Citation Nr: 20060652 Decision Date: 09/15/20 Archive Date: 09/15/20 DOCKET NO. 15-44 031 DATE: September 15, 2020 ORDER Service connection for a heart condition, to include as secondary to medication taken for service-connected disabilities, is denied. FINDING OF FACT The preponderance of the competent evidence supports that the Veteran’s heart conditions were neither proximately caused nor aggravated by service-connected disabilities or the medication taken for them. CONCLUSION OF LAW The criteria for service connection for a heart condition have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1951 to July 1953. He died in August 2017. The appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2020 the Board remanded the claim for an addendum opinion, and as the directives of that decision were complied with, the Board will now adjudicate the service-connection claim on the merits. The appellant seeks service connection for the Veteran’s heart condition, contended as caused by the Veteran’s other service-connected disabilities or medications for them. Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires 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 event, injury, or disease and the present injury or disease. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for a disability which is proximately due to or aggravated in severity beyond its natural progression by a service-connected injury or disease. 38 U.S.C. § 1110; 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439 (1995). Turning to the evidence, a VA opinion was obtained in March 2020. After comprehensively reviewing the Veteran’s medical history, the clinician found that during the duration of the appeal period (2011 to 2017) the Veteran had diagnoses of left ventricular hypertrophy, diastolic dysfunction, biatrial enlargement, and atrial fibrillation. Regarding the mentions of coronary artery disease or atherosclerosis within the record, the clinician found no testing to support such diagnoses. Though a December 2015 CT scan noted scattered atheromatous changes in the abdominal aorta, this was not associated with any definitive plaques or change in the caliber of the aorta and therefore did not equate to coronary artery disease or heart disease. The clinician opined that none of the Veteran’s service-connected disabilities had a direct risk of proximately causing the Veteran’s heart conditions. All these conditions “clearly developed and/or continued through [the] appeal period due to long-term effects of H[ypertension], with associated effects of partially treated O[bstructive] S[leep] A[pnea], primary risk factors for the aforementioned cardiac conditions.” The clinician further opined that the Veteran’s service-connected disabilities had not aggravated the Veteran’s heart conditions, which had “progressed very slowly over years” without any evidence in the record of “aggravation or progression beyond [the] expected course.” As directed by the Board’s previous remand, the March 2020 clinician issued an addendum opinion in July 2020 to address whether the Veteran’s heart conditions were secondary to any of the medications he took for his service-connected disabilities. After comprehensive and thorough review of the Veteran’s medical history and medications, the clinician found that the Veteran’s heart conditions were not proximately due to the medication taken for any service-connected disability. She noted that the pain medication the Veteran took were not taken in quantities or intervals sufficient to increase the risk of cardiac disability and were discontinued before the Veteran’s cardiac conditions manifested to a significant degree. The other medications the Veteran took were prescribed for non-service-connected conditions. The clinician remarked that in general, the majority of medication side effects manifest suddenly and severely, and the Veteran never exhibited sudden or severe cardiac disability in relation to the initiation or adjustment of any of the medications for his service-connected disabilities. Noting that the Veteran’s cardiac conditions “slowly progressed over time, as is typical of the disorders,” the clinician likewise opined that none of the Veteran’s cardiac conditions were aggravated by medications or treatments associated with his service-connected disabilities. The Board finds the March 2020 and July 2020 opinions the most probative evidence of record regarding any potential etiology between the Veteran’s heart conditions and his service-connected disabilities or the medication he took for them. Though the Board acknowledges that the Veteran strongly believed, as the appellant still maintains, that his heart conditions were due to his service-connected disabilities or medications for them, there is no evidence of record to show that the Veteran or appellant have the education, training, or experience to opine on the etiology of the Veteran’s heart conditions or associated symptoms, which are medically complex issues beyond observation by the senses. Layno v. Brown, 6 Vet. App. 465 (1994). Thus, the March 2020 and July 2020 opinions are the most probative evidence of record regarding a connection to service-connected disabilities or the medication taken for them. See Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2006). In conclusion, as the preponderance of the competent evidence of record supports that the Veteran’s heart conditions were not proximately due to or aggravated by his service-connected disabilities or the medication taken for them, service connection for any heart disability must be denied. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310(a). K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Davis, 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.