Citation Nr: A21020101 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 200713-96346 DATE: December 16, 2021 ORDER Entitlement to service connection for chronic heart failure is denied. FINDING OF FACT The preponderance of the evidence is against finding that a heart disorder began during active service or within one year of service, or is otherwise related to an in-service injury, event, or disease, to include exposure to environmental toxins. CONCLUSION OF LAW The criteria for service connection for chronic heart failure are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1976 to August 1989. In the July 2020 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. Therefore, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). The Board is bound by the favorable findings identified by the RO in its June 2020 rating decision. Specifically, favorable findings include the Veteran's diagnosis of congestive heart failure with cardiomyopathy and atrial fibrillation. Entitlement to service connection for chronic heart failure The Veteran contends that he is entitled to service connection for a chronic heart failure due to exposure to environmental toxins in service. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Certain chronic diseases, including cardiovascular disease, may be presumed to have been incurred during service if they become disabling to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Furthermore, in determining whether service connection is warranted for a disability, 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). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of matter, the benefit of the doubt will be given to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Service treatment records (STRs) are silent for any complaints, diagnosis, or treatment of a heart disorder. Private medical treatment records from March 2020 show the Veteran was hospitalized for several conditions, including a new onset of congestive heart failure. His provider noted that he is a poor historian and the only information he could provide was that he did not have any previous heart or kidney problems. The Veteran submitted a private opinion by Dr. K.B. in May 2020. She stated that the Veteran was diagnosed with chronic systolic congestive heart failure in March 2020 and requires close medical monitoring and medication and may need an implantable cardiac defibrillator in the future. She also noted the Veteran has a history of severe hypertension, which in her medical opinion is a result of injuries sustained during his years of military service as an infantryman. The Board notes, however, the Veteran is not service connected for hypertension. Further, the provider offers no nexus opinion linking the Veteran's heart condition at issue to service, nor does she provide an explanation of how his history of hypertension is related to service or his heart condition. Thus, the Board offers no probative value to this opinion. At the February 2021 Board hearing, the Veteran testified that his heart symptoms began in 2013. He stated he was getting very tired and could not do the things he used to do. In 2020, his body began to swell up and he was admitted to the hospital where his doctor told him he had heart failure. He stated that his doctor told him the cause of his heart failure was due to blood clots in his lungs and the "strenuous things he did". During service, he said he used to get tired like everyone else and had occurrences of some shortness of breath. He believed his heart condition was related to the military because he went into buildings for a long period of time with gas. The Veteran's private physician, Dr. K.B., who was also present at the Board hearing, stated that a big risk factor for congestive heart failure is high blood pressure, and that the Veteran has had high blood pressure for a long time. She also stated that chronic severe pain tends to drive up blood pressure and she believed that there was a logical connection between knee pain and heart failure. She believed that his knee pain was associated with hypertension, which caused his heart condition. In a March 2021 private medical opinion from Dr. F.G., he stated that the Veteran serviced, repaired, and flew in C123 aircrafts and the Veteran believes he was exposed to chemicals, including cleaning solvents, silica ducts, sand and smoke and diesel engine exhaust. He opined that there is a more likely than not causal nexus of his heart condition and military service. He stated that the Veteran incurred toxicant exposures during service, as he was exposed to aerosolized pollutants, including silica, dust, sand, smoke and diesel engine exhaust and low molecular weight cleaning solvents. He stated that he was more likely than not exposed to products of incomplete combustion through being stationed near burn pits. Dr. F.G. stated that these substances are absorbed trans-dermally, through inhalation and ingestion are substantially causal to his current and severe, advanced cardiopulmonary disease. He stated that exposure to low molecular weight organic pollutants as well as high molecular weight fat soluble toxicants during his military career formed the basis for toxicant injury leading to later severe cardiopulmonary disease. The examiner's opinion relies predominantly on the Veteran's alleged exposure to toxicants during service. The Board notes the Veteran was vague in describing his exposure at the Board hearing, alleging he was exposed to gas from being inside buildings. There is no specific evidence of record that the Veteran was exposed to gas or other chemicals, such as low molecular weight cleaning solvents, at any time during service. Further, there is no evidence in the personnel records, of the Veteran's proximity of duty station near burn pits during service. As exposure to toxicants, to include silica, dust, sand, smoke and diesel engine exhaust and low molecular weight cleaning solvents have not been shown, Dr. F.G.'s opinions are not probative. The Veteran submitted another medical opinion from Dr. K.B. dated March 2021. She stated that pain is perceived by the body as a stressor and will cause an elevation in blood pressure. She further explained that pain that is intractable and chronic, that is present constantly and for more than three months can cause hypertension by several different mechanisms. She stated that the Veteran has had very high blood pressure for many years despite being on multiple antihypertensive medications. Over the course of time, chronic hypertension causes progressive damage to a number of organs, such as the eyes, kidneys and blood vessels and it is an important independent risk factor in developing congestive heart failure. She opined that it was as likely as not that the chronic severe knee pain due to his 13 years of service, has been an important contributing factor to his severe hypertension and that his hypertension, in large part, over the course of many years contributed to the development of congestive heart failure. She stated that his heart muscle had simply worn out after pushing against a far too heavy resistance for too many years. She concluded that it is fair to state that congestive heart failure is actually connected to the Veteran's military service. The Board notes, however, that the examiner relies on an intermediate step of causation between knee pain and chronic heart failure, in that the clinician opined knee pain caused hypertension, which then caused chronic heart failure. However, the Veteran has recently been denied service connection for a knee condition and has not claimed the issue of service connection for hypertension. Thus, the medical opinion has no probative value. Based on the foregoing, there is no evidence that the Veteran's heart condition was manifested in service or to a compensable degree in the first year following his separation from service. Specifically, private treatment records indicate that the Veteran's treatment for a heart condition began over 30 years after separation from service. Significantly, by the Veteran's own admission, he denied previous heart conditions in March 2020. Consequently, service connection for a heart condition on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112), is not warranted. Service connection is also not warranted based on secondary service connection to a knee condition or hypertension, as the Veteran is not service connected for those conditions. Thus, the Veteran is precluded as a matter of law from entitlement to secondary service connection where the primary disability is not service connected. Lastly, service connection is not warranted based on exposure to environmental toxins. The Veteran vaguely stated he was exposed to gas in buildings; however, he did not provide any credible evidence of exposure to any toxicants, nor did he provide evidence of being stationed near burn pits. Although the Veteran believes his heart condition is due to service, he is not competent to render an etiology opinion for his heart condition. Therefore, his opinion cannot satisfy the nexus element of a service connection claim. In light of the foregoing, the Board concludes that the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for his heart disability. Accordingly, the appeal is denied. MICHAEL KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Jaigirdar, 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.