Citation Nr: 21007072 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 13-00 163 DATE: February 8, 2021 ORDER Entitlement to service connection for a heart disability separate and distinct from cardiac arrhythmia is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran’s hypertension began during service, or is otherwise related to an in-service injury or disease. 2. The preponderance of the evidence is against finding that the Veteran’s sinus bradycardia, began during service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a heart disability separate and distinct from cardiac arrhythmia have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from July 1964 to April 1970. In April 2015, the Board remanded this matter for further development. In August 2017, the Board issued a decision denying the claim appeal. The Veteran appealed to the U.S. Court of Appeals for Veterans Claims (Court). In a January 2019 Memorandum Decision, the Court set aside the Board’s August 2017 decision and remanded for further proceedings consistent with the Memorandum Decision. In September 2019 and in September 2020, the Board remanded this matter. 1. Entitlement to service connection for a heart disability separate and distinct from cardiac arrhythmia. The Veteran essentially contends he has a heart disability, including hypertension and sinus bradycardia, that is separate and distinct from his service-connected cardiac arrhythmia, and had an onset during his active 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, 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). The question for the Board is whether the Veteran has any current heart disability, separate and distinct from cardiac arrhythmia, that began during active service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of hypertension, the preponderance of the evidence weighs against finding that hypertension began during service or is otherwise related to an in-service injury, event, or disease. The Board also concludes that, while there were findings of sinus bradycardia in service and on EKGs in 2011 and 2015, the preponderance of the evidence weighs against a finding that his sinus bradycardia is a heart disability that began during service or is otherwise related to an in-service injury, event, or disease. Service connection requires a showing of a current disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The Board also notes that the Veteran’s sinus bradycardia does not result in functional impairment of earning capacity. Saunders v. Wilkie, 886 F.3d 1356 (Fed.Cir. 2018). Review of the record includes service treatment records showing that in May 1966, the Veteran was hospitalized for cardiac arrhythmia. An electrocardiogram (EKG) revealed a basic rhythm of sinus bradycardia with frequent ventricular, nodal, and atrial ectopic beats. A Lead II rhythm strip following exercise revealed the development of a normal sinus rhythm. He remained asymptomatic during his hospital stay. At discharge in June 1966, his diagnosis was revised to “medical evaluation for a specified problem; no disease found.” VA treatment records show that in 1977, the Veteran was hospitalized for joint and muscle aches and weight loss. He reported palpitations of 8 months duration. A cardiology consultation revealed PACs (premature atrial contractions) on an EKG, and the assessment was PACs, possible question of atrial tachycardia by history. At discharge it was noted that the EKG showed nonspecific abnormalities, and the assessment was possible rhythm disturbance, PACs, anxiety. Additionally, VA treatment records show that the Veteran was not diagnosed with hypertension until May 2016, and elevated blood pressure readings were first noted in January 2016, which is approximately 46 years after his separation from service. EKGs conducted in conjunction with the VA examinations in 2011 and 2015 showed sinus bradycardia. Further, on a January 2020 report, the VA examiner noted there were EKG documentations in post-service records showing that the Veteran had asymptomatic sinus bradycardia with heart rates in the mid to upper fifties. The examiner indicated the Veteran was not aware of any symptoms or triggers when his heart rate was below 60 bpm (beats per minute), and that sinus bradycardia, when mild and asymptomatic, could be considered within normal physiologic tolerances. The examiner noted that episodes of asymptomatic sinus bradycardia were documented and within normal limits for this Veteran, noting that in the 2011 VA examination, the Veteran had stated his wife was a nurse who checked his vital signs regularly, and his pulse was usually between 50-60 bpm. The examiner noted the Veteran did not describe lightheadedness, fainting, or shortness of breath, that would be described with pathologic bradycardia, and that a heart rate of 50-60 bpm (or even lower) was considered normal, if asymptomatic. The examiner explained that for some people, including the Veteran, bradycardia did not cause symptoms or complications, such as PSVT (paroxysmal supraventricular tachycardia), and opined that therefore, the Veteran’s episodes of sinus bradycardia did not represent a functional disability. The examiner also opined that although sinus bradycardia was a separate and distinct condition from PVST, it did not first manifest in service, was not a functional disability that would be considered pathology, and did not result from, nor was it aggravated by, PVST. The January 2020 VA examiner’s opinion is probative as to whether the Veteran’s sinus bradycardia is a heart disability separate and distinct from cardiac arrhythmia because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Additionally, the examiner cited medical sources to support the opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). With regard to hypertension, on a VA examination report in September 2020, the examiner opined it was less than likely that the Veteran's hypertension was incurred in or aggravated by service, citing for rationale that no elevated or high blood pressures were found in service treatment records, and that it was most likely his hypertension was due to advancing age and marked weight gain, which were major risk factors for the development of hypertension. The examiner noted no other aggravating factors that were related to the development of hypertension. The Board finds that the January 2020 VA examiner’s opinion is probative as to whether the Veteran’s hypertension is related to service because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, supra. While the Veteran is competent to report having experienced any symptoms since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of a heart or cardiac disability. Further, the Board acknowledges that the Veteran believes his sinus bradycardia and/or hypertension are related to an in-service injury, event, or disease. However, the Veteran in this case is not competent to provide a medical nexus opinion regarding this issue. As noted above, the issue is medically complex, and is therefore outside the competence of the Veteran because the record does not show that he has the medical training or credentials to make such a determination. Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examiner’s medical opinions. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Casula 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.