Citation Nr: 21072292 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 17-28 861A DATE: December 2, 2021 ORDER Entitlement to service connection for a heart condition (diagnosed as coronary artery disease) is denied. REMANDED Entitlement to service connection for arthritis is remanded. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran has an in-service event, injury, or incurrence for which to relate his diagnosed coronary artery disease. CONCLUSION OF LAW The criteria for entitlement to service connection for a heart condition (diagnosed as coronary artery disease) have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7101(a)(2). The Veteran served on active duty for training (ACDUTRA) in the Army National Guard from December 1965 to May 1966. This case comes before the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in St. Petersburg, Florida. In October 2020, the Board remanded the Veteran's claims for additional development. The Board notes that there was substantial compliance with its October 2020 remand directives with regard to the issue of entitlement to service connection for a heart condition. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). As an initial matter, the Board further notes that the record reflects the Veteran raised the contention of his service connection claims being etiologically related to exposure to the herbicide, Agent Orange, while serving on active duty during the Vietnam Era. See Form 9, June 2017. However, a review of the claims file, to include the Veteran's military personnel records, does not reveal any credible evidence of service in the Republic of Vietnam; and thus, the Board concludes that herbicide exposure cannot be conceded. As such, the Board will not address this contention in the service connection claims below. Service Connection Generally, to prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303 (a). When a claim for service connection is based on a period of ACDUTRA, there must be some evidence that the appellant became disabled as a result of a disease or injury incurred or aggravated in the line of duty during the period of ACDUTRA; or for inactive duty for training (INACDUTRA), there must be some evidence that the appellant became disabled as a result of an injury (not disease) incurred or aggravated in the line of duty during the period of INACDUTRA. Smith v. Shinseki, 24 Vet. App. 40, 47 (2010). Certain "chronic diseases" may be presumed to have been incurred during service if manifested to a compensable degree within one year of separation from active military service; however, if the evidence of the record is insufficient to establish a disease was chronic in service, and/or manifested within the specified time period, then there must be a continuity of disease symptoms shown after discharge in order to warrant service connection. 38 C.F.R. § 3.303(b). Entitlement to service connection for a heart condition (diagnosed as coronary artery disease). The Veteran contends that he has a current heart condition that is directly related to his service. As an initial matter, the Board notes that a review of the record reflects the Veteran was given a diagnosis of coronary artery disease (CAD) during the March 2021 VA examination. See C&P Exam, March 2021. As CAD is considered to be a "chronic disease" under 38 C.F.R. § 3.309(a), the Board finds that consideration of the Veteran's CAD claim for presumptive service connection is warranted. 38 C.F.R. §§ 3.307, 3.309. However, after review of the record, the Board finds that service connection is not warranted for the Veteran's CAD as a chronic disease under the provisions of 38 C.F.R. §§ 3.307 and 3.309, as the medical evidence establishes that this condition was first diagnosed in 2010, which is approximately 44 years after the Veteran's service. As noted above and in this case, chronic diseases, such as CAD, are only subject to presumptive service connection if manifested to a compensable degree within one year of separation from a period of active duty service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307 (a), 3.309(a). Additionally, the record does not reflect that a diagnosis of a CAD or any other heart disease was noted during service; nor does the record reflect that the Veteran has had continued CAD since service. Therefore, as the Veteran's CAD was not incurred until decades after service, with no probative evidence of continuity of symptomatology, presumptive service connection for this disability as a chronic disease is not warranted. The evidence of record also does not support a conclusion that the Veteran's CAD was etiologically related to his service. As mentioned above, the Veteran has a current disability of CAD, as shown by the medical evidence of record. However, the record does not reflect an in-service event, injury/disease, or incurrence for which to relate the Veteran's disability to. While the Board acknowledges the Veteran contention of his CAD being related to herbicide exposure, the Board reiterates that the record does not reflect credible evidence of service in the Republic of Vietnam, and thus, any alleged exposure to herbicides cannot be used as probative evidence of an in-service event, injury, or incurrence to satisfy the second prong of a service connection claim. The Veteran has written that he believes that he may have been involved in removing storage containers of herbicides that were going to be shipped to Vietnam, but this does not actually indicate that he came into any physical contact with an herbicide agent, and the Board finds there is no reasonable possibility that the Veteran could have substantiated exposure to herbicide agents. Therefore, as the Veteran has not provided any additional in-service event, injury, or incurrence for which to relate his condition to, the Board finds that the preponderance of the evidence of record is against the Veteran's claim; and the claim is denied. The only medical opinion of record, that of the March 2021 VA examiner, also weighs against the claim, as he found that the condition was less likely than not incurred in or caused by service, because the medical records did not show any heart condition in service. The Board finds this medical opinion to be adequate, as there are not actually any in-service events or injuries which could potentially be related to heart disease which the examiner needed to discuss. To the extent the Veteran's lay statements assert that his CAD is related to his service, his assertions do not constitute competent medical evidence, as he is a lay person without the requisite specialized knowledge and training to provide a medically complex opinion. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In reaching its determination, the Board has considered the doctrine of giving the benefit of the doubt to the Veteran, under 38 U.S.C. § 5107 and 38 C.F.R. § 3.102, but does not find that the evidence is of such approximate balance as to warrant its application. Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1991). The claim of entitlement to service connection for a heart condition is denied. REASONS FOR REMAND Entitlement to service connection for arthritis is remanded. The Veteran contends that he has arthritis that is directly related to his service, to include due to working on heavy equipment that resulted in him having a crushed and broken finger. In March 2021, the Veteran was afforded two VA examinations and a medical opinion to determine the nature and etiology of his claimed arthritis. Upon review of each, the examiner diagnosed the Veteran with bilateral shoulder sprain and degenerative disc disease other than intervertebral disc syndrome, however, provided an unfavorable opinion as to these conditions being etiologically related to his service. Nevertheless, the Board finds this opinion to be inadequate, as the examiner failed to provide an etiology opinion regarding the actual diagnosed conditions, to include any consideration of the Veteran's lay statements regarding the in-service cause of his conditions. In fact, the examiner only opined to the Veteran's arthritis, a condition that was not diagnosed in the record, nor doing the VA examinations. Additionally, the Board notes that the Veteran noted his arthritis was in his hand/finger, however, as of this date, no assessment has been made to determine whether the Veteran has arthritis in the hand/finger that is related to working on heavy equipment in service. Therefore, the Board finds that an addendum VA medical opinion is needed to adequately address the Veteran's diagnosed conditions, and a VA examination for possible arthritis in the finger/hand is warranted, prior to readjudication of the claim. The matters are REMANDED for the following action: 1. Request the Veteran to identify all medical providers (VA and private) from whom he has received treatment for his arthritis, shoulder and/or back condition, and obtain any outstanding records and associate them with the Veteran's claims file. 2. Schedule the Veteran for an orthopedic examination to assess the nature and etiology of any arthritis condition, including in his hands/fingers, shoulder, and spine. The entire claims file, including a copy of this remand, must be made available to the examiner, and note review of the record in the examination report. Any indicated tests or studies should be performed. All pertinent medical complaints, symptoms, and clinical findings must be reported in detail. The examiner must address: (a) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's shoulder strain had its onset during any period of ACDUTRA, or is otherwise etiologically related to his service, to include as due to lifting heavy. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's degenerative disc disease had its onset during any period of ACDUTRA, or is otherwise etiologically related to his service, to include as due to lifting heavy. (c) Identify any diagnosis related to arthritis in the Veteran's hand/finger. (d) For any diagnosed arthritis condition in the hand/finger, opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's condition had its onset during any period of ACDUTRA, or is otherwise etiologically related to his service, to include as due to lifting heavy. Any opinion should include a detailed rationale. The examiner should consider the entire claims file, and discuss the Veteran's lay statements regarding the nature, onset, and chronicity of symptoms. The examiner is advised that the Veteran is competent to report symptoms, and that his reports must be considered in formulating the requested opinion. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a full explanation why. Mary E. Rude Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Carter, 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.