Citation Nr: 21002265 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 13-15 467 DATE: January 13, 2021 ORDER Entitlement to service connection for a cardiac condition (to include claimed as coronary artery disease, congestive heart failure, and cardiomyopathy), claimed secondary to Agent Orange exposure, is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record indicates the Veteran has a diagnosis of alcohol induced (and nonischemic) cardiomyopathy; the Veteran does not have ischemic heart disease or coronary artery disease. 2. The Veteran’s cardiomyopathy was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; the disability is not presumptively associated with Agent Orange exposure; and the disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a cardiac condition are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Marine Corps from May 1971 through March 1973, to include service in the Republic of Vietnam. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a rating decision dated no later than September 2011 issued by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in December 2018 and again in August 2020 when it was remanded for additional development. The Veteran’s claims file was previously lost and has been reconstructed, Unfortunately, the Veteran’s initial claim for a heart condition has not been recovered. In order to give the Veteran the benefit of the doubt and adjudicate his claim as fairly as possible, the Board previously construed the Veteran’s claim to include a claim for service connection of any cardiac condition (to include coronary artery disease, congestive heart failure, and cardiomyopathy). See Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009). The Board finds there was substantial compliance with the August 2020 remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board has limited the discussion below to the relevant evidence required to support is finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545 552 (2008). Entitlement to service connection for a cardiac condition (to include coronary artery disease, congestive heart failure, and cardiomyopathy) is denied. The Veteran contends that he was exposed to herbicide agents while serving on active duty during the Vietnam era, resulting in a current heart-related condition. As will be discussed more thoroughly below, the matter was remanded twice before by the Board to clarify the nature of the Veteran’s heart-related condition. The Veteran’s service in Vietnam is not in dispute and, therefore, he is presumed to have been exposed to Agent Orange herbicides. See 38 C.F.R. § 3.307. Only ischemic heart diseases (such as coronary artery disease), however, are presumptively associated with Agent Orange herbicide exposure. The record was unclear whether the Veteran’s heart condition was ischemic in nature or not. Based on the development, however, the Board concludes the Veteran does not have a cardiac condition presumptively associated with Agent Orange exposure and the preponderance of the evidence is against any other nexus to service. Thus, the Veteran’s claim must be denied. Service connection may be granted for a disability resulting from personal injury suffered or disease contracted in the line of duty, or for the aggravation of a pre-existing injury or disease in the line of duty. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing a service connection generally requires (1) evidence of a current disability, (2) an in-service incurrence or aggravation of an injury or disease, and (3) a causal connection or “nexus” between the claimed in-service injury or disease and the current disability. Shedden v. Principi, 381 F.3d. 1163, 1166-67 (Fed. Cir. 2004). Alternatively, service connection may also be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) the existence of a chronic disease in service or during an applicable presumption period under 38 C.F.R. § 3.307 and (ii) present manifestations of the same chronic disease, or (b) when a chronic disease is not present during service, evidence of continuity of symptomatology. The provisions of 38 C.F.R. § 3.303(b) relating to continuity of symptomatology can be applied only in cases involving those conditions explicitly recognized as chronic under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Additionally, VA regulations provide that certain disease associated with exposure to herbicide agents may be presumed to have been incurred in service even if there is no evidence of the disease in service, provided the requirements of 38 C.F.R. § 3.307(a)(6) are met. 38 C.F.R. § 3.309(e). However, should a veteran be found not to be entitled to a regulatory presumption of service connection for a given disability, the claim must nevertheless be reviewed to determine whether service connection can be established on another basis. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994). The Veteran served in the Republic of Vietnam while on active duty in 1972, and while there, he was exposed to herbicide agents. The records obtained for the Veteran do not show any heart related issues or injuries during his time on active duty, or within one year of leaving service. The Veteran’s medical records show some inconsistencies about which heart conditions the Veteran was diagnosed with and when he was diagnosed. The service treatment records included in the claims file show no in-service injuries, issues, or treatments for any cardiac conditions. VA treatment records as early as 1987 indicate occasional complaints of chest pain. On or around December 2000, the Veteran started receiving regular treatment for a cardiac condition variously characterized. Stress tests and EKGs for ischemic heart disease had negative results. A February 2001 cardiac catherization revealed “normal” coronary arteries. A repeat procedure in 2005 revealed essentially the same results. Largely, the Veteran’s condition was characterized as “nonischemic cardiomyopathy” and typically noted as “alcohol induced.” Occasionally, however, VA outpatient treatment records from 2006 to 2013 mention a diagnosis of coronary artery disease. Further adding to confusion, an October 2010 VA examination inconsistently notes, on the one hand, a “history” of ischemic heart disease, but on the other hand, opined that the Veteran had alcohol-induced cardiomyopathy and chronic heart failure, and did not (and never had) coronary artery disease or any ischemic heart disease. In order to resolve this ambiguity, the Board remanded the matter twice for supplemental VA medical opinions, obtained in September 2019 and September 2020. In both medical opinions the examiner found the Veteran had nonischemic cardiomyopathy presumed secondary to alcohol and chronic congestive heart failure. In the September 2020 addendum opinion (which was provided by the same VA examiner who rendered the September 2019 opinion), the examiner elaborated finding that none of the Veteran’s cardiac conditions were caused by herbicide exposure or any other incident of his military service. The examiner explained that upon review of all the records, the Veteran never complained of any heart-related symptomatology in service or for years thereafter and there was no evidence of heart disease in service. The Veteran’s medical history and current pathology is not consistent with ischemic heart disease. Rather, the Veteran has cardiomyopathy, which the examiner opined was alcohol induced. The examiner further highlighted the fact that in 2001, the Veteran’s cardiac cath demonstrated normal coronaries. The Board finds the VA examinations and medical opinions taken together to be persuasive and conclusive. There is no doubt left in the record that the Veteran does not have an ischemic heart disease, but rather has cardiomyopathy and congestive heart failure, neither of which are presumptive conditions associated with Agent Orange exposure. See 38 C.F.R. § 3.309(e). None of the medical evidence, moreover, links these diagnoses to the Veteran’s military service. Indeed, the examiners all consistently opine to the contrary. While the Veteran may sincerely believe his heart condition is related to in-service Agent Orange exposure or some other in-service event or injury, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical knowledge. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. (Continued on the next page)   Accordingly, the Board finds service connection for a cardiac condition is not warranted. The claim is denied. Shereen M. Marcus Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Boivin, 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.