Citation Nr: 21071055 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 14-37 548 DATE: November 29, 2021 ORDER Entitlement to service connection for a heart disorder, to include heart murmur and hypertension (heart condition), is denied. FINDING OF FACT The evidence does not show that the Veteran's pre-existing heart murmur aggravated beyond natural progression during service; nor does it show that the Veteran had any elevated blood pressure readings or other hypertensive symptoms during service. CONCLUSION OF LAW The criteria for entitlement to service connection for a heart condition have not been met. 38 U.S.C. §§ 1110, 1111, 1131, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from November 1988 to June 1991. This matter comes before the Board of Veterans' Appeals (Board) from a June 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office in Detroit, Michigan. In July 2018, April 2021, and July 2021, the Board remanded the case to the Regional Office for further evidentiary development. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in, or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. That determination requires a finding of a current disability that is related to an injury or disease in service. Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). To establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313(Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). The Veteran asserts that he is entitled to service connection for a heart condition because his heart murmur, which he developed prior to his enlistment into service, was aggravated by his military service. See October 2021 Appellate Brief. He also asserts entitlement to service connection for hypertension, as part of his claim for a heart condition. Specifically, he suggests that his heart murmur worsened in basic training; his military service impacted his elevated blood pressure and stress level, and that his heart condition worsened due to stress from bootcamp. See January 2012 Statement in Support of Claim; see also March 2012 Statement in Support of Claim; see too October 2014 Statement of Accredited Representative. He also asserted that he suffers from vertigo (headaches and dizziness) that are related to his blood pressure medicine. See October 2014 Board Appeal. Generally, a Veteran is considered to be in sound condition when examined, accepted, and enrolled for service except as to defects, infirmities, or disorders noted at entrance into service or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto. Only such conditions as are recorded in examination reports are to be considered as noted. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Service treatment records indicate that the Veteran had a heart murmur at the time he enlisted into service. See September 1988 Report of Medical Examination for Enlistment into Service. Therefore, the Board will consider whether such was subject to aggravation during service. 38 U.S.C. § 1153. Any in-service aggravation of the pre-existing condition is considered as sufficient basis for service connection, unless there is clear and unmistakable evidence that the disorder was not permanently aggravated beyond the natural progression of the condition during service. See 38 C.F.R. § 3.306. Once the evidence has established the presence of a pre-existing condition, the Board must first determine whether there was a measured worsening of the disability during service, and if so, it must also determine whether any worsening of this disability constitutes an increase in the disability, which must be permanent in nature. Browder v. Brown, 5 Vet. App. 268, 271 (1993). Although the Veteran has current heart-related diagnoses, including a heart murmur and hypertension, see e.g. June 2013 Primary Care Physician Outpatient Note, service treatment records do not show that the Veteran had any complaints or issues with heart-related conditions, aside from the pre-existing heart murmur that is listed in his enlistment examination. More so, service treatment records do not show any evidence of elevated blood pressure readings or any other related hypertensive symptoms. However, service treatment records indicate that the Veteran complained about having dizziness and headaches during his time in service. See e.g. July 1990 Dental Health Questionnaire; see also May 1991 Report of Medical History for Separation from Service. Although VA examiners rendered opinions on the etiology of the Veteran's heart condition in October 2019 and April 2021, the Board found that these opinions were inadequate. See April 2021 Board Remand; see also July 2021 Board Remand. Thus, in evaluating this claim, the Board shall not address or consider these opinions. After the July 2021 Board remand, however, the Regional Office obtained another VA opinion on the Veteran's heart condition. In this September 2021 VA opinion, the VA examiner opined that the Veteran's heart murmur, which clearly and unmistakably existed prior to service, was not aggravated, beyond its natural progression, by an in-service injury, event or illness. As the rationale for this opinion, the VA examiner reasoned, in pertinent part, that that there is no evidence to suggest that aggravation of the Veteran's heart murmur occurred while he was in service, and that the Veteran's separation examination suggests that his heart murmur resolved. Expounding on this rationale, the VA examiner explained that it is highly unlikely that any murmur, which was noted on entry, but was not noted on separation from service, is related to any valvular change, currently identified as of a 2011 echocardiogram. He also explained that if it is somehow related, it is clear that no progression beyond the natural course occurred because the 2011 findings were minimal, and that this would not suggest progression beyond the natural course. The VA examiner further explained that no aggravation, due to dizziness or migraine headaches (or any cause), can be substantiated because these symptoms are unrelated to an innocent heart murmur during service. The VA examiner additionally reasoned that no notation of a cardiac condition that is related to a murmur is noted within service treatment records; and that there is nothing in the Veteran's medical history to suggest significant valvular or other cardiac disease from 1991 through 2011. In a second September 2021 VA opinion, the VA examiner additionally reasoned that there is no evidence of an ongoing heart condition or symptoms while in service; the separation examination is negative for signs or symptoms associated with heart murmurs; these exams are notably thorough; and that it is highly unlikely a significant heart condition would have gone unnoted or unreported. Additionally, the VA examiner opined that it is less likely than not the Veteran's hypertension had its nexus in service, or is due to, or incurred from the in-service headaches and dizziness that the Veteran reported. As the rationale for this opinion, the VA examiner explained that hypertension is generally not associated with headaches and dizziness, except in rare conditions involving a hypertensive crisis. The VA examiner additionally explained that the Veteran was not diagnosed as hypertensive until or around 2011, twenty years after his separation from service. Although the VA examiner conceded that the Veteran is competent to report symptoms, he clarified that the Veteran is not competent to assign an etiology to his symptoms. Here, the Board agrees with the VA examiner because his observation and assessment of the Veteran's assertions are accurate and consistent with case law precedent on a veteran's competency to provide an opinion on his medical condition. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (holding that although a claimant is competent, in certain situations, to provide a diagnosis of a simple condition, such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions, such as, for examples, a diagnosis). (Continued on the next page) The Veteran has not submitted, nor does the medical evidence provide any medical evidence or opinion that is controverting or contrary to this September 2021 VA opinion. Further, as this opinion is supported by a clear, detailed rationale, which is responsive and is in substantial compliance with the July 2021 Board remand directives, the Board finds that this is the most probative medical opinion of record, which is dispositive of this claim. Moreover, the Veteran has not submitted any other evidence to suggest that his heart murmur was aggravated by his service; or that his hypertension was incurred in service; or that his hypertension is related to his in-service complaints of headaches and dizziness; or that his hypertension is otherwise related to his service. Therefore, the Board finds that the preponderance of the evidence is against this claim, and service connection for a heart condition must be denied. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V-N. Pratt 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.