Citation Nr: 21075042 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 16-15 416 DATE: December 17, 2021 ORDER Entitlement to service connection for ischemic heart disease and arrhythmia is denied. FINDING OF FACT The Veteran does not have a current disability of ischemic heart disease, and no competent evidence links his arrhythmia to any event of service. CONCLUSION OF LAW The criteria to establish service connection for ischemic heart disease are not met. 38 U.S.C. § 1110, 1116, 5107; 38 C.F.R. § 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1966 to May 1970 and January 2, 1975 to January 17, 1975. This appeal comes to the Board of Veterans' Appeals (Board) from a September 2012 rating decision of the Department of Veterans' Affairs (VA) regional office (RO). The Veteran testified at a hearing with the undersigned in March 2021. The matter was remanded in June 2021 to attempt to obtain records from the Veteran's private cardiologist. In a June 2021 letter, VA asked the Veteran to identify and provide release forms for all relevant private providers. However, no response was received from the Veteran. The United States Court of Appeals for Veterans Claims (Court) has held, "[t]he duty to assist in the development and adjudication of a claim is not a one-way street." Wamhoff v. Brown, 8 Vet. App. 517, 522 (1996). "If a [claimant] wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence." Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). To the extent possible, VA has attempted to assist the appellant. Accordingly, no further attempts to assist the appellant are warranted. See Olson v. Principi, 3 Vet. App. 480 (1992). The appellant has not identified any additional outstanding records that have not been requested or obtained. The Board finds there was substantial compliance with its remand directive. Entitlement to service connection for ischemic heart disease, to include as due to herbicide exposure Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To establish a right to compensation for a present disability, a veteran 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"-the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). The requirement of a current disability is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed, or recent to or during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). The Veteran has a pacemaker, which has been present since August 2007, and underlying bradycardia and atrial fibrillation. VA treatment records show a diagnosis of arrhythmia. However, there is no medical evidence that the Veteran has a diagnosis of ischemic heart disease. While the Veteran believes he has a current disability of ischemic heart disease, the supporting evidence does not corroborate this assertion. Further, as the Veteran is a lay person who has not demonstrated medical expertise, he is not competent to provide a diagnosis of ischemic heart disease. The issue of diagnosing this disorder is medically complex and requires specialized medical education with the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Given the finding of no current disability of ischemic heart disease, the preponderance of evidence is against the Veteran's claims of entitlement to service connection for ischemic heart disease. Consequently, the benefit of the doubt doctrine does not apply, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As for the current diagnoses of bradycardia, atrial fibrillation, and arrhythmia resulting in use of a pacemaker, the Board explains below why the evidence does not show that these diagnoses are related to any event of service. In the absence of competent evidence of a nexus, the Board need not reach the second element of service connection (the question of whether the claimed in-service injury of herbicide exposure took place). Presumptive service connection is not available for bradycardia, atrial fibrillation, and arrhythmia, as they are not enumerated diseases listed in 38 C.F.R. § 3.309. Even though a disease is not included on the list of presumptive diseases, a nexus between the disease and service may nevertheless be established on the basis of direct service connection. Stefl v. Nicholson, 21 Vet. App. 120 (2007). When a claimed disorder is not included as a presumptive disorder, direct service connection may nevertheless be established by evidence demonstrating that the disease was in fact incurred during service. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). The Veteran's service treatment records (STRs) do not contain complaints, treatments, or diagnosis for this condition. The only evidence submitted to support the nexus element of service connection is the Veteran's own lay statement that his condition is related to herbicide exposure. The only suggested relationship between the current disability and active duty comes from the Veteran himself. While the Veteran may genuinely believe his current disability of bradycardia, atrial fibrillation, and arrhythmia are related to an event in service, as a lay person who has not demonstrated medical expertise, he is not competent to provide a nexus opinion relating this disability to any incident of service. Jandreau, 492 F.3d at 1377. VA did not provide a medical examination or obtain a medical opinion for this claim and the Board finds VA's duty to do so was not triggered. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159 (c)(4). This duty is only triggered if the record contains competent evidence or symptoms of a current disability; evidence establishing that an event, injury, or disease occurred in service, or a disease manifested during an applicable presumptive period; and an indication that the disability or persistent or recurrent symptoms of a disability may be associated with service or a service-connected disability. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, the only indication that the current disability may be related to an event in service is the Veteran's lay statement to that effect. The Court has held that, in circumstances similar to this, where the supporting evidence of record consists only of a lay statement, VA is not obligated, pursuant to 38 U.S.C. §5103A(d), to provide an appellant with a medical nexus opinion. See Duenas v. Principi, 18 Vet. App. 512, 519 (2004). Moreover, a conclusory generalized lay statement that a service event or illness caused the claimant's current condition is insufficient to require an examination under McLendon. Waters v. Shinseki, 601 F.3d 1274, 1278-79 (Fed. Cir. 2010) (rejecting appellant's argument that his "conclusory generalized statement that his service illness caused his present medical problems was enough to entitle him to a medical examination under the standard of [38 U.S.C. § 5103A(d)(2)(B).]"). A conclusory generalized lay statement that a service event or illness caused the claimant's current condition is also insufficient to establish medical etiology or nexus. Waters, 601 F.3d 1274. As there is no competent evidence of nexus, the third element of service connection is not met. Service connection cannot be established for bradycardia, atrial fibrillation, and arrhythmia and the claim is denied. LAURA E. COLLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Brewer, 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.