Citation Nr: 21067066 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 18-29 099 DATE: November 3, 2021 ORDER Entitlement to service connection for atrial fibrillation, secondary to service-connected coronary artery disease (CAD) on a causation basis, is granted. FINDING OF FACT The evidence is at least evenly balanced as to whether the Veteran's atrial fibrillation is proximately due to his by his service-connected CAD. CONCLUSION OF LAW With reasonable doubt resolved in favor of the Veteran, the criteria for entitlement to service connection for atrial fibrillation secondary to CAD have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1967 to September 1969. This case comes before the Board of Veterans' Appeals (Board) on appeal from a January 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which, among other things, denied service connection for atrial fibrillation. In February 2017 the Veteran filed a notice of disagreement (NOD) and in April 2018 RO issued a statement of the case (SOC). In June 2018 the Veteran filed a substantive appeal (via VA Form 9). In November 2019 the Veteran testified at a travel board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the record. In a February 2020 decision, the Board denied service connection for a heart disability, to include cardiac arrhythmia. The Veteran appealed the Board's decision to the U.S. Court of Appeals for Veterans' Claims (Court). In January 2021, while the matter was pending before the Court, the Veteran's attorney and VA's General Counsel filed a joint motion for partial remand (JMPR). In January 2021 the Court granted the parties' motion and remanded the matter for action consistent with the JMPR. In June 2021 the Board remanded the claim for additional development. The Board characterized the issue as entitlement to service connection for cardiac arrhythmia. The Board has recharacterized the issue as service connection for atrial fibrillation because that is the diagnosis rendered by the VA examiner on whose medical opinion the grant of service connection is being based. The Rating Schedule reflects that atrial fibrillation is a type of supraventricular arrhythmia. See 38 C.F.R. § 4.104, Diagnostic Code 7010. Consequently, the benefit sought is being granted in full. Thus, consideration of whether the agency of original jurisdiction complied with the Board's remand instructions is unnecessary. Service connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a),(b). Atrial Fibrillation secondary to CAD A December 2015 VA physician diagnosed the Veteran with atrial fibrillation. Also, a March 2016 VA examiner diagnosed the Veteran with supraventricular arrhythmia. Thus, a current disability has been demonstrated. The Veteran is service connected for CAD, leaving a connection between the Veteran's atrial fibrillation and his service-connected CAD the remaining dispositive issue. A September 2021 VA examiner opined that the Veteran's atrial fibrillation is less likely than not proximately due to or the result of the Veteran's service-connected CAD. The VA examiner acknowledged that atrial fibrillation is the most common heart irregularity or cardiac arrhythmia and that the Mayo Clinic found that anyone with CAD has an increased risk of atrial fibrillation. The VA examiner also cited to a study which noted a strong correlation between coronary artery disease and atrial fibrillation. The VA examiner then explained that the Veteran's atrial fibrillation was present prior to him being diagnosed with coronary artery disease and concluded it is less likely that his CAD caused his atrial fibrillation. The September 2021 VA examiner also opined that the Veteran's CAD aggravated his atrial fibrillation. The VA examiner explained CAD and atrial fibrillation share associated risk factors and that CAD can impact the development of atrial fibrillation. The Board notes that the primary disability (i.e., CAD in this case) need not be service-connected, or even diagnosed at the time the secondary condition is incurred to show entitlement to service connection on secondary basis under a causation theory. Frost v. Shulkin, 29 Vet. App. 131, 133 (2017). Thus, it is possible for service connection to be granted for atrial fibrillation secondary to CAD even if this disability was diagnosed prior to his CAD. In this regard, in can be inferred from the VA examiner's explanation that had she known a temporal requirement was not necessary, she would have concluded the Veteran's CAD caused his atrial fibrillation. For the foregoing reasons, the evidence is at least evenly balanced as to whether the Veteran's atrial fibrillation was caused by his service-connected CAD. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, the criteria for service connection for atrial fibrillation are met and service connection for this disability is warranted on a secondary, causation basis. 38 U.S.C. §§ 5107(b); 38 C.F.R. § 3.102. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James R. Miller, 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.