Citation Nr: 21065210 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 07-21 755 DATE: October 25, 2021 ORDER Entitlement to service connection for residuals of heat stroke, to include a heart disorder and hypertension, is denied. FINDING OF FACT The weight of the most probative evidence of record is against finding the appellant has residuals of heat stroke, a heart disability, and/or hypertension due to a period of active duty for training (ACDUTRA) or inactive duty for training (IDT). CONCLUSION OF LAW The criteria for service connection for residuals of heat stroke, to include a heart disorder and hypertension, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant served on active duty for training (ACDUTRA) from June 1981 to November 1981. He was a member of the National Guard from September 1980 to March 2000. This case came before the Board of Veterans' Appeals (Board) from a December 2005 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The appellant appeared before the undersigned Acting Veterans Law Judge (AVLJ) at an August 2009 hearing, and before another VLJ at a July 2015 hearing. The July 2015 VLJ has since become unavailable to participate in the appeal. In February 2020, the Board sent a letter to the appellant explaining his right to present testimony at a new hearing before a different VLJ. The appellant responded that he did not wish to appear at another Board hearing and asked the Board to consider his case on the evidence of record (12/08/2015 Correspondence). In January 2010, September 2012, May 2016, May 2018, and July 2020, the Board remanded the issue on appeal to the RO for additional development. The Board finds there has been substantial compliance with the Board's remand directives in accordance with Stegall v. West, 11 Vet. App. 268, 271 (1998). Service connection for residuals of heat stroke, to include a heart disorder and hypertension. The appellant contends he suffered from heat stroke during training in 1981, and residuals from heat stroke include or resulted in a current diagnosis with a heart disorder and hypertension (09/07/2004 VA 21-526 Veterans Application for Compensation or Pension, pg. 8; 07/28/2015 Hearing Testimony, pgs. 3-4). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 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 injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The term "active military, naval, or air service" includes (1) active duty; (2) any period of active duty for training (ACDUTRA) during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in line of duty; and (3) any period of inactive duty for training (IDT) during which the individual concerned was disabled or died from an injury incurred or aggravated in line of duty; or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident occurring during such training. 38 U.S.C. § 101 (24). 38 C.F.R. § 3.6 (a). Presumptive service connection does not apply to claims predicated on ACDUTRA and INACDUTRA service, but only for active duty. Biggins v. Derwinski, 1 Vet. App. 474 (1991); Smith v. Shinseki, 24 Vet. App. 40 (2010). Reserve and National Guard service generally means ACDUTRA and IDT. ACDUTRA is full time duty for training purposes performed by Reservists and National Guardsmen pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c). That usually includes two weeks of annual training and/or an initial period of training. IDT includes duty, other than full-time duty, performed for training purposes by Reservists and National Guardsmen pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505. 38 U.S.C. § 101 (23); 38 C.F.R. § 3.6 (d). That usually indicates weekend drills or training. A member of the National Guard serves in the federal military only when formally called into the military service of the United States. At all other times, a member of the National Guard serves solely as a member of the State militia under the command of a state governor. For a period of National Guard service to be qualifying service for VA compensation benefits, such period of service must have been when the National Guardsman was ordered into Federal service under 38 U.S.C. §§ 316, 502, 503, 504, 505; 38 C.F.R. §§ 3.6 (c), (d) (§ 502 concerns drill and annual training). While the law applicable to active duty service establishes veteran status without further requirements, the law pertaining to periods of ACDUTRA and IDT requires that the claimant have become disabled during the period of ACDUTRA or IDT in which the injury or disease occurred, and specifically requires that the disease and/or injury have been incurred in the line of duty. The claimant bears the burden of establishing that this sequence of events has occurred before veteran status is granted for the period of service in question. 38 U.S.C. § 101 (24). The Board emphasizes the more restrictive requirements applicable to periods of ACDUTRA and IDT as compared to active duty service. Before addressing service connection entitlement, the Board must address whether the appellant became disabled during a period of ACDUTRA or IDT and if so, whether the injury was incurred in the line of duty. For the reasons set forth below, the Board finds the appellant did not become disabled as claimed, during a period of ACDUTRA or IDT. The appellant contends he suffered from heat stroke during training in 1981, and residuals from heat stroke include or resulted in a heart disorder and hypertension (09/07/2004 VA 21-526 Veterans Application for Compensation or Pension, pg. 8; 07/28/2015 Hearing Testimony, pgs. 3-4). The appellant's medical record does not include a diagnosis of heat stroke nor residuals thereof. While not entirely dispositive, this weighs against the appellant's contentions and claim. The appellant's service treatment records reflect that he was admitted to the hospital from September 16-19, 1981 for complaints of extreme headaches, nausea, and dizziness. The nature and extent of the condition was characterized as acute respiratory disease and was found to have been incurred in the line of duty (06/19/2015 Military Personnel Record, pg. 17). The medical records indicated a diagnosis of upper respiratory infection in September 1981; a heat stroke diagnosis was not made (06/19/2015 STR, pgs. 3-4). Upon hospital discharge, the line of duty paperwork indicates the appellant was released to his unit. While the September 1981 line of duty finding confirms acute respiratory disease, it does not suggest the appellant became disabled during the period of ACDUTRA as a result of heat stroke or heart disability. The appellant's other service treatment records reveal the appellant complained of and was treated for tension headaches in June 1981. In January 1984, the appellant's heart was assessed as normal, and his lungs were clear. In May 1985, the appellant was clinically evaluated as normal, to include his heart. No other defects or diagnoses were made, and he was found qualified for retention (06/19/2015 STR, pgs. 16, 17, 18). In December 1989, the appellant indicated he was in good health and on no medication. He was clinically evaluated as normal and found qualified for retention (06/19/2015 STR, pgs. 25, 27, 28). The forgoing medical evidence weighs against finding the appellant became disabled due to heat stroke, a heart disorder, or hypertension, during any period of ACDUTRA, specifically including the period from June 1981 to November 1981. The Board acknowledges that the appellant believes that he was diagnosed with a heat stroke during service. The appellant also believes he has a heart disability and hypertension that is related to a heat stroke or his September 1981 hospitalization during training. While a lay person is competent to testify as to their recollections or beliefs, the record does not show that the appellant has the medical training or credentials to diagnose heart disability, heatstroke, or heat exhaustion, or provide nexus opinions. The issue is medically complex, as it requires medical knowledge and understanding of the relationship between organ systems. As such, the Board finds diagnoses and nexus opinions to be outside the competence of the appellant. Additionally, the Board finds the medical records from 1981 to be more reliable as to the appellant's diagnosis than his memory. Consequently, the Board assigns more probative weight to the medical evidence of record. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24 Vet. App. 428 (2011). The Board has also reviewed and considered the articles of record: "Heat Stress disorders and headache: a case of new daily persistent headache secondary to heat stroke"; "Management of Heatstroke and Heat Exhaustion"; and "Case Report of a New Headache Developed by a Combat Soldier after an Episode of Exertional Heat Illness." The articles have been presented in support of the appellant's assertion that his heart disability results from in-service heatstroke. The Board finds the articles relating to headaches are not probative as to the appellant's claim for service connection for a heart disability. The article relating to management of heatstroke and heat exhaustion, although stating heat exhaustion and heatstroke are considered heart related illnesses, the article primarily discusses symptoms and treatment. The Board acknowledges and considered that some of the symptoms noted in the article to include dizziness and headache are associated with heatstroke or heat exhaustion. Beyond the forgoing, the Board does not find the articles to be probative as to the question of inservice onset or nexus. Although symptoms common to heatstroke or heat exhaustion were noted in the appellant's medical record, the appellant was assessed with in-service headaches and an upper respiratory infection as opposed to heatstroke or heat exhaustion. Service physical examinations did not note heat stroke or exhaustion as a common problem. Service treatment records after 1981 suggest the appellant was clinically evaluated as normal consistently. These records were contemporaneous with the appellant's in-service health assessments at various points during service and made by medical personnel for the purpose of treatment. Accordingly, the Board finds the diagnoses and assessments made during service to be more probative than the articles of record in determining inservice onset or injury. The Board considered the January 2018 examiner report, basing the negative nexus opinion on the absence of medical evidence suggesting complications of heat stroke, including rhabdomyolysis, kidney failure, seizure, or death. Although the appellant's lay assertions were not specifically addressed, this opinion weighs against the appellant's claim (01/15/2018 C&P Exam, pg. 5). To the extent that it explains symptoms of heat stroke that would contribute to a heart disability, the Board finds it probative and weighing against the appellant's claim. The appellant was also afforded March 2021 VA examinations for heart conditions and hypertension. The March 2021 examiner found a less than 50 percent likelihood of a residual of heat stroke, to include cardiac or heart disease or heart disorder or hypertension. The examiner also opined there was a less than 50 percent probability that the onset or etiology of the appellant's hypertension is related to an inservice event such as training, active or inactive, or heat exhaustion or heatstroke. The examiner explained the appellant's hypertension appears to be essential, in light of his family history of hypertension and apparent formal diagnosis of hypertension until approximately 2000 or later (08/14/2021 C&P Exam, pg. 3). With regard to the appellant's service history, he was discharged from the National Guard in February 2000 (03/16/2017 DPRIS Response, pg. 16). He did not have any periods of ACDUTRA or IDT after September 1997 (12/06/2017 VR&E-General, pg. 7). As the March 2021 examiner explained, the appellant's hypertension was diagnosed after service. The examiner considered the appellant's apparent syncope while being immunized in July 1981. This was explained to be a vagal reaction. The examiner also noted the University of South Alabama discharge summary, dictated in January 2007 noting the appellant's blood pressure of 144/98. At that time the appellant indicated he did not recall having elevated blood pressure in the past. He was diagnosed with atypical chest pain and myocardial infarction was ruled out (08/14/2021 C&P Exam, pg. 3). Taken together, the appellant's diagnostic history and his service history suggest that any currently diagnosed heart disability, to include hypertension, had its onset after service and did not manifest as a disability during a period of ACDUTRA or IDT. In light of the forgoing, the Board finds the most probative evidence of record weighs against finding that the appellant became disabled during a period of ACDUTRA or IDT, or that the appellant has a heart disability, to include hypertension, that is related to an in-service event including training, active or inactive, or heat exhaustion or heatstroke. CONTINUED ON NEXT PAGE... Accordingly, the appellant's claim of entitlement to service connection for residuals of heat stroke, to include a heart disorder and hypertension, is denied. M.W. KREINDLER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. A. Myers 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.