Citation Nr: 21077544 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 18-06 897 DATE: December 30, 2021 ORDER Entitlement to service connection for a heart disorder, to include ischemic heart disease, is denied. FINDING OF FACT The probative evidence of record does not reflect that the Veteran has ischemic heart disease or any heart disorder that was incurred in service or due to any incidents therein. CONCLUSION OF LAW The criteria for an award of service connection for ischemic heart disease have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 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 December 1967 to December 1970, including service in Vietnam. This issue is before the Board of Veterans' Appeals (Board) on appeal from a February 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2016, the Veteran requested a hearing before a decision review officer (DRO). However, in December 2017, he withdrew his request. In August 2021, the Veteran testified at a videoconference Board hearing before the undersigned Veterans Law Judge (VLJ). A copy of the transcript is of record. The Board notes that during the Veteran's Board hearing, he testified that he sought treatment in approximately 2000 for his heart disability. The Board finds no prejudice to the Veteran in not remanding for the RO to attempt to obtain these records considering that the Veteran testified that there were no records since he only saw the doctor once and at which time, the doctor did not touch him or diagnose him with anything. He testified that the doctor "just talked to me and pretty much kind of blew me out the door" because he was a smoker. Entitlement to service connection for ischemic heart disease is denied. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1131 (2012); 38 C.F.R. § 3.303. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity for certain diseases. 38 C.F.R. §§ 3.303 (a), (b), 3.309(a) (2018); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). To establish service connection for the claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163 (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 during the pendency of that claim." McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Presumptive service connection is available for ischemic heart disease as associated with exposure to herbicide agents listed under 38 C.F.R. § 3.309 (e) if the disease becomes manifest to a degree of 10 percent or more at any time after service. 38 C.F.R. § 3.307. The Veteran served in the Republic of Vietnam and is therefore presumed to have been exposed to herbicide agents. The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence considering the entirety of the record. The standard of proof to be applied in decisions on claims for veterans' benefits is outlined in 38 U.S.C. § 5107 (2012). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. Alemany v. Brown, 9 Vet. App. 518 (1996). The Veteran asserts that he has a heart disorder, to include ischemic heart disease, due to his exposure to herbicide agents in the Republic of Vietnam. The Veteran's service treatment records (STRs) are silent for any complaint, diagnosis of, or treatment for heart or chest complaints; nor does he so contend. The Veteran's separation examination in December 1970 noted a normal heart, with thrust, size, rhythm, and beats. A review of the Veteran's post-service private treatment records dated in June 2015 noted not an enlarged, but that "[c]oronary artery calcifications present indicating coronary artery disease." Treatment records dated in July 2015, indicate that the Veteran reported a history of heart disease. In June 2021, treatment records note a normal heart size and "[h]yperinflated lungs consistent with known advanced emphysematous changes." The Veteran was afforded a VA Heart Conditions: (Including Ischemic & Non-ischemic Heart Disease, Arrhythmias, Valvular Disease, and Cardiac Surgery) examination in December 2015. The medical history was noted to include a June 2015 private treatment record indicating hospitalization in May 2015 with a clinical picture consistent with sepsis. The examiner opined that the Veteran had "no chronic ischemic heart disease and that his acute cardiac injury of May 2015 was transient and did not result in permanent injury or decreased cardiac function. The [V]eteran's acute heart failure was transient and completely resolved, and [there are] no residuals from either condition." In arriving at his findings, the examiner explained that the Veteran was admitted for septic shock in May 2015, requiring ICU admission. He had acute kidney failure and demonstrated troponin leak with a reduced ejection fraction estimated at 45%. He had an equivocal nuclear stress test in the setting of acute illness. With the resolution of his illness, he underwent a dobutamine echocardiogram, where he had a normal EKG. He reached 95% of the maximum predicted heart rate. He had normal LV function and wall motion both at rest and with dobutamine, indicating no ischemia and no evidence of permanent ischemia/infarction. This normal echocardiogram suggests that the [V]eteran's troponin leak and decreased cardiac function were secondary to an acute mismatch between oxygen supply and demand. This is not uncommon in the setting of acute systemic illnesses such as sepsis and septic shock. This type of cardiac demand ischemia can happen even in the absence of significant coronary artery disease if the systemic insult is severe enough. The cardiologist's note indicates non-STEMI because demand ischemia is a diagnosis of exclusion; the follow-up TTE had not yet been performed to rule out coronary artery disease. In addition to the December 2015 VA examination findings, the Veteran testified during his August 2021 hearing that he was not sure that he had a heart condition and that he was not currently being treated therefor. He, however, had "a corroded artery that had nothing to do with his heart." He also has plaque and calcium in his heart and experiences irregular heartbeat, shortness of breath, and lightheadedness. Based on the evidence as reflected above, the Board finds that the Veteran does not have ischemic heart disease or any heart condition resulting from service or any incidents therein, including exposure to herbicide agents. Most probative are the findings of the December 2015 VA examiner, who determined that the Veteran's cardiac demand ischemia was a diagnosis of exclusion by his cardiologist. As a result of sepsis and septic shock, the Veteran developed cardiac demand ischemia, which per the examiner "can happen even in the absence of significant coronary artery disease." In support of his findings, the examiner acknowledged a review of the relevant evidence of record. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Further, there is no competent medical evidence of record that contradicts the comprehensive findings of the VA examiner. Board acknowledges that the Veteran is competent in describing irregular heartbeat, shortness of breath, and lightheadedness. Layno v. Brown, 6 Vet. App. 465, 470 (1994). His assertions are also credible. However, while he is deemed competent and credible to report observable symptoms, the specific issue in this case, is whether he has a heart disorder, including ischemic heart disease that is related to service or incidents therein, including herbicide exposure. Such a determination falls outside the realm of common knowledge of the Veteran. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428 (2011). Determining the etiology of a heart disability is a medically complex task and is not within the competence of the Veteran who, in this case, has not been shown by the evidence of record to have the training, experience, or skills needed to diagnose and determine the etiology of a heart disorder. As there is no competent, probative medical or lay evidence linking the Veteran's heart disorders to his service or any incidents therein, including herbicide exposure, service must be denied. In sum, the Board finds that while the Veteran is presumed exposed to herbicide agents because of his service in Vietnam, the probative evidence of record does not establish that ischemic heart disease manifested to a degree of 10 percent or more at any time after service. is a result of herbicide agent exposure. Therefore, presumptive service connection diseases associated with exposure to herbicide agents. 38 C.F.R. § 3.307 (a)(6); 38 C.F.R. § 3.309 (e). Additionally, there is no probative evidence that any heart disorder was incurred in service or manifested within one year of separation and continued. Thus, as there is no continuity of symptomology, service connection under 38 C.F.R. § 3.303 (b) is also not warranted. As such, the preponderance of the evidence is against the Veteran's service connection claim for a heart disorder, including ischemic heart disease. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Stevens, 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.