Citation Nr: 21066240 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 13-33 978 DATE: October 29, 2021 ORDER Entitlement to service connection for congestive heart failure is denied. Entitlement to service connection for hypertensive vascular disease, to include hypertension is denied. FINDINGS OF FACT 1. The Veteran's heart condition was not present in service or for many years thereafter and is not otherwise etiologically related to service, to include as due to herbicide exposure. 2. The Veteran's hypertension is not secondary to service-connected Diabetes Mellitus type II, and is not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for congestive heart failure are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for hypertensive vascular disease, to include hypertension are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 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 from July 1971 to June 1972 and from November 1974 to February 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in March 2018 and April 2019 for further development. A review of the record indicates that there has been substantial compliance with the previous remand directives such that further remand is not necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran testified before the undersigned Veterans Law Judge at a videoconference hearing in January 2017. A transcript of the hearing has been associated with the file. Service Connection Entitlement to service connection for congestive heart failure The Veteran contends that his congestive heart failure is due to service. Specifically, he believes that his congested heart failure is manifested by ischemic heart disease and is due to his service in Vietnam. 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 Board concludes that, while the Veteran has a current diagnoses of congestive heart failure, supraventricular arrythmia, implanted cardiac pacemaker, idiopathic cardiomyopathy, and he was presumptively exposed to herbicides while in service, the preponderance of the evidence weighs against finding that the Veteran's diagnoses began during service or is otherwise related to an in-service injury or disease. The Veteran believes that his heart conditions are ischemic heart disease, which is a condition that is presumed to be due to herbicide exposure. In an August 2010, heart disability benefits questionnaire, Dr. M.S. diagnosed the Veteran to have ischemic heart disease, although the findings in the report appeared to be linked to congestive heart failure. The examiner did not provide any information regarding the diagnosis of ischemic heart disease and did not provide a date of diagnosis of ischemic heart disease. In an August 2018 VA examination the Veteran was stated to have a heart condition that falls within the generally accepted medical definition of ischemic heart disease. The examiner also noted a past history of coronary artery disease. The diagnoses at that time were congestive heart failure and hypertensive heart disease. The examiner noted that the cause of both conditions was poorly controlled hypertension. In her corresponding opinion, the August 2018 VA examiner stated that the Veteran's congestive heart failure was less likely as not due to service. She noted that his records showed no signs of coronary artery disease and that his left ventricular hypertrophy suggests that poorly controlled hypertension played a significant role in the development of congestive heart failure. Due to the inconsistency in the examinations, the Board sought an additional examination and opinion. In the July 2021 examination the Veteran was diagnosed to have congestive heart failure, supraventricular arrythmia, implanted cardiac pacemaker, and idiopathic cardiomyopathy. The examiner stated that none of these diagnosed conditions were within the generally accepted medical definition of ischemic heart disease. The examiner further noted that the Veteran has not had a myocardial infarction. In the corresponding opinion, the examiner noted that there was no objective evidence of ischemic heart disease. The Board finds this examination and opinion to be more probative than either the August 2018 or August 2010 examinations and opinions, due to a complete and thorough history of the current and past conditions, lack of internal inconsistency, and sound basis for the conclusions offered. As such, the Board finds that the Veteran does not have ischemic heart disease and that his congestive heart failure cannot be service connected on a presumptive basis. While the Veteran's congestive heart failure cannot be service connected on a presumptive basis, it can still be service connected on a direct basis. However, VA and private treatment records show the Veteran was not diagnosed to have congestive heart failure until 2003, 14 years after his separation from service. Further, the Veteran has not described experiencing symptoms of congestive heart failure from separation until 2003, and no probative evidence shows it related to any in-service disease or injury. While the Veteran believes his congestive heart failure is related to exposure to herbicides in service, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of pathology and the relationship between herbicides and internal organs. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Entitlement to service connection for hypertensive vascular disease, to include hypertension The Veteran contends that his hypertension is due to his service-connected Diabetes Mellitus type II. Preliminarily, the Veteran has suggested that his hypertension is due to herbicide exposure in service. The Board notes that hypertension is not a disability that is recognized as due to herbicide exposure. Further, the Veteran has not submitted any evidence that would link his hypertension to such exposure. The August 2018 VA examiner noted that there was no medical evidence that linked hypertension to herbicide exposure. As such, service connection on a direct basis as due to herbicide exposure is not warranted. Further, the Veteran's service treatment records do not show evidence of elevated blood pressures or other evidence of a diagnosis of hypertension. Thus, service connection on a direct basis other than for exposure to herbicides is not warranted. Although service connection is not warranted on a direct basis, service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The Board concludes that, while the Veteran has a current diagnosis of hypertension, the preponderance of the evidence is against finding that the such a disability is proximately due to or aggravated beyond its natural progression by service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The August 2018 VA examiner opined that the Veteran's hypertension was not due to or aggravated beyond its natural progression by his service-connected Diabetes Mellitus type II. The examiner noted that Diabetes Mellitus type II is not a known risk factor for hypertension and that there is no evidence in the Veteran's medical records that his Diabetes Mellitus type II aggravated his hypertension. Rather, the examiner noted that the obesity and physical inactivity are two known risk factors for the condition and its severity. The Veteran was noted as being both obese and physically inactive. (Continued on the next page) The Veteran believes his hypertension is proximately due to or aggravated beyond its natural progression by a service-connected disability. The Veteran in this case is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the August 2018 VA examiner's opinion. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Uller, 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.