus, so no aggravation would be possible. See March 2020 Addendum Report. The Board finds that the evidence for and against the claim, as to whether the Veteran’s heart condition was caused by his diabetes mellitus, is at least in equipoise. Therefore, the Board resolves reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert, 1 Vet. App. at 55. Accordingly, service connection for a cardiac disability, as secondary to service-connected diabetes mellitus, type II, is granted. See 38 C.F.R. § 3.310. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. M. Stedman, 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.