Citation Nr: A21017348 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 210831-183737 DATE: October 27, 2021 ORDER Service connection for atrial fibrillation is granted. FINDING OF FACT The Veteran's atrial fibrillation either began during or were otherwise caused by his active military service. CONCLUSION OF LAW The criteria for service connection for atrial fibrillation have 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 from November 1960 to November 1964. This case is on appeal from an August 2021 rating decision. In the August 2021 rating decision, the RO found that new and relevant evidence had been received and thus, readjudication of the atrial fibrillation claim was warranted. 38 C.F.R. §§ 3.2501, 19.2. The RO readjudicated the claim and denied it on the merits. The Board is bound by this favorable finding that new and relevant evidence was received sufficient to readjudicate the claim. See 38 C.F.R. § 3.104(c). Service connection for atrial fibrillation. 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 his atrial fibrillation was incurred in service. In an August 2021 notice of disagreement (NOD), the Veteran's representative reported that the Veteran experienced symptoms associated to atrial fibrillation incurred in service. In this regard, the representative reported that during service the Veteran had been reported chest pains after a lengthy hospitalization related to infectious mononucleosis at an Air Force hospital. The representative referenced the Veteran's in-service medical visits in which medical professionals could not find any chest issues. Also, the representative reported that the Veteran stopped seeking medical attention for his chest pain for fear of retaliation and lack of assistance in previous medical encounters. The representative submitted medical literature, discussing a nexus between infectious mononucleosis and atrial fibrillation. Furthermore, the representative requested a readable service exit exam and a new examiner for any necessary future VA examinations. In a September 2021 correspondence, the Veteran's representative maintained that the VA has yet to consider a "missed diagnosis" made in 1966 when the Veteran reported a history of chest pain dating back 3 years to include the few years of his service. The Veteran's service personnel records (SPRs) show that he served as an aircraft mechanic in the Air Force. His service treatment records (STRs) show that the Veteran reported anterior chest problems upon waking up in the mornings. Furthermore, his record show that he was diagnosed and treated for infectious mononucleosis in June 1961. The Veteran's enlistment and separation examinations are marked normal for chest and heart. The Veteran's post-service records shows that the Veteran was diagnosed and treated for atrial fibrillation. Further, the records note Veteran's history with paroxysmal atrial fibrillation from 1965. The Veteran's private medical records show that he was diagnosed and treated for atrial fibrillation for many years since service. A November 1965 hospital treatment record shows that the Veteran was admitted to the hospital for chest pain complaints. The attending physician found "some" atrial fibrillation. Also, the records show that the Veteran was hospitalized for same condition several times after 1965. Additionally, in a private January 1966 medical evaluation and opinion, a physician reported that the Veteran had been experiencing chest pains for 3 years prior. The physician opined that "it would be entirely reasonable to regard" the Veteran's condition, "as a paroxysm of atrial fibrillation." In July 2021, the Veteran was afforded a VA examination for this claim. The Veteran reported a past medical history for paroxysmal atrial fibrillation since 1965 for which he reported being hospitalized 15 times over the years. The examiner reviewed the claims file. The examiner reported a 1965 to 1966 diagnosis for atrial fibrillation. Also, the examiner noted that the Veteran experienced persistent atrial fibrillation. The examiner found an abnormality in the Veteran's chest wall thickness to include a dilated left atrium. The examiner opined that the Veteran's disability was less likely than not incurred in or caused service injury, event, or illness. The examiner explained that while the Veteran's atrial fibrillation was first diagnosed around 1962 in service, the evidence of atrial fibrillation was not found in the Veteran's STRs. The Board finds that the probative evidence is at least in equipoise as to a link between the Veteran's atrial fibrillation and service. In this regard, the Veteran's STRs, post-service, and private treatment records show that the Veteran's atrial fibrillation was incurred in-service. In this regard, the Veteran's STRs show that the Veteran did report chest pain in August 1963 to service medical professionals despite a lack of diagnosis. Moreover, the November 1965 hospital record showed evidence of atrial fibrillation within a few weeks after the Veteran's first post-service year. Additionally, in the January 1966 private medical opinion, the physician noted the Veteran's atrial fibrillation dating back 3 years which coincides with the Veteran's August 1963 chest pain reports made in service. Also, after reviewing the Veterans' medical file and examining the Veteran, the physician found there was a likelihood that the chest pain reported by the Veteran are attributed to paroxysm of atrial fibrillation. The examiner's opinion is persuasive because it is based on an accurate medical history and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Also, post-service and private medical records regarding the Veteran's disability show extensive treatment and hospitalization, noting consistently the Veteran's 1965 diagnosis for atrial fibrillation. Even though the examiner in the July 2021 incorrectly found that the Veteran's atrial fibrillation is not service-connected for lack of in-service documentation of atrial fibrillation, she confirmed the Veteran's diagnosis for atrial fibrillation going back to 1962 during the Veteran's service. Moreover, the Veteran's representative medical literature submission presents a likelihood of a positive nexus between infectious mononucleosis and atrial fibrillation which were both experienced by the Veteran during service. However, a medical opinion could speak to such relationship. In this case, nonetheless, the rest of record substantiates that the Veteran's disability was incurred in service. Accordingly, when reasonable doubt is resolved in the Veteran's favor, the Board finds that his atrial fibrillation was ultimately related to service. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Board also finds that no intercurrent causes have been shown in this case and therefore the Veteran's atrial fibrillation is attributable to service. As a chronic condition, any subsequent manifestations are service-connected unless attributable to intercurrent causes. Moreover, the Board finds that the examiner incorrectly concluded that there was no in-service evidence of the Veteran's atrial fibrillation as shown by the August 1963 STR. Therefore, service connection is warranted for atrial fibrillation. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Nevarez-Myrick, Nancy 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.