Citation Nr: 21006043 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 18-21 354 DATE: February 3, 2021 ORDER Entitlement to service connection for a heart disability, to include as secondary to service-connected disease or injury is denied. FINDING OF FACT 1. A heart disability, coronary artery disease, did not manifest in service and is not attributable to service; coronary artery disease did not manifest within one year of separation from service. 2. A heart disability is not caused or aggravated by service-connected disease or injury. CONCLUSION OF LAW 1. A heart disability was not incurred or aggravated during service, nor may coronary artery disease be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. A heart disability is not proximately due to or the result of (causation or aggravation) a service-connected disease or injury. 38 C.F.R. § 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1974 to March 1980. In April 2020, the Board of Veterans Appeals (Board) reopened the issue of entitlement to service-connection for a heart disability and remanded this issue back to the VA in order to obtain an addendum medical opinion. The Board requested an addendum medical opinion on whether the Veteran’s coronary artery disease was aggravated by his service-connected depressive disorder. 1. Entitlement to service connection for coronary artery disease, to include as secondary to depressive disorder Veterans are entitled to compensation if they develop a disability “resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty.” 38 U.S.C. §§ 1110 (wartime service), 1131 (peacetime service). To establish entitlement to service-connected compensation benefits, 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.” See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). For certain chronic disease, including cardiovascular-renal disease or arteriosclerosis, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. With chronic disease shown as such in service (or within the presumptive period under § 3.307) so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected unless clearly attributable to intercurrent causes. This rule does not mean that any manifestation of joint pain, any abnormality of heart action or heart sounds, any urinary findings of casts, or any cough, in service will permit service connection of arthritis, disease of the heart, nephritis, or pulmonary disease, first shown as a clearcut clinical entity, at some later date. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection is also warranted for disability which is proximately due to, aggravated by or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(b). For secondary service connection to be granted, generally there must be (1) evidence of a current disability; (2) evidence of a service-connected disease or injury; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). The Veteran contends that his coronary artery disease is proximately due to, aggravated by or the result of his service-connected depressive disorder.   Direct Service Connection The Board notes that the Veteran has a documented history of coronary artery disease. See, e.g., a VA examination report dated April 26, 2017. To the extent that the Veteran contends that his coronary artery disease is related to service the Board finds that the objective evidence outweighs this contention. Crucially, the Veteran’s service treatment records indicate no suggestion of treatment for or complaints of symptoms related to a heart disability. Additionally, his separation examination dated February 1980 indicated normal examination of the heart and normal blood pressure reading. He denied a history of heart trouble, high or low blood pressure. The chest X-ray examination was determined to be negative for pathology. A January 1981 VA examination stated that the Veteran had a finding of incipient and labile hypertension. For VA purposes, hypertension, at minimum, refers to “Diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control.” 38 C.F.R. § 4.104, Diagnostic Code 7101. The Board finds that, based on this observation, the Veteran does not meet the minimum criteria for hypertension and did not manifest hypertension to a degree of 10 percent at that time. The Board observes that lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person (e.g. any evidence not requiring that the proponent has specialized education, training, or experience). 38 C.F.R. § 3.159(a)(2). As such, the Veteran can competently testify about symptoms he experienced in service. However, competency must be distinguished from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Layno v. Brown, 6 Vet. App. 465, 469 (1994). In the present case, the Board finds that the Veteran’s history of a heart disability since service is outweighed by the objective evidence of record in light of the lack of any post service identification within a year of service as well as the available service treatment records which indicate normal findings with regard to the heart and blood pressure. Therefore, to the extent that the Veteran contends that his heart disability and hypertension manifested during service, this lay evidence is at odds with the remainder of the record, which reflects normal findings during service and his denial of pertinent pathology. As such, the Veteran’s statements are lacking credible probative value. See Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) [VA cannot ignore a veteran’s testimony simply because the veteran is an interested party; personal interest may, however, affect the credibility of the evidence]. In short, there is no credible evidence of an in-service manifestation of a heart disability. In addition, there is no evidence of such pathology to a degree of 10 percent within one year of separation. Notably, the first manifestation of heart disease was 2008, nearly 28 years after the Veteran’s separation from service. See Heart Conditions (Including Ischemic and Non-Ischemic Heart Disease, Arrhythmias, Valvular Disease and Cardiac Surgery)- Disability Benefits Questionnaire, dated May 20, 2020. To the extent that the Veteran asserts that his heart disability is related to service, the Board finds that the Veteran’s statements regarding this disability being incurred in service are outweighed by the objective evidence of record to include the service treatment records and the post service medical records. The Board also notes that while the Veteran currently evidences coronary artery disease, in as much as the service treatment records reveal normal examinations, he did not have characteristic manifestations sufficient to identify the chronic disease entity during service or within one year of separation. 38 C.F.R. § 3.303(b). Secondary Service Connection A VA examiner saw the Veteran in April 2017 and reviewed his medical file. When asked if the Veteran’s coronary artery disease is at least as likely as not proximately due to or the result of his depressive disorder, the examiner stated that it was not. The examiner rationalized that “coronary disease is caused by lifestyle and hereditary influences and is not secondary to psychological depression.” A VA examiner produced an addendum medical opinion in May 2020 regarding aggravation of the Veteran’s coronary artery disease by his depressive disorder. The examiner stated that the Veteran’s baseline level of severity of his coronary artery disease could not be determined because the medical evidence was not sufficient to support a determination of a baseline level of severity. However, the examiner concluded that the Veteran’s coronary artery disease was less likely than not aggravated beyond its natural progression by the Veteran’s depressive disorder. The examiner reasoned that “psychiatric conditions are not known to directly contribute to worsening cardiac function.” In adjudicating a claim, the Board is charged with the duty to assess the credibility and weight given to evidence. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). The probative value of a medical opinion primarily comes from its reasoning; threshold considerations are whether a person opining is suitably qualified and sufficiently informed. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In this case, the Board accepts the April 2017 and May 2020 VA medical opinions that the Veteran’s coronary artery disease was not proximately due to, the result of or aggravated by depressive disorder as highly probative medical evidence on this point. The Board notes that the examiner rendered these opinions after thoroughly reviewing the claims file and relevant medical records. The examiner noted the Veteran’s pertinent history and provided a reasoned analysis of the case. See Hernandez-Toyens v. West, 11 Vet. App. 379, 383 (1998); Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994). The Board finds these medical opinions to be highly probative as they are adequately supported by additional rationale, particularly expressing the examiners’ knowledge of the effects of depressive disorder. The Board has considered the lay statements of the Veteran regarding secondary service connection. The Veteran is competent to provide evidence of what he experiences, including his symptomatology and medical history. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Veteran is competent to report what he experienced. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the Board does not find his statements to be as probative as the VA examiners’ opinions, which were based on extensive review of the record, thorough examination, consideration of the lay statements, and the VA examiners’ medical expertise. Notably, the Veteran has not indicated that a medical professional provided him with a diagnosis of a heart disability during active service, or within a year of separation or that there is a relationship to service-connected disease or injury. For the reasons and bases expressed above, the Board finds that the preponderance of the evidence is against the Veteran’s claims of entitlement to service connection for a heart disability, to include as secondary to service-connected disease or injury. The benefits sought on appeal are accordingly denied. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jonah Nelson, 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.