Citation Nr: 21075209 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 09-30 331 DATE: December 17, 2021 ORDER Service connection for a heart disability as secondary to service-connected posttraumatic stress disorder (PTSD) and/or hypertension is denied. FINDING OF FACT The preponderance of the evidence shows that the Veteran's heart condition did not had its onset in service or is related to service or his service-connected disabilities. CONCLUSION OF LAW The criteria for service connection for heart condition have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from July 1979 to January 1990, with service in Korea from July 1981 to July 1982, and from October 1984 to October 1985. These matters come before the Board of Veterans' Appeals (Board) on appeal from a November 2007 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in October 2013, March 2017, December 2018, October 2020 and June 2021 and remanded for additional developments. Heart condition The Veteran seeks service connection for his heart condition. In support, the Veteran representative reports that his heart condition is related to service and his service-connected PTSD and hypertension. See Appellate Brief (November 2021). In general, service connection may be granted for a disability or injury incurred in or aggravated by active military service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) an 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. See Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be established by credible lay evidence and medical evidence provided by the Veteran or otherwise. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (2018). Service connection may also be found on a secondary basis where the following criteria is met: (1) a current disability that is not already service-connected; (2) at least one service-connected disability; and, (3) evidence that the non-service-connected current disability is either proximately due to or as the result of a service connected disability; or, aggravated by a service connected disability. See 38 C.F.R. § 3.310 (2018); see also El-Amin v. Shinseki, 26 Vet. App. 136 (2013); Allen v. Brown, 7 Vet. App. 439 (1995). In order to prevail under a theory of secondary service connection, the evidence must demonstrate an etiological relationship between (1) a service-connected disability or disabilities and (2) the condition said to be proximately due to the service-connected disability or disabilities. See Buckley v. West, 12 Vet. App. 76, 84 (1998); see also Wallin v. West, 11 Vet. App. 509, 512 (1998). In addition, secondary service connection may also be found in certain instances when a service-connected disability aggravates another condition. See Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. See Alemany v. Brown, 9 Vet. App. 518 (1996). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA's policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. See 38 U.S.C. § 1154 (a); 38 C.F.R. § 3.303 (a). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C. § 7104 (a) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). In June 2021, the Board remanded this issue with instructions for the examiner to indicate if the Veteran's heart condition is related, proximately due or aggravated by his service-connected PTSD and hypertension. In remanding this appeal, the Board noted that the contains February 2021 medical opinions addressing whether the Veteran's heart disability was caused or aggravated by his serviceconnected PTSD. The medical opinions, provided by the same examiner, state that the Veteran's claims folder was reviewed. Regarding causation, the examiner concluded that the Veteran's heart disabilities, valvular heart disease, bradycardia, and implanted cardiac pacemaker, are less likely than not due to his service-connected PTSD, as a review of medical literature does not show an association between PTSD and these heart diseases. The Board noted that as to aggravation, the examiner found that the Veteran's heart disabilities were less likely than not aggravated by his PTSD as a review of his medical records do not show such a relationship and there is no pathophysiological pathway between PTSD and his heart disabilities. In September 2021, the Veteran was provided a VA examination and the examiner noted that the Veteran has a diagnosis of valvular heart disease, implanted cardiac pacemaker and bradycardia. Additionally, the examiner opined that his heart condition was less likely than not incurred or caused by service and his service-connected PTSD and hypertension. The rationale was that there is no medical evidence or literature that indicates that PTSD can cause or aggravated bradycardia. The bradycardia etiology is unknown. Bradycardia has many possible etiologies including tissue damage to normal aging, congenital causes, infections, inflammatory conditions, and many other possible causes. The pacemaker implant was for treatment of bradycardia therefore is secondary to bradycardia. Also, medical records indicate that Veteran was diagnosed with bradycardia in 1995 requiring pacemaker implant in 1995. The medical records indicate hypertension was not diagnosed until 1998. Bradycardia and first pacemaker implant were prior to onset of hypertension therefore the hypertension could not have caused the bradycardia and pacemaker implant. Further, the examiner stated that there is no evidence that the valvular heart disease has increased in severity from baseline. The valvular heart disease is asymptomatic. It is possible that hypertension can aggravate valvular heart disease, however, there is no evidence of increased severity. Therefore, the valvular heart disease was less likely than not aggravated by the hypertension. See VA medical examination and Addendum (September and October 2021). The Board finds that the evidence does not show that the Veteran suffered from a heart condition or functional impairment in service or within one year after service. Additionally, the Board acknowledges that the September 2021 examiner opined that it is possible that hypertension can aggravate valvular heart disease, however, the examiner noted that there is no evidence of increased severity or aggravation in the Veteran's heart condition. See VA medical examination and Addendum (September and October 2021). Therefore, service connection is not warranted since the record does not show that the Veteran's heart condition started in service, or within one year after service, or was aggravated or proximately due by service or his service-connected disabilities. In light of the forgoing, the Board finds that the September 2021 VA examination and October 2021 addendum and the absence of medical evidence reflecting that his heart condition is related to service or proximately due, aggravated or related to his service-connected conditions to be persuasive and of the greatest probative value. It is apparent that the Veteran's heart condition is not related to service or his service-connected disabilities, thus, service connection is not warranted. As such, the preponderance of the evidence is against the claim of service connection. Therefore, the Veteran does not warrant service connection for his heart condition. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Alvarado- 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.