Citation Nr: 21000318 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 13-10 634 DATE: January 5, 2021 ORDER Entitlement to service connection for a heart disorder is granted. FINDING OF FACT With consideration of the benefit of the doubt, the preponderance of the evidence shows that the Veteran’s heart disorder was caused or aggravated by his service-connected low back disorder. CONCLUSION OF LAW Resolving reasonable doubt in favor of the Veteran, a heart disorder was caused or aggravated by a service-connected disability. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from July 1966 to February 1967. The Veteran testified at a hearing before a Veterans Law Judge in March 2016. A transcript of that hearing is associated with the claims file. In March 2018, the Board notified the Veteran that the Veterans Law Judge who conducted the March 2016 hearing was no longer employed at the Board, and that he was entitled to another hearing before another Veterans Law Judge if he so desired. 38 C.F.R. § 20.717. There was no response received within the required 30-day time limit and the Veteran has not otherwise requested a new hearing. Accordingly, the Veteran is deemed to have waived his right to another hearing before the Board. The Board has considered the Veteran’s claim and decided entitlement based on the evidence or record. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with respect to his claims. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Entitlement to service connection for a heart disorder Service connection may be established for a disability resulting from diseases or injuries which are present in service or for a disease diagnosed after discharge from service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires medical or, in certain circumstances, 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. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service connection may be established on a secondary basis for a disability which is shown to be proximately due to, the result of, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310(a). 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) caused by or (b) aggravated by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc) (additional disability resulting from aggravation of a nonservice-connected disorder by a service-connected disorder is also compensable under 38 C.F.R. § 3.310). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). After thorough consideration of the evidence of record, the Board concludes that service connection for a heart disorder is warranted. There is a current diagnosis of coronary artery disease with ischemic cardiomyopathy status post coronary artery bypass graft status post pacemaker/defibrillator placement with paroxysmal arterial fibrillation and paroxysmal ventricular tachycardia and moderate mitral regurgitation, as noted in a February 2020 VA examination. Degmetich v. Brown, 104 F.3d 1328, 1333 (Fed. Cir. 1997) (holding that the existence of a current disability is the cornerstone of a claim for VA disability compensation). In addition, the weight of the medical evidence of record reflects that the Veteran’s heart disorder was at least as likely as not caused or aggravated by his service-connected low back disorder. 38 U.S.C. § 1113(b); 38 C.F.R. §§ 3.303; see Allen, 7 Vet. App. 439 (holding that secondary service connection requires that evidence is sufficient to show that the current disability was either caused or aggravated by a service-connected disability). In a May 2010 medical opinion, E.P., M.D. opined that excessive stress experienced as a result of the Veteran’s service-connected low back disorder had “at least some impact on the development of his cardiovascular disease and resultant myocardial infarction.” In a November 2013 opinion, Dr. E.P. concluded that excessive stress, resultant pain, and exposure to Darvon resulting from the Veteran’s service-connected low back disorder “contributed to the development of his cardiovascular disease.” While VA opinions dated in July 2016, February 2020, and October 2020 determined that the Veteran’s heart disorder was not directly related to his active duty service and was not caused by in-service treatment for a low back disorder with Darvon, none of these examiners considered or addressed whether stress resulting from the Veteran’s low back disorder caused or aggravated his heart disorder. The only VA opinion of record to consider the impact of stress associated with the service-connected low back disorder on the current heart disorder is a January 2013 VA opinion which concluded that, after review of pertinent medical literature, there was no evidence to support the claim that the Veteran’s heart condition was “caused by stress resulting from chronic pain associated with [the low back disorder].” However, the VA examiner did not discuss whether the Veteran’s heart disorder was aggravated by such stress. Additionally, the Veteran submitted medical treatise evidence in April 2013 which notes a relationship between stress and the development of heart disease. Accordingly, the Board does not find the January 2013 VA opinion to be particularly probative in this case. The law is clear. Pursuant to the “benefit-of-the-doubt” rule, where there is “an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter,” the Veteran shall prevail upon the issue. 38 U.S.C. § 5107(b). Upon weighing the evidence of record, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s heart disorder was caused or aggravated by his service-connected low back disorder. The Board therefore concludes that, with the benefit of the doubt resolved in the Veteran’s favor, a grant of service connection for a heart disorder is warranted. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990) (“[T]he ‘benefit of the doubt’ standard is similar to the rule deeply embedded in sandlot baseball folklore that ‘the tie goes to the runner’.... [I]f... the play is close, i.e., ‘there is an approximate balance of positive and negative evidence,’ the veteran prevails by operation of [statute].”). ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Katz, 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.