Citation Nr: 21002668 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 18-29 747 DATE: January 14, 2021 ORDER Entitlement to service connection for a heart disability to include a heart murmur is denied. FINDING OF FACT The preponderance of the evidence is against finding a nexus between Veteran’s current heart disability and his active service. CONCLUSION OF LAW The criteria for service connection for a heart disability are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1960 to March 1962. In August 2019, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. This matter was previously remanded by the Board of Veterans Appeals (Board) in November 2019 for additional development. It now returns for further appellate review. After completing the requested development on remand, the VA notified the Veteran and his representative that the appeal was being returned to the Board and the Veteran had 90 days to change representation or submit additional argument or evidence. See December 2019 Board Letter. To date, no further argument or evidence has been received. As such, the Board notes that the Veteran and his representative were given an opportunity to present additional argument. 1. Service connection The Veteran contends that his heart murmur was caused by an allergic reaction to an immunization for cholera which required him to be hospitalized for three days during active service. See Hearing Transcript. Legal Criteria Service connection may be granted for any current disability that is the result of a disease contracted or an injury sustained in the line of duty during active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for a disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). Relevant Facts and analysis The evidence of record confirms that the Veteran was diagnosed with heart disabilities including heart murmur, atrial fibrillation, and aortic valve stenosis. See December St. Thomas Moore Hospital Private Echocardiography Report; January 2020 VA Heart Conditions Disability Benefits Questionnaire (DBQ). Thus, the first element of service connection, a current disability, has been satisfied. The second element of service connection, an-inservice occurrence, has also been satisfied. In this regard, the Veteran asserted in lay statements and in his March 2017 Notice of Disagreement that his heart murmur was caused by an allergic reaction to an inoculation for cholera he received during active service. The Veteran’s service treatment records (STRs) confirm that the Veteran was inoculated with Bicillin injection in March 1960. See March 1960 Health Record Note in STR-Medical. Twenty days letter the Veteran was treated for complaint of chills and fever due to cholera immunization the day before. Id. He was assessed with systemic reaction to immunization. Id. Treatment records from Fort Carson Army Hospital confirmed that the Veteran was hospitalized for one week in March 1960 due to allergic reaction to Bicillin manifested by generalized urticaria and fever. See March 1960 Fort Carson Army Hospital Clinical Record. A chest X-ray taken during the inpatient treatment at Fort Carson Army Hospital was negative. See Fort Carson Army Hospital Radiographic Report. The February 1962 separation examination indicates a diagnosis of cardiac murmur, grade I, systolic, probably functional. See February 1962 Report of Medical Examination. Thus, the lay and medical evidence demonstrates that the Veteran was treated for an allergic reaction to Bicillin and was diagnosed with a heart murmur at the time of discharge. As the first and second elements of service connection have been met, the issue for the Board is whether there is a nexus between Veteran’s current heart disabilities and his in-service allergic reaction to Bicillin or diagnosis of heart murmur. On this issue, the VA obtained three medical nexus opinions including in December 2016, February 2017, and most recently in January 2020. The December 2016 VA examiner assessed the Veteran with functional murmur (FM). Id. He opined that “[i]t is medically clear that the Veteran’s 3/1961 shot-induced allergic fever did NOT produce the FM identified at the time of the discharge [physical examination].” See December 2016 VA Medical Opinion DBQ. However, the Board found this medical opinion was inadequate in its November 2019 Board remand in part because the examiner failed to provide an etiology for the Veteran’s heart murmur and because the examiner indicated the Veteran’s cardiac records should be obtained. In February 2017, another VA medical opinion was accomplished by the same VA examiner from December 2016. See February 2017 VA Heart Conditions DBQ. The examiner was unable to provide an etiology for the Veteran’s mild right hypertrophy and mild arterial dilation. Accordingly, the Board remanded the claim for a new VA examination and medical opinion. See November 2019 Board Remand. Pursuant to the Board, the VA obtained a VA examination and medical opinion in January 2020. See January 2020 VA Heart Conditions DBQ. The January 2020 VA examiner provided a negative nexus opinion for the Veteran’s current heart disabilities. See January 2020 VA Medical Opinion DBQ. Specifically, the examiner stated that the Veteran’s “current heart murmur is less likely than not related to the functional murmur in March 1962.” Id. She further noted that the etiology of the 1962 murmur was unknown. She also concluded that the Veteran’s current murmur was not related to his allergic reaction to cholera immunization in March 1961 because “there is no evidence of diagnosis of a hear[t] murmur in the remainder of 1961.” The examiner also noted that the Veteran was first diagnosed with aortic stenosis in 2016 and that it was “caused by progressive wear and tear of the aortic valve, not allergic reactions.” Id. The Board finds that the January 2020 VA examination opinions are probative, because they are based on an accurate medical history and provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The opinions also consistently found that the Veteran’s heart disabilities disability was not related to active service to include his allergic reaction to Bicillin and the 1962 diagnosis of heart murmur. Importantly, this medical opinion is uncontroverted by any medical evidence of record. The Board acknowledges the Veteran’s competent and credible lay statements regarding the symptoms he experienced. Although the Veteran believes his current heart disabilities are related to an in-service allergic reaction to Bicillin and the 1962 diagnosis of heart murmur, his lay statements are not competent for the purpose of establishing a nexus. The Veteran in this case is not competent to provide a nexus opinion regarding this issue.  The etiology of his heart disabilities is medically complex and falls outside the realm of common knowledge of a lay person.  Essentially, the record does not demonstrate that the Veteran has any special training or acquired any medical expertise in evaluating that his heart disability was caused by his allergic reaction to Bicillin and the 1962 diagnosis of heart murmur. See King v. Shinseki, 700 F.3d 1339, 1345 (2012).  Consequently, the Board gives more probative weight to the January 2020 VA medical opinion. Thus, based on the foregoing, the Board finds that the evidence fails to establish a nexus between the Veteran’s current disabilities and his active service. Therefore, the third element of service connection has not been met. The Board is grateful to the Veteran for his service, and regrets that it cannot render a favorable decision in this matter. However, as the preponderance of the evidence weighs against a finding that the Veteran’s current heart disabilities are related to his service the claim for service connection for the Veteran’s current heart murmur, atrial fibrillation, and aortic valve stenosis must be denied.  Gilbert v. Derwinski, (1990). (Continued on the next page) YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Lilly, 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.