Citation Nr: 21071331 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 16-38 625 DATE: November 30, 2021 ORDER Entitlement to service connection for a heart disorder is denied. FINDING OF FACT Heart disease was not shown in service or for many years thereafter, and the Veteran's current heart disability is not shown to be causally related to any disease, injury, or incident in service. CONCLUSION OF LAW The criteria for entitlement to service connection for a heart disorder have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1984 to July 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was last before the Board in May 2021, when it was remanded for further development. . 1. Entitlement to service connection for a heart disorder The Veteran contends a current heart disorder is related to findings of sinus bradycardia during his active duty service. 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). Moreover, where a veteran served continuously for 90 days or more during active service, and cardiovascular disease becomes manifest to a degree of 10 percent within one year from date of termination of such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. The question for the Board is whether the Veteran has a current disability that began during service, manifested to a compensable degree within one year of discharge from service, or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current heart diagnosis to include coronary artery disease, the preponderance of the evidence weighs against finding that the Veteran's current heart disability began during service or within the year following discharge from service, or is otherwise related to an in-service injury, event, or disease. The Veteran's service treatment records (STRs) show that an April 1990 electro-cardiogram was found to show sinus bradycardia with sinus arrythmia. A June 1992 electrocardiogram was found to show sinus bradycardia. The Veteran reported a history of pain or pressure in his chest in a June 1992 report of medical history. The Veteran's lungs and chest were marked abnormal on his June 1992 separation examination. The examiner noted "TTP" [tender to palpation] of the sternum and ribs anteriorly with deep inspiration and bronchitis. Post-service, the Veteran had a normal electrocardiogram (ECG) and normal sinus rhythm in October 2003. In October 2012, the Veteran complained of chest pain. He had a normal heart echocardiogram and was scheduled for a pharmacologic stress test and started on 81mg aspirin daily. The Veteran was afforded a VA examination in January 2020. The Veteran reported a strong family history of heart problems but did not know if he has a heart problem. He denied hypertension and myocardial infarction (MI). He reported chest pains but denied chest pain going down the left arm or the neck. The January 2020 VA examiner noted that there was not enough evidence of prior cardiac condition or current cardiac condition and opined that it is less likely than not that a heart disorder is due to service. The Veteran was afforded another VA examination in October 2020. The October 2020 VA examiner diagnosed myocardial infraction, coronary artery disease and stable angina. The October 2020 VA examiner opined that the Veteran's heart disorder is less likely than not incurred in or due to service. The examiner noted the Veteran had an MI in January 2020, had a stent placed, and has had stable angina since. The examiner explained that sinus bradycardia on examination is a clinical sign and not a separate condition. He noted that STRs show the Veteran has typical pulse on bottom end of normal which is expected for physically active and cardio-vascular healthy individuals in the military. The Veteran was asymptomatic and did not report cardiac symptoms during service. An addendum VA medical opinion was obtained in October 2021. The physician noted there was no evidence of a cardiac condition, including coronary artery disease, while in service and that the Veteran's age while in service made it unlikely. Furthermore, the Veteran's complaint and findings at the time of the separation examination are clearly noted to be secondary to bronchitis and not cardiac in origin. The examiner explained that had coronary artery disease had its nexus in service, it is highly unlikely the Veteran could have endured a span of 28 years without manifestations. The Veteran was diagnosed with coronary artery disease, status post-MI, status post-stents, in June 2020. Therefore, it is less likely than not that the Veteran's cardiac conditions had their nexus in service or are due to events in service. The Veteran's sinus bradycardia in April 1990 is not indicative of coronary artery disease and may have been secondary to being well trained physically. Regardless, there was no cardiac abnormality at the time of separation. The leading risk factors for coronary artery disease are family history, smoking, atherosclerosis, hyperlipidemia, peripheral vascular disease and obesity. The Board finds that the October 2021 VA opinion to be most probative. The opinion was based on a thorough review of the Veteran's medical records to include examination reports, considered his lay statements, and is supported by a fully articulated rationale. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). There is no medical opinion to the contrary. The Board finds that the most probative evidence of record shows that the Veteran's current heart disorder did not have its onset during service or within a year of discharge, and is not otherwise etiologically related to service. Finally, to the extent that the Veteran believes that his current disability is related to service, as a lay person, the Veteran has not shown that he has specialized training sufficient to render such an opinion. In this regard, the diagnosis and etiology of cardiovascular disorders are matters that require medical training and expertise to determine. Accordingly, his opinion as to the diagnosis or etiology of his heart disability is not competent medical evidence. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). The Board finds the opinion of the VA examiner to be significantly more probative than the Veteran's lay assertions. In summary, the preponderance of the evidence weighs against finding in favor of the Veteran's service connection claim for a heart disorder. The evidence shows that his current heart condition first manifested many years after service and there is no competent medical opinion relating his current heart disorder to service. In reaching the above conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Asare, 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.