Citation Nr: 21063602 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 15-02 365 DATE: October 14, 2021 ORDER Service connection for aortic insufficiency is granted. FINDING OF FACT The Veteran's aortic insufficiency had its onset during service. CONCLUSION OF LAW The criteria for service connection for aortic insufficiency are 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 from July 1985 to April 1988 and from January 1993 to May 1993, with additional service in the Army National Guard. The case is on appeal from a June 2014 rating decision. In April 2018, the Veteran testified at a Board hearing. Most recently, in April 2021, the Board remanded the claim on appeal for additional development. Service connection for aortic insufficiency. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Analysis The Veteran contends that he has aortic insufficiency due to military service. In this regard, during the April 2018 Board hearing, the Veteran reported struggling with physical fitness testing during his active duty service. He also reported being advised he should end his National Guard service due to a heart condition, but that he was allowed to continue such service for several years thereafter. During the April 2018 Board hearing, the Veteran reported experiencing reduced stamina due to this condition. After being discharged from active duty in both April 1988 and May 1993, the Veteran served in the Army National Guard. In July 1994, the Veteran was treated for strep throat and heart symptoms. In August 1994, a cardiology consultation found that the Veteran had a bicuspid aortic valve and dilated aortic root. Thereafter, in December 1995, the Veteran was treated by a private medical facility for shortness of breath, dyspepsia, weakness, and fatigue following a two mile training run. Later that month, he was diagnosed with a bicuspid aortic valve, reduced left ventricular ejection, and a prolapsed aortic leaflet resulting in moderately severe aortic insufficiency. A periodic service examination in July 1996 noted that the Veteran has an aortic condition. Subsequently, in October 1996, a medical duty review board recommended that he be found unfit for retention in the National Guard. However, the Veteran remained in the National Guard and was placed on profile limiting his required physical fitness training. He underwent surgery to replace an aortic heart valve in December 1998. During later periods, he performed physical training of walking 2.5 miles in February 2000, October 2001, and April 2003. However, a May 2003 medical retention board found that continued periods of active duty for training (ACDUTRA) may aggravate the Veteran's heart condition and place him at unnecessary risk. Subsequently, the Veteran completed another 2.5 mile physical training walk in October 2003. The Veteran served in the National Guard through January 2005. The Veteran was afforded a VA examination in regard to this claim in October 2007 in connection with the original claim. The examiner noted the date of onset of aortic insufficiency as 1994 and that an aortic valve replacement was done in December 1998. The examiner found the Veteran's aortic insufficiency was not aggravated by military service. Pursuant to the July 2018 Board remand, the Veteran was afforded another examination in March 2019 performed by a registered nurse. The Veteran reported experiencing dizziness and shortness of breath with exertion. The registered nurse found that the Veteran's aortic insufficiency had its onset in 1994 and is a progression of a congenital aortic valve defect. She also found that the condition was not related to his ACDTURA service. Pursuant to the July 2019 Board remand, the Veteran was afforded another examination in March 2020. However, the examiner did not provide sufficient rationale for his findings and concluded that the Veteran has not had symptoms since service without considering the Veteran's reports of symptoms during the appeal period. Pursuant to an April 2021 Board remand, another medical opinion was obtained in June 2021. The opinion was provided by a cardiologist. The cardiologist found that it is at least as likely as not that the Veteran's aortic insufficiency is not a congenital condition and that it had its onset during active duty service. He explained that the Veteran did not experience aortic insufficiency symptoms or objective findings prior to entrance into service. He also explained that the Veteran first experienced symptoms of aortic insufficiency during active duty service and found that the condition was first diagnosed during an August 1994 echocardiogram. He further explained that the Veteran's current aortic insufficiency is a continuation of the same disease process diagnosed in 1994. In July 2021, the RO asked the cardiologist for an addendum opinion. The RO asked him to categorize aortic insufficiency as either a congenital disease or a congenital defect. As the cardiologist was given only those two options, he indicated that it would be a congenital disease because under the applicable definitions congenital diseases, unlike congenital defects, are considered capable of getting better and worse. The Board finds that the evidence is at least in equipoise as to whether the Veteran's aortic insufficiency had its onset during the period of active duty service. In this regard, the Veteran competently and credibly reported experiencing the onset of relevant symptoms during service. In addition, his STRs also indicate that he experienced heart symptoms during service. While the March 2019 registered nurse explained that he has a congenital aortic valve defect, the cardiologist explained in April 2021 that the aortic insufficiency is not congenital and that it had its onset during service. Furthermore, there is no indication of an intercurrent cause of the aortic insufficiency between the Veteran's discharge in May 1993 and the diagnosis in August 1994. The Board notes that the cardiologist also reported that aortic insufficiency is a congenital disease in the July 2021 addendum opinion, but it is clear that he was only making this determination based on the ability of the condition to improve and worsen in response to the RO requesting he designate it as either a congenital disease or a congenital defect. Therefore, resolving reasonable doubt in the Veteran's favor, the Board finds that the aortic insufficiency had its onset during service. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, service connection is warranted for aortic insufficiency. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jimerfield, David 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.