Citation Nr: A21018522 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 181116-1544 DATE: November 19, 2021 ORDER Entitlement to service connection for atrial fibrillation is granted. FINDING OF FACT The probative medical evidence of record is in relative equipoise as to whether the Veteran's currently diagnosed atrial fibrillation began during military service. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran's favor, atrial fibrillation was incurred in active duty service. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1989 to October 1995. These claims come before the Board from a rating decision by the VA Regional Office (RO). On November 2018, the Veteran opted his legacy appeal to the Board into the Hearing option of the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55, 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). The discussion that follows is conducted in accordance with that framework. At a November 2020 hearing, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the proceeding has been associated with the claims file. Under the laws administered by VA, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge from service when all the evidence, including that pertinent to service, establishes that the disease was incurred during service. 38 C.F.R. § 3.303 (d). Generally, the evidence must show: (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. 38 C.F.R. § 3.303 (a); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). The Veteran contends that he developed atrial fibrillation during military service. In this regard, he recounted having experienced frequent episodes of racing and irregular heartbeats beginning in training and lasting through the present day. The Veteran has submitted several lay statements, including a January 2018 statement from his wife indicating that she had observed his palpitation incidences over the course of his military and post-military life as well as a June 2018 correspondence from the Veteran's sister, who is also a registered nurse, indicating that the Veteran was first diagnosed with atrial fibrillation in the month immediately after discharge from military service in November 1995 and that he has experienced this condition ever since. The Veteran's service treatment records (STRs) showed that, in August 1989, the Veteran was provided with an electrocardiogram (ECG), which showed no heart abnormalities. Additional records showed evidence of an July 1991 incident in which the Veteran was seen for complaints of chest pain and tightness. No testing was completed, and no diagnosis was rendered. Post-service treatment records show a diagnosis of atrial fibrillation. The earliest document reflecting the presence of relevant abnormality is dated in November 2004, showing the Veteran at that time had a history of supraventricular tachycardia. . The Veteran's private physician submitted letter dated in November 2018. Read as a whole, it relates the conclusion that the Veteran developed atrial fibrillation while in military service as first evidenced by the July 1991 chest pain incident as well as the Veteran's lay complaints of palpitations during that time period until the present. VA opinions dated in October 2017 and July 2018, come to the conclusion that atrial fibrillation is less likely than not due to service. However, the 2017 opinion did not appear to rely on an accurate history, and addressed itself more to a mitral valve disability, than an arrythmia. As such, it is of little evidentiary weight. The 2018 opinion appears to rely on the absence of an in-service record of an ECG as reason for the conclusion. Of course if the record already contained medical evidence, such as an ECG, showing the onset of the claimed disability during service, there would be little reason to seek out a medical opinion on whether it was incurred in service. Relying on the absence of an in-service test that would have confirmed the presence or absence of the claimed disability as the reason for finding the disability unrelated to service adds such little insight into the question presented by the claim, it too is accorded little evidentiary weight. The Board is left then with the Veteran's report of symptoms in service which later coincided with a diagnosis of atrial fibrillation; reports from family members, (one of whom has medical training) that support the in-service and post service presence of his symptoms, as well as their reports of a formal diagnosis soon after service; and a 2004 treatment record noting a history of an irregular heartbeat. The Board is mindful that an accurate determination of etiology is not a condition precedent to granting service connection. Here at least two individuals with medical training have indicated their belief the claimed disability had its onset in service, and there is corroborating medical documentation that in 2004, the Veteran was known to have a history of an irregular heartbeat. When considered with the symptoms shown in service, and those reported by the Veteran and others in relation to his atrial fibrillation episodes, it may be concluded that there is at least a balance of evidence on whether the Veteran's atrial fibrillation was incurred in service. Resolving reasonable doubt in his favor, the Board concludes a basis upon which to establish service connection for atrial fibrillation has been presented. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dodd, Ryan 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.