Citation Nr: 21000333 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 11-11 773 DATE: January 5, 2021 ORDER Entitlement to service connection for a heart disability is denied. FINDING OF FACT The Veteran’s heart disability did not have its onset during active service, manifest within one year of service, nor is it otherwise related to service, to include as secondary to, or aggravated by, the Veteran’s service-connected acquired psychiatric disorder, to include major depressive disorder, intermittent explosive disorder, and alcohol use disorder (acquired psychiatric disorder). CONCLUSION OF LAW The criteria for service connection for heart disease are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(a), 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from March 1974 to May 1975. The Veteran also had periods of service from July 1977 to July 1980 and July 1983 to March 1987, but these periods of service are not considered eligible for VA benefits. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a May 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Board has remanded the appeal several times. The first remand was in May 2014, which directed that an opinion was needed to determine if the Veteran’s heart disability first manifested in service. The Board remanded again in January 2018, because an opinion was not provided as to whether the Veteran’s heart condition had its onset in service. The appeal was most recently remanded in January 2020, because it was determined that an opinion was needed which addressed whether the Veteran’s heart disability is secondary to his service-connected acquired psychiatric disorder. The Veteran contends that his heart disability is related to service because he has suffered from chest pains since the 1970’s. Alternatively, the Veteran contends that he has heart disease secondary to his service-connected acquired psychiatric disorder. Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. This means that the facts establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). 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 current disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table). Service connection may also be granted through the application of statutory presumptions for chronic conditions. See 38 U.S.C. § 1101(3), 1131, 1132, 1133; 38 C.F.R. § 3.303(b), 3.307(a)(3), 3.307(a)(7), 3.309(a), 3.309(f). Coronary artery disease is classified as a “chronic disease” under 38 C.F.R. § 3.309(a); therefore, 38 C.F.R. § 3.303(b) also applies. 38 C.F.R. § 3.307; Walker v. Shinseki, 708 F.3d 1331, 1337 (Fed. Cir. 2013). Presumptive service connection for “chronic diseases” must be considered on three bases: chronicity during service, continuity of symptomatology since service, and manifestations within one year of the claimant’s separation from service. 38 C.F.R. § 3.303(b); Walker, 708 F.3d at 1336-38. The application of these presumptions operate to satisfy the “in-service incurrence or aggravation” element and establish a nexus between service and a current disability, which must be found before entitlement to service connection can be granted. Further, service connection may be established on a secondary basis for a disability which was either caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Entitlement to service connection for a heart disability The medical records demonstrate that the Veteran suffers from coronary artery disease. Therefore, the first criteria for service connection has been established. The question for the Board is whether the Veteran’s heart disability is related to his military service, in that the onset occurred in service, it was diagnosed within one year of discharge, or it is secondary to, or aggravated by, the Veteran’s service-connected acquired psychiatric disorder. The service treatment records indicate that the Veteran’s heart was normal upon entrance. The service treatment records do not reveal any instances of complaints of or treatment for a heart condition and include multiple indications of a normal heart. The medical treatment records demonstrate that the Veteran stated he had a history of chest pain since 1988. The Veteran has also stated that he has had chest pain since the 1970’s. The medical records demonstrate that the Veteran was first treated for chest pain in May 1990. The Veteran recounted that May 1990 chest pain was a heart attack. However, the records reveal that the medical tests from May 1990 showed no evidence of cardiac damage, and that there was no evidence of coronary disease. The medical treatment records do show that the Veteran has a heart disability, but they do not opine as to the connection between his heart disability and his military service. As such, the Veteran was provided a VA heart examination, along with subsequent addendum opinions, to determine whether the Veteran’s heart disability is sufficiently related to his military service to establish service-connection. In October 2015, the Veteran was afforded a VA examination. The examiner confirmed a diagnosis of coronary artery disease. The examiner opined that it is less likely than not that the Veteran’s stated complaints of chest pain while in the service were indicative of any true cardiac disease because he did not have any objective cardiac abnormalities until July 2003, more than 30 years later. This finding is consistent with the record, as multiple testing performed prior to the July 2003 electrocardiogram indicated normal heart findings. As such, the Veteran’s onset of his heart disability did not occur in service, did not continue in symptoms since service, did not manifest to a compensable degree within one year of discharge from service, and his heart disability is not related to service or any event of service. 38 C.F.R. §§ 3.303, 3.307, 3.309. Addendums to the October 2015 VA heart examination were provided in March 2020 and April 2020. Those addendums considered whether the Veteran’s heart disability is secondary to, or aggravated by, his service connected acquired psychiatric disorder. 38 C.F.R. § 3.310. The March 2020 examiner reviewed the Veteran’s file and opined that the Veteran’s heart disability is less likely than not related to his service connected acquired psychiatric disorder. The examiner explained that the most likely cause of the Veteran’s coronary artery disease is hypertension, systemic lupus erythematosus and hyperlipidemia. The April 2020 addendum addressed whether the Veteran’s heart disability has been aggravated by his service-connected acquired psychiatric disorder. The examiner determined that the Veteran’s baseline level of severity for his heart disability was his myocardial infarctions in 2003 and 2004. The examiner explained that myocardial infarctions were evidence of significant coronary artery disease, and since that time the Veteran has done well from a cardiovascular standpoint. The examiner noted that as of February 2019, the Veteran had no symptoms of ischemia, no further infarctions, and no cardiovascular limitations. As such, the examiner opined that the Veteran’s heart disability is not aggravated beyond the normal progression by the service-connected mental condition because the Veteran’s level of cardiovascular function has actually improved from his baseline level of cardiovascular function. The Board finds the October 2015 VA opinion, and the March 2020 and April 2020 addendum opinions, to be highly probative because the reviewing physicians considered the Veteran’s relevant history, provided sufficiently detailed description of the condition, provided analysis to support the opinions concerning the etiology of the condition, and considered the Veteran’s lay assertions. See Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). To the extent that the Veteran has stated that his heart disability is attributable to service, the Board finds that he is competent to report on his symptoms and that of which he has personal knowledge, but he is not competent to provide an opinion as to the diagnosis or etiology of his heart disability because such a question is not answerable by the application of knowledge within the realm of a lay person. See Layno, 6 Vet. App. at 469-70; Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Accordingly, the Veteran’s opinion as to the diagnosis or etiology of his heart disease is not competent medical evidence. The Board finds the opinions of the VA examiners to be significantly more probative than the Veteran’s lay assertions. [Continued On The Next Page] Therefore, the Board finds that the preponderance of the probative evidence of record does not warrant entitlement to service connection for a heart disability. There is no doubt to be resolved in this case. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Temple, 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.