Citation Nr: 21072113 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 15-22 732A DATE: December 2, 2021 ORDER Service connection for sinus bradycardia is granted. FINDING OF FACT The evidence is at least in equipoise that the Veteran's sinus bradycardia was incurred in service. CONCLUSION OF LAW The criteria for entitlement to service connection for sinus bradycardia are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1968 to September 1972. This matter is on appeal from a January 2010 decision of a Department of Veterans Affairs (VA) Regional Office (RO). In October 2018, a hearing was held before the undersigned. A transcript of the hearing is in the record. The case was previously before the Board in September 2019 and May 2021 when it was remanded for further development. Sinus Bradycardia The Veteran contends that he is entitled to service connection for sinus bradycardia. Service connection will be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110. To establish service connection, the evidence must show: (1) a present disability; (2) an 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Competent medical evidence is evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may include statements conveying sound medical principles found in medical treatises. Competent medical evidence may also include statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. For example, lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing observable symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In this case, the Veteran was provided with a VA examination in November 2019 in which the examiner noted a diagnosis of sinus bradycardia. The examiner also noted dyspnea and fatigue at a greater than 7 to 10 METs level of activity due to the sinus bradycardia. This METs level is consistent with activities such as climbing stairs quickly, moderate bicycling, sawing wood, and jogging. During the October 2018 hearing, the Veteran reported readily observable symptoms including fatigue, lightheadedness, and flutters of chest pain that he indicated limited his ability to engage in physical activities, including mowing the lawn. Thus, the first element of Shedden is satisfied as the record reflects that sinus bradycardia results in functional impairment. See Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018). Further, an April 1972 service treatment record notes sinus bradycardia; thus, the second element of Shedden is satisfied, as well. A July 1977 letter from private Dr. J.S.M. states that the Veteran had been under his care through the winter for treatment for severe bradycardia and anemia and was unable to attend all his school classes. During the November 2019 VA examination, the clinician opined that the Veteran's condition noted that despite "the lack of ECG documentation corroborating the SB, this examiner believes it is at least as likely as not that the Veteran's sinus bradycardia was present while the Veteran was in military service." However, the examiner stated that there is a lack of evidence for continuous symptoms related to sinus bradycardia and that there is a lack of chronic symptoms from the period immediately after discharge from service to the present. He noted that the sinus bradycardia was an asymptomatic finding associated with no medical disability. The examiner also stated that the Veteran's condition was most likely present since birth. However, as the examiner did not provide a rationale for his finding that the Veteran's condition was likely present from birth, the Board assigns no probative value to this conclusion. In June 2021, VA obtained an addendum opinion from the November 2019 examiner, who clarified that it is at least as likely as not that the Veteran had a continuous condition, asymptomatic sinus bradycardia, since discharge from military service. He further opined that it was at least as likely as not that the Veteran had the chronic presence of asymptomatic sinus bradycardia throughout his military career. He also stated that it is not at least as likely as not that the Veteran had a chronic disability from the presence of asymptomatic sinus bradycardia throughout his military career. He explained that the service treatment records do not show signs or symptoms, cardiac-related or otherwise, secondary to the in-service finding of sinus bradycardia. The examiner noted that July 1977 private treatment records indicate severe bradycardia but also stated that there is no medical evidence to support this conclusion. However, the Board finds no reason to doubt the contemporaneous findings documented in the July 1977 private letter, which was submitted by a medical professional who had been treating the Veteran. As this opinion otherwise reflects thorough consideration of the Veteran's medical history, the Board assigns a high degree of probative value to the opinion that it is at least as likely as not that the Veteran incurred asymptomatic sinus bradycardia in service that has continued since service. The record further supports that the previously asymptomatic sinus bradycardia has become symptomatic and caused functional impairment, as shown by the October 2018 hearing testimony and the November 2019 VA examination. As such, the Board finds that the evidence is at least in equipoise that the Veteran's sinus bradycardia was incurred in service and that current sinus bradycardia with functional impairment is related to asymptomatic sinus bradycardia in service. Accordingly, the benefit of the doubt is resolved in the Veteran's favor, and service connection for sinus bradycardia is granted. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. H. White, 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.