Citation Nr: 21062459 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 17-27 014 DATE: October 7, 2021 ORDER Entitlement to service connection for coronary artery disease (CAD), also claimed more generally as heart disease and residuals of a heart attack, is denied. FINDING OF FACT The Veteran's CAD did not incept during his service or within one year of his separation from service, and there is no probative (competent and credible) indication his CAD is otherwise related or attributable to his service. CONCLUSION OF LAW The criteria are not met for entitlement to service connection for CAD. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1973 to October 1993. This appeal to the Board of Veterans' Appeals (Board) is from a January 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In February 2021, the Veteran testified in support of this claim during a "virtual" teleconference hearing before the undersigned Veterans Law Judge of the Board. A transcript of the hearing is of record. In April 2021, the Board remanded this claim back to the RO (Agency of Original Jurisdiction (AOJ)) for further development and consideration including obtaining supplement medical comment concerning the etiology of the Veteran's CAD, particularly in terms of whether related or attributable to his military service. There since has been the required compliance, certainly the acceptable substantial compliance, with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions); but see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only "substantial" rather than strict or exact compliance with the Board's remand directives is required under Stegall); accord Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Entitlement to service connection for CAD, also claimed more generally as heart disease and residuals of a heart attack The Veteran argues that his heart condition, resulting in a heart attack in 2014, is the culmination of the chest pains he first experienced during his service. He also asserts that his CAD is related to his precursor hypertension. Service connection is granted for disability resulting from disease or injury incurred in or aggravated by active military service in the line of duty. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or an injury; and (3) a causal relationship ("nexus") between the current disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Certain "chronic" diseases, including CAD, will be presumed related to service if they were shown as chronic in service, or if they manifested to a compensable degree (generally meaning to at least 10-percent disabling) within a year following separation from service, or if they were noted in service with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a). See also Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015). Service connection may be granted, as well, on a secondary basis for disability that is proximately due to, the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310(a) and (b). See also Allen v. Brown, 7 Vet. App. 439 (1995). To show this correlation, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). At the onset, although, as mentioned, this claim is partly predicated on the notion that the Veteran's CAD is related to his hypertension, his hypertension has not been determined to be a service-connected disability. In fact, to the contrary, the Board already denied his claim for service connection for hypertension in April 2021, when instead remanding this claim for CAD. Consequently, he cannot attribute his CAD to his service secondarily by way of his hypertension since his hypertension, itself, has not been attributed to his service. Turning next, then, to whether the Veteran's CAD is directly or presumptively related to his service, the Board also finds that it is not. The Veteran first received a diagnosis of CAD in February 2012, so nearly 19 years after conclusion of his service in October 1993, therefore even well beyond the one-year presumptive period immediately following his service. Moreover, although his service treatment records (STRs) show complaints of chest pain associated with coughing in August 1984, the diagnosis was a simple head cold. His STRs do not otherwise reveal any complaint, treatment, or diagnosis of CAD or other heart-related ailment or disorder of any sort. The Board nonetheless remanded this claim back to the RO in April 2021 for supplemental medical comment (an addendum opinion) concerning the origins of the Veteran's CAD, especially in terms of whether it onset during his service, within a year of his discharge, or is otherwise related or attributable to his service, including to the chest pains he had in service. To this end, the Veteran underwent a VA examination in May 2021. The examiner determined the Veteran's CAD most likely was caused by his high cholesterol, age, and hypertension and less likely than not caused by his service. This VA examiner reasoned that, while the Veteran reports chest pain during his service, there were no suspicions or concerns for a cardiac condition. This VA examiner also pointed out the separation examination was unremarkable for complaint or indication of chest pain and that an electrocardiogram (EKG) in 1993, so that same year, showed no myocardial infarction (MI), i.e., heart attack. Still further, this VA examiner noted that tests showed elevated cholesterol in 1993. A finding of high cholesterol or hyperlipidemia is a mere laboratory finding, and laboratory test results are not in and of themselves disabilities. See 61 Fed. Reg. 20440, 20,445 (May 7, 1996) (supplementary information preceding Final Rule amending the criteria for evaluating endocrine system disabilities indicates that diagnoses of hyperlipidemia, elevated triglycerides, and elevated cholesterol are mere laboratory test results and are not, in and of themselves, disabilities). Moreover, while this VA examiner acknowledged that a more recent EKG in 2011 showed prior MI, that was not confirmed on subsequent stress test in 2012. This VA examiner explained that the causes of CAD include arteriosclerosis from high cholesterol and the Veteran is documented to have high cholesterol. Thus, there was not the required association of the Veteran's CAD with his military service. The Board therefore finds that entitlement to service connection for CAD is not established. There is not the required probative indication this disease initially manifested during the Veteran's service from October 1973 to October 1993 (even when considering his complaint of chest pain in service), or that it initially manifested to the required compensable degree of at least 10-percent disabling within a year of his discharge from service so by October 1994, to in turn warrant presuming it was incurred during his service, or that it is otherwise shown to be related or attributable to his service (even if not until later diagnosed). See 38 C.F.R. § 3.303(d). An opinion based on the mere absence of treatment records, both contemporaneous to or even in the years since the alleged event(s) in service, without consideration of a Veteran's competent reports as concerning the continuing experiencing of symptoms is inadequate. Dalton v. Nicholson, 21 Vet. App. 23 (2007). Indeed, in Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006), the U. S. Court of Appeals for the Federal Circuit (Federal Circuit Court) recognized lay evidence as potentially competent to support the presence of the claimed disability, both during service and since, even where not corroborated by contemporaneous medical evidence such as actual treatment records. The Federal Circuit Court went on to indicate in Buchanan, however, that the Board retains the discretion to make credibility determinations and otherwise weigh the evidence submitted, including lay evidence. See also Bardwell v. Shinseki, 24 Vet. App. 36 (2010) (indicating that, for non-combat Veterans providing non-medical related testimony regarding an event during service or where the event in question is not claimed to have occurred in combat, Buchanan is distinguishable; the lack of documentation in service records must be weighed against the Veteran's statements). The Federal Circuit Court has recognized the Board's "authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other items of evidence." Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). The Board has considered the Veteran's statements regarding the etiology of his CAD in relation to his service. But, although lay persons are competent to provide opinions on some medical issues, as to the specific issue in this case, a nexus between the Veteran's CAD and service is outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007) (lay persons not competent to diagnose cancer). Moreover, a VA medical examiner has explained that the Veteran's CAD has known causes and risks (including high cholesterol and hypertension) and, therefore, is less likely than not attributable to his service. As the preponderance of the evidence is against a finding that he has CAD owing to his service, service connection for CAD is denied. See King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012) (indicating lay evidence must demonstrate some competence and affirming the Court's conclusion that the Board did not improperly discount the weight of a lay opinion in finding a medical expert's opinion more probative on the issue of medical causation). KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Hamm, 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.