Citation Nr: 21002095 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 16-35 647 DATE: January 12, 2021 ORDER The claim of entitlement to service connection for cardiac arrhythmia is denied. REMANDED The claim of entitlement to service connection for erectile dysfunction is remanded. FINDINGS OF FACT It has not been shown, by credible, competent evidence, that the Veteran’s cardiac arrhythmia is related to service. CONCLUSION OF LAW The criteria for service connection for cardiac arrhythmia have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from July 1967 to April 1971. This case was remanded by the Board in November 2018 for VA examination and opinion. 1. Entitlement to service connection for cardiac arrhythmia The Veteran claims that he has cardiac arrhythmia that is directly related to military service. He also claims in the alternative that it is related secondarily to non Hodgkins lymphoma and/or any medications taken for his service connected disabilities. See statements received February 29, 2016. Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d, 1362, 1366 (Fed. Cir. 2009). Alternatively, under 38 C.F.R. § 3.303 (b), service connection may be awarded for a “chronic” condition when (1) a chronic disease manifests itself and is identified as such in service, or within the presumptive period under 38 C.F.R. § 3.307, and the veteran presently has the same condition; or (2) a listed chronic disease (under 38 C.F.R. § 3.309 (a) (such as arthritis or organic diseases of the neurological system) manifests itself during service, or during the presumptive period, but is not identified until later, and there is a showing of continuity of related symptomatology after discharge, and medical evidence relates that symptomatology to the Veteran’s present condition. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (holding that the theory of continuity of symptomatology analysis is applicable in cases involving conditions explicitly recognized as chronic diseases under 38 C.F.R. § 3.309 (a)). Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the appellant or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the e-file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). The record contains service treatment records (STRs), private hospital records, VA outpatient and examination reports to include medical opinion and statements of the Veteran. Direct service connection In regard to element (1), current disability, post-service private examination reports dated in August 2013 (received in March 2014) indicate diagnoses of cardiac arrhythmia. Concerning the second element, medical or lay evidence of in-service incurrence or aggravation of a disease or injury, in reviewing the e-file, there are no complaints, findings or diagnoses during service pertaining to the heart. The Veteran received treatment for dizziness and nausea in September 1967. However, this was considered secondary to a hip injection. There was no other treatment for dizziness. His heart was considered normal on the February 1971 examination conducted prior to separation from service. He also specifically denied any heart palpitations at this examination. Just as importantly, there is no indication the Veteran had cardiac problems to a compensable degree (meaning to at least 10-percent disabling) within this prescribed 1-year presumptive period following the conclusion of his service. 38 C.F.R. § 3.307 (a)(3), 3.309(a). So, to the extent, it may not be presumed that a cardiac disorder was incurred in service. There are no clinical records reflecting complaints, diagnosis or findings related to heart problems until December 2001 (according to a discharge summary from Nebraska Heart Hospital dated April 30, 2012, when diagnosed with paroxysmal atrial fibrillation). Just as significant, this is over 30 years after his military service ended. The United States Court of Appeals for the Federal Circuit has determined that such a lapse of time is a factor for consideration in deciding a service connection claim. Maxson v. Gober, 230 F.3rd. 1330, 1333 (Fed. Cir. 2000). Moreover, at that time, the Veteran did not attribute his cardiac problems to military service. In considering the third element, nexus, the record contains an October 2020 VA contract disability benefits questionnaire, wherein a physician noted the Veteran’s inservice history of reported dizziness which was related to a reaction to a shot. The examiner further noted that the Veteran’s heart examination was considered normal at separation. His pulse rate was normal at 80. Further, atrial fibrillation was not diagnosed until 41 year after service discharge. It was also noted that the medical studies indicate that the most common cardiac arrhythmia in adults over the age of 65 is atrial fibrillation, which etiology is unknown. The physician concluded that there was not ample evidence to support the claim for service connection. Therefore, the preponderance of the evidence is against a finding as to the third element of the Holton analysis as it pertains to the requirement of a nexus or link between the current disability and an event, injury or disease in service. There also is no other competent and credible opinion in the file refuting the VA examiner’s unfavorable opinion. The Veteran’s statements are insufficient to rebut this opinion given the complexity of cardiac disorders; he is not competent to comment on such matters. Secondary service connection As noted above, the Veteran also claims that his cardiac arrhythmia is related secondarily to non Hodgkins lymphoma and/or any medications taken for his service connected disabilities. Initially the Board notes that the Veteran’s claim for secondary service connection based on non-Hodgkins lymphoma fails, as service connection has been denied for this disability. The Veteran also claims that cardiac arrhythmia is caused by medication prescribed for service connected disabilities. The Veteran is service connected for hearing loss and tinnitus. Significantly, however, he has not identified any medications that are taken for these disabilities and the medical record does not support this contention. Moreover, the Veteran has neither provided nor identified any competent evidence showing such a nexus. Therefore, the Board finds that the evidence weighs against a finding that this disability is caused or aggravated by previously service-connected disability. For these reasons and bases, the preponderance of the evidence is against the claim for service connection on a direct or secondary basis. Since the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Service connection for erectile dysfunction As noted above, the Board remanded the claim for service connection for erectile dysfunction in November 2018 for VA examination and opinion. The VA contract examiner, in October 2020, determined that the Veteran’s erectile dysfunction was unrelated to military. Since then, in November 2018, the Veteran’s representative submitted a medical study that relates to the Veteran’s claim; “Chronic prostatitis and erectile dysfunction; results from a cross-sectional study.” Since the Veteran received inservice treatment for prostatitis, supplemental medical comment is needed. This matter is REMANDED for the following action: Provide the Veteran’s e-file to an appropriate medical examiner with the necessary expertise for supplemental comments (addenda) concerning the nature and etiology of erectile dysfunction. The examiner must opine whether erectile dysfunction is at least as likely as not related to an in-service injury, event, or disease, to include inservice treatment for prostatitis. The examiner should comment on the medical study “Chronic prostatitis and erectile dysfunction; results from a cross-sectional study;” submitted by the Veteran’s attorney on November 25, 2020. An examination is only required if deemed necessary by the examiner. Nathaniel Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.D. Jackson, 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.