Citation Nr: 21061392 Decision Date: 10/01/21 Archive Date: 10/01/21 DOCKET NO. 14-35 405 DATE: October 1, 2021 ORDER Entitlement to service connection for a chest disability is denied. FINDING OF FACT The evidence does not show that the Veteran's current cartilage injury is related to an in-service chest injury, and/or that it is otherwise related to his active service. CONCLUSION OF LAW The criteria for service connection for a chest disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from April 1975 to February 1976. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office in Boston, Massachusetts. In September 2018, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of this hearing is of record. In October 2020 and April 2021, the Board remanded the case to the Regional Office for further evidentiary development. As the matter has returned to the Board for adjudication, the Board finds that the requested evidentiary development is in substantial compliance with the Board's remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that as a matter of law, a Board remand affords a veteran or other claimant the right to substantial compliance with the remand order). Service Connection for a Chest Disability Service connection may be granted for a disability resulting from a disease or injury incurred in, or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. That determination requires a finding of a current disability that is related to an injury or disease in service. Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). Generally, to establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313(Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). The Veteran asserts entitlement to service connection for a chest disability due to the residuals of an in-service chest injury. See September 2018 Videoconference Hearing Transcript. At his videoconference hearing, the Veteran testified that his chest injury resulted from his active duty, in his capacity as a tank crew member. He also indicated that over the course of the week, he started feeling better. However, he clarified that he noticed that there were times when he coughed, sneezed, or was forced to take a deep breath, his heart started fluttering, which caused him to think he was having heart attacks, and thus, at that point, he started going to the doctor. Additionally, the Veteran also explained that it is his belief that he sustained injuries to his cartilage, between the breastplate and the ribs. Service treatment records (STRs) do not show, however, that the Veteran sustained a chest injury from any accident or other event, nor do they reflect any complaints and/or treatment for a chest injury. In a February 1976 report of medical history for separation from service, the Veteran reported that he was in excellent health, and he did not report having a history of chest conditions, despite reporting his history of other conditions. Similarly, a February 1976 report of examination for separation from service does not indicate that the Veteran had any conditions related to his chest or the in-service chest injury. The fact that he sought treatment for other conditions in service for several other ailments but not for any chest injury, weighs against the credibility of any statements that the disorder persisted since discharge. See AZ v. Shinseki, 731 F.3d 1303 (Fed. Cir. 2013) (recognizing the widely held view that the absence of an entry in a record may be considered evidence that the fact did not occur if it appears that the fact would have been recorded if present). Post-service treatment records indicate that the Veteran complained of chest pains, and that he is diagnosed with atrial fibrillation, well after his separation from service. See e.g. September 2013 Hospital Discharge Summary, Private Treatment Records; see also June 2019 H & P Note (assessing the Veteran's condition as atypical chest pain). Additionally, the medical opinion evidence is against the claim. In July 2021, the Veteran was afforded a VA examination for muscle injuries. However, the VA examiner found that the Veteran does not have a diagnosed muscle injury. The VA examiner noted that the Veteran reported that he sustained an intercostal cartilage injury to his rib cage when the butt of a gun was lifted and pressed down to his chest, and that consequently, his sternum was injured. The VA examiner further noted that the Veteran clarified that he did not go to sick call immediately because his colleagues gave him grief. The VA examiner explained that the Veteran reported that he feels pain when coughing, sneezing, reaching the wrong way, and that he feels like a he is having a heart attack, which makes him go into muscle spasms that feel similar to atrial fibrillation. On physical assessment, the VA examiner found that the Veteran did not have, nor has he ever had, an injury to any muscle group, especially including the torso and neck. Although the VA examiner found that the Veteran does not have any documented muscular injury, however, he found that the Veteran has an intercostal cartilage injury. Further, he remarked that other diagnostic studies of the chest/abdomen indicate a 2013 CXR which reflects RUL granuloma that has been stable since a 2003 diagnosis; a September 2019 EKG which reflects a diagnosis of atrial fibrillation with "RVR and L anterior fascicular block"; a previous September 2019 EKG that reflected normal sinus rhythm (NSR); a 2018 CTA that reflected negative chest results; and a 2013 exercise stress test that showed no anginal symptoms or significant "ST segment changes", with good exercise tolerance. See July 2021 VA Examination Report. In a July 2021 VA opinion, the VA examiner opined that the Veteran's chest disability is less likely than not (less than 50 percent probability) incurred in or caused by an in-service injury, event, or illness. As the rationale for this opinion, the VA examiner explained that during service, the Veteran's chest disability was acute; there is no evidence of chronicity of care; and that his symptoms are subjective only. Further, the VA examiner explained that the Veteran did not begin to note episodes of chest pain and symptoms of atrial fibrillation until many years after his in-service crushing injury; the Veteran's recent recurrent emergency room visits for chest pain had inconsistent presentations, sometimes including associated dizziness, shortness of breath, or radiating pain. Thus, the VA examiner also concluded a lack of chronicity and inconsistent presentation of symptoms make it less likely than not that his current chest disability is related to his in-service intercostal cartilage injury. In an August 2021 appellate brief, the Veteran asserted that his medical treatment records reflect a history of treatment for chest issues, which do not address the etiology of his claimed condition; and specifically, that the VA examiner failed to provide an etiology of the claimed chest disability. However, the Board clarifies that in rendering a negative nexus opinion, a VA examiner is not required to provide an alternative etiology for the Veteran's disability. Rather, a VA examiner is only required to render an adequate opinion, which must be based on a consideration of the Veteran's prior medical history and examinations; and additionally, describes the disability in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one. Barr v. Nicholson, 21 Vet App. 303, 311 2007) (citing Ardison v. Brown, 6 Vet. App. 405, 407 (1994); and Green v. Derwinski, 1 Vet. App. 121, 124. In this regard, the Board finds that the above-mentioned VA examination is adequate as it is based on the VA examiner's evaluation of the Veteran's medical history, to include a review of the Veteran's STRs and post-service treatment records; the VA examiner clearly identified the Veteran's current chest related conditions and/or associated disabilities; he contemplated the Veteran's lay statements about the onset of his injury; and he provided a clear rationale to support his opinion. The Veteran has not submitted any other evidence, such as, for example, private treatment records from that period of service, and/or any other documentation to show that his chest injury resulted in residuals, including chronic or recurring chest pains, and/or a diagnosis of atrial fibrillation. Therefore, the Board also finds that the preponderance of the evidence is against this claim and thus, service connection for a chest disability must be denied. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V-N. Pratt 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.