Citation Nr: 21004873 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 13-26 038 DATE: January 28, 2021 ORDER Entitlement to service connection for a heart condition is denied. Entitlement to service connection for a sleep apnea (claimed as a sleep disorder) is denied. FINDINGS OF FACT 1. The preponderance of the evidence establishes the Veteran’s heart conditions were not present until more than one year following his discharge from service and is not etiologically related to his active service 2. The preponderance of the evidence establishes the Veteran’s sleep apnea was not present until more than one year following his discharge from service and is not etiologically related to his active service CONCLUSIONS OF LAW 1. The criteria for establishing entitlement to service connection for a heart condition have not been met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for establishing entitlement to service connection for a sleep disorder have not been met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from August 1969 to August 1999. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2016 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). When this case was last before the Board in July 2019, it was remanded for additional development. Specifically, the RO was instructed to obtain medical opinions regarding the etiology of the Veteran’s claimed disabilities. The Veteran was provided with the relevant examinations. As such, the Board finds that the AOJ substantially complied with the directives in the July 2019 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection—Legal Criteria Establishing service connection generally requires 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. See Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). In this case, the Board has reviewed all of the evidence of record, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence where appropriate and the Board’s analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. Heart Conditions The Veteran is seeking service connection for a heart disability which he claims is etiologically related to his active duty service. The Veteran has current diagnoses of coronary artery disease (CAD), supraventricular arrhythmia, heart block, diastolic dysfunction and status post 2V CABG. See February 2020 VA Heart Conditions examiner’s report. The Board notes that the Veteran was evaluated for chest pain in service. However, the Veteran’s service treatment records (STRs) contain no complaints, treatment, or diagnoses of cardiac conditions. There are no treatment records for these conditions while the Veteran was in service, and no medical examiner has given an opinion linking the Veteran’s current heart conditions to his service. Additionally, the Veteran was not diagnosed with any heart conditions until 2015, approximately 16 years after the Veteran’s separation from active duty service. The Veteran’s private treatment records indicate that he has been diagnosed with, and treated for, CAD. However, they do not provide a nexus for the Veteran’s cardiac conditions. Recently, the Veteran was afforded a November 2019 VA Acceptable Clinical Evidence (ACE) review for his claimed heart conditions. The reviewer opined that it was less likely than not (less than a 50 percent probability) that the Veteran’s heart conditions were etiologically related to his active duty service. The rationale provided was that the Veteran was seen in service for acute chest pain which resolved in service. Further, the reviewer noted that the Veteran’s chest pain in service was related to coughing from an upper respiratory infection with no cardiac component to the pain. The reviewer noted that the Veteran’s ECGs in service were normal and there is no evidence of cardiac disease or chronic cardiac conditions. Finally, the reviewer noted that the Veteran had a stress test in 2012 which was normal, with no evidence of CAD in 2012. The Veteran was diagnosed with CAD in 2015, 16 years after leaving service, there is no nexus to service, and no onset of cardiac disease in service. The Veteran was next provided with a January 2020 Heart Conditions examination. After an in-person examination, and a thorough review of the evidence, the examiner opined that the Veteran’s claimed heart conditions are less likely than not (less than a 50 percent probability) etiologically related to his active duty service. The rationale provided was that the Veteran was first diagnosed with heart disease in 2015. The examiner noted that a prior cardiac workup in 2012 was normal. Additionally, the examiner continued, during his active duty the Veteran was evaluated for chest pain 3 times. The first time he was evaluated and was diagnosed and treated for costochrondritis. The second time, he reported feeling sweaty and lightheaded with nausea and was diagnosed with gastroenteritis. The examiner noted that these events were acute in onset, self-limited, and resolved; with neither associated with a cardiac diagnosis. The third time the Veteran reported pain in service was associated with a 3-month history of an upper respiratory tract infection and nasal congestion. Multiple EKGs that were completed prior to the Veteran’s separation time, all were reported as normal. The examiner concluded that given the above information, there is no evidence to suggest that the Veteran’s cardiac condition, which was first diagnosed in 2015 had an onset during his active duty service. The Board weighs the above-mentioned VA examinations against the Veteran’s lay statements in support of his claim. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno 6 Vet. App. at 469. However, the Veteran is not competent to offer an opinion as to the etiology of his current disorders due to the medical complexity of the matter involved. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462. The Veteran indicated that the VA examiner’s opinions were not facts, that he believes his heart conditions are related to active service, and that he should be granted service-connection for cardiac conditions based on equipoise. The lay statements regarding the Veteran’s heart conditions being related to service are not competent as the Veteran is not medically qualified to provide evidence regarding matters requiring medical expertise, such as an opinion as to etiology. As such, the Board finds the VA examinations, which opined against a link between the Veteran’s heart disabilities and his service, to be of high probative value. The examiners reviewed the entire claims file, examined the Veteran, and took into account the Veteran’s competent lay statements. As such, the Board affords the VA examiners’ medical opinions great weight. Thus, the probative evidence of record preponderates against the Veteran’s claim for service connection for his heart disabilities. In light of the above discussion, as there is no evidence that the Veteran sought treatment for these alleged conditions while in service and there is no medical opinion in the record linking his current heart conditions to his active duty service. The evidence fails to show that the Veteran’s heart conditions were etiologically related to his active duty service. Therefore, the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable to this claim because the preponderance of the evidence is against the claim. Sleep Apnea The Veteran is seeking service connection for sleep apnea which he claims is etiologically related to his active duty service. The Veteran has a current diagnosis of sleep apnea. See January 2020 VA Sleep Apnea examiner’s report. However, the Veteran’s STRs contain no complaints, treatment, or diagnosis of this condition. There are no treatment records for this condition while the Veteran was in service, and no medical examiner has given an opinion linking the Veteran’s current sleep apnea to his service. The Board notes that the Veteran was treated for snoring in active duty service, however, his snoring was indicated as due to his deviated nasal septum. Additionally, the Veteran was not diagnosed with a sleep apnea condition until 2015, approximately 16 years after his separation from active duty service. The Veteran was afforded a February 2016 VA Sleep Apnea examination. The examiner opined that it was less likely than not (less than a 50 percent probability) that the Veteran’s sleep apnea was etiologically related to active duty service. The rationale provided was that while the Veteran complained of snoring during service in 1988, he was noted to have a left nasal septal deviation. Additionally, the examiner noted that the Veteran had a sleep study in 2012 which came back as normal, and the Veteran’s current sleep apnea is due to advancing age, a large neck size, weight gain, and being overweight. The examiner concluded that the Veteran’s sleep apnea has no relationship to his in-service snoring or to his service. In November 2019, the Veteran was provided with an ACE review regarding his sleep apnea claim. The reviewer opined that it was less likely than not (less than a 50 percent probability) that the Veteran’s sleep apnea was etiologically related to his active duty service. The reviewer noted the Veteran’s in-service report of snoring, however related his snoring to his deviated septum and nasal valve weakness. The reviewer noted that the Veteran had no diagnosis of sleep apnea in service and had a 2012 sleep study which was normal. The reviewer further noted that that Veteran was first diagnosed with sleep apnea in August 2015, 16 years after leaving service. Finally, the reviewer concluded that the Veteran did not have sleep apnea in service, and his current sleep apnea is due to advancing age, increased weight, and a large neck; the reviewer continued that the Veteran’s sleep apnea developed after 2012 and there is no nexus to active duty service. Most recently, the Veteran was provided with a January 2020 VA Sleep Apnea examination. After an in-person examination, and a thorough review of the evidence, the examiner opined that the Veteran’s sleep apnea condition is less likely than not (less than a 50 percent probability) etiologically related to his active duty service. The rationale provided was that the Veteran was first diagnosed with sleep apnea following a positive sleep study in 2016, while a prior sleep study completed in 2012 was negative for findings of sleep apnea. Regarding the Veteran’s snoring in service, and the reports of the Veteran’s wife about his snoring, the examiner reported that the Veteran was diagnosed with a deviated septum in the military. The examiner explained that snoring is one of the many symptoms associated with a deviated septum and likely responsible for the Veteran’s symptoms during active duty. The examiner continued that despite having similar symptoms of snoring, the etiologies for sleep apnea and a deviated septum are separate and distinct. Therefore, taking into consideration the negative sleep study in 2012 and the likely etiology of the Veteran’s snoring during his active duty, the examiner concluded that it is less likely than not (less than a 50 percent probability) that the Veteran’s sleep apnea was present prior to the diagnosis in 2016 or during his active duty during service. The Board weighs the above-mentioned VA examinations against the Veteran’s lay statements in support of his claim. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno 6 Vet. App. at 469. However, the Veteran is not competent to offer an opinion as to the etiology of his current disorders due to the medical complexity of the matter involved. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462. The Veteran stated that the VA examiner’s opinions did not say that his sleep apnea was 100 percent not caused by his active duty service, and that the VA examiner’s opinion is just an opinion. Further the Veteran stated that in his opinion his sleep apnea is related to service, and he should be granted service connection based on equipoise of the opinions involved. The lay statements regarding the Veteran’s sleep apnea being related to service are not competent as the Veteran is not medically qualified to provide evidence regarding matters requiring medical expertise, such as an opinion as to etiology. Given the above, the Board finds the VA examinations, which opined against a link between the Veteran’s sleep apnea and his service, to be of high probative value. The examiners reviewed the entire claims file, examined the Veteran, and took into account the Veteran’s competent lay statements. As such, the Board affords the VA examiners’ medical opinions great weight. Thus, the probative evidence of record preponderates against the Veteran’s claim for service connection for his heart disabilities. In light of the above discussion, as there is no evidence that the Veteran sought treatment for this alleged condition while in service and there is no medical opinion in the record linking his current sleep apnea to his active duty service. The evidence additionally shows that the Veteran was first diagnosed with this condition 16 years after active duty service. Therefore, the claim must be denied. In reaching this decision, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable to this claim because the preponderance of the evidence is against the claim. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Gresham 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.