Citation Nr: 21007234 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 16-23 501 DATE: February 9, 2021 ORDER Service connection for atrial fibrillation with rapid ventricular response is denied. Service connection for chronic obstructive pulmonary disease (COPD) is denied. Service connection for a disorder characterized by spondylosis is denied.   FINDINGS OF FACT 1. The Veteran’s atrial fibrillation and COPD were not related to service, to include herbicide exposure. 2. The Veteran did not have a diagnosed spondylosis disorder which is related to service, to include herbicide exposure. CONCLUSIONS OF LAW 1. The criteria for service connection for atrial fibrillation have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for COPD have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for a disorder characterized by spondylosis have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1969 to December 1970. He died in August 2019. The appellant is his surviving spouse and has been substituted in this appeal. The case is on appeal from an October 2015 rating decision. The claims came before the Board in October 2018 and were remanded for further development. The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran, the appellant and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(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.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases are presumed to be service connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there is no record of the disease during service. This presumption does not include atrial fibrillation and COPD. 38 U.S.C. § 1116; 38 C.F.R. § 3.309(e). 1. Service connection for atrial fibrillation with rapid ventricular response. The Veteran filed a September 2015 claim for atrial fibrillation with rapid ventricular response. This was followed by a November 2015 notice of disagreement (NOD) in which he asserted the disorder was related to his in-service Agent Orange exposure. The Board notes the Veteran had service in Vietnam and thus, exposure to herbicides, such as Agent Orange, is established. The medical evidence of record includes a March 2016 VA treatment record in which the Veteran was prescribed medication to control his elevated heartrate. The examiner attempted cardioversion and the Veteran’s rhythm converted to sinus bradycardia for a brief period of time and then converted back to atrial fibrillation with rapid ventricular response of 110-120. The Veteran’s VA treatment records include a history of EKGs which showed his atrial fibrillation goes back to approximately 2013. His VA treatment records include a February 2015 pulmonary function test (PFT) which showed severe obstructive ventilatory defect with air trapping and significant fvc bronchodilator improvement. The examiner noted the diffusion capacity is moderately reduced. Testing from November 2015 revealed left ventricular ejection fraction (LVEF) of 65 percent, normal systolic function and normal wall motion. A May 2017 PFT showed severe obstructive defect without change with bronchodilator, related to dyspnea and COPD. A February 2019 medical record indicated the Veteran has a past history of atrial fibrillation. The claim was remanded by the Board in October 2018 for further development, including a VA examination to determine the etiology of the disorder. As noted, the Veteran died in August 2019, while the claims were on appeal. The appellant submitted an October 2019 statement in which she indicated all the Veteran’s medical conditions were the result of his herbicide exposure in Vietnam. Thereafter, a VA opinion from a physician was obtained in June 2020 addressing the claim pursuant to the Board’s remand. The examiner indicated the Veteran’s atrial fibrillation is not related to service, to include his herbicide exposure. He reported that an electrocardiogram from July 2018 showed atrial fibrillation since 2013. The physician noted an August 2018 transthoracic echocardiogram showed a left ventricle of normal size and wall thickness, without regional wall motion abnormalities, and his LVEF was normal at 60-65 percent. The examiner opined that myocardial infarction was effectively ruled out due to the normal wall motion shown on the echocardiogram. The June 2020 VA examiner opined there is no plausible mechanism by which Agent Orange exposure would cause atrial fibrillation. He noted ischemic heart disease is caused by Agent Orange exposure and in the setting of a myocardial infarction, especially an acute myocardial infarction, atrial fibrillation may occur. He stated, however, that is not pertinent to this claim, as the Veteran has not been found to have myocardial infarction or ischemic heart disease. He indicated with a normal LVEF, the Veteran’s metabolic equivalents (METs) score due solely to cardiac functioning would be expected to be 10 or higher. He noted a PFT from September 2018 showed a severe obstructive defect, establishing COPD. The airflow limitation from COPD is the most likely cause of any exercise limitation and is a plausible cause of the atrial fibrillation, although he stated there are other possibilities that are not fully addressed in the records. The examiner reported one possible exception to the conclusion that exercise tolerance due solely to cardiac functioning would be 10 METs or higher, is grounded in the inability on echocardiography to measure left ventricular diastolic function. He indicated if the Veteran had markedly impaired diastolic function, his exercise tolerance due to cardiac functioning would be expected to be lower. He concluded there is no plausible mechanism in the clinical context by which Agent Orange exposure would have caused impaired left ventricular diastolic function. The Board determines service connection for atrial fibrillation with rapid ventricular response is not warranted. The most probative evidence of record does not support that the Veteran’s atrial fibrillation is etiologically related to his service, including his in-service herbicide exposure. The Board accords the most probative weight to the June 2020 VA physician’s opinion. The examiner addressed the Veteran’s contention and found that there is no plausible mechanism by which Agent Orange exposure would have caused impaired left ventricular diastolic function and atrial fibrillation. The Board finds the opinion to be highly persuasive as it is clear and unequivocal and based on the relevant evidence, including the Veteran’s medical records. The Physician’s opinion contains clear conclusions with supporting data and is consistent with the facts and information given. As such, the June 2020 opinion is entitled to significant probative weight. See Nieves-Rodriguez, 22 Vet. App. at 295 (2008). To the extent the Veteran or appellant were told by treating physicians that there was a connection, this represents low probative evidentiary value as there is no authored opinion with any rationale. The Board is sympathetic with the appellant’s contentions and also acknowledges the consistent assertions offered. However, the issue related to the etiology of the Veteran’s atrial fibrillation during his lifetime is a complex medical issue requiring training and expertise the appellant has not been shown to possess. See Jandreau v. Nicholson, 492 F.3d 1372, 1977 (Fed. Cir. 2007). Thus, for the reasons indicated above, the most probative evidence rests with the medical opinion from the June 2020 physician. In sum, the June 2020 medical opinion is the most probative evidence of record and weighs against the appellant’s claim, in particular the nexus element. The preponderance of the evidence is against the claim and the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As such, service connection for atrial fibrillation is not warranted. 2. Service connection for COPD. Following the September 2015 claim, the Veteran submitted a November 2015 NOD in which he asserted his COPD was related to his in-service Agent Orange exposure. A diagnosis of COPD was established during the Veteran’s lifetime, including in a March 2016 medical report. December 2018 and February 2019 VA treatment records also indicated a history of COPD. As noted, the claim was remanded by the Board in October 2018 for a VA examination to determine the and etiology of the Veteran’s COPD. Thereafter, the appellant submitted an October 2019 statement in which she indicated all the Veteran’s medical conditions were the result of his herbicide exposure. A June 2020 VA opinion was provided from a physician which indicated the Veteran’s COPD is not related to service, to include his herbicide exposure. He stated PFTs of record showed severe airflow limitation, suggestive of severe COPD, and COPD is listed as a problem throughout the record. He noted, however, Agent Orange exposure is not generally recognized as a cause of airway diseases, including COPD. The examiner reported the relevant medical literature related to the health consequences of Agent Orange exposure suggests exposure to herbicides, including Agent Orange, does not lead to COPD. He noted VA has determined based on relevant medical reports and studies that there is “inadequate or insufficient evidence to determine an association” between Agent Orange and COPD. Moreover, he indicated this applies to all non-cancerous respiratory conditions. He stated, “there is inadequate or insufficient evidence of an association between exposure to the COIs [compounds of interest] and mortality from all non-cancerous respiratory diseases or from COPD specifically. There is also inadequate or insufficient evidence of an association between exposure to the COIs and the prevalence of respiratory disorders.” Thus, the examiner opined it is less likely than not that the Veteran’s COPD is due to his in-service herbicide exposure. The Board determines service connection for COPD is not warranted. The most probative evidence of record supports that the Veteran’s COPD is not related to his in-service herbicide exposure. The Board accords the most probative weight to the June 2020 medical opinion provided by a VA physician. He provided a complete rationale in determining that the Veteran’s COPD is not etiologically linked to service. The opinion is predicated on a thorough review of the record, as the examiner reviewed and discussed the objective medical evidence. The physician’s opinion is logical and consistent with the facts and information given, as well as relevant medical literature and studies. See Nieves-Rodriguez, 22 Vet. App. at 295. To the extent the Veteran or appellant were told by treating physicians that there was a connection, this represents low probative evidentiary value as there is no authored opinion with any rationale. The Board acknowledges the Veteran’s lay statements during his lifetime, as well as those offered by the appellant. However, as lay persons, they have not been shown to have specialized training sufficient to render an opinion as to the etiology of the Veteran’s COPD, as such is a complex medical question. See Jandreau, 492 F.3d at 1372. Therefore, the Board accords greater probative weight to the June 2020 opinion than to the lay statements in support. Accordingly, the June 2020 medical opinion is the most probative evidence of record and weighs against the appellant’s claim, in particular the nexus element. The preponderance of the evidence is against the claim and the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As such, service connection for COPD is not warranted. 3. Service connection for a disorder characterized by spondylosis. The Veteran submitted a September 2015 claim for a disorder characterized by spondylosis. In his September 2015 claim form, he specifically stated “Frozen rotor cup C spondylosis.” In the November 2015 NOD, the Veteran asserts the disorder was related to his in-service Agent Orange exposure. In the May 2016 substantive appeal, the Veteran reported that his “frozen rotor cup” is due to Agent Orange exposure. He stated he is unable to have surgery to address this condition due to his other health problems. The claim was remanded by the Board in October 2018 for further development. The Board directed the RO to clarify with the Veteran the condition or conditions he was claiming characterized by “frozen rotor cup c spondylosis,” as well as how such disorder is related to service. A VA examination was also requested to determine the etiology of such condition. A July 2019 clarification letter was sent to the Veteran during his lifetime. No response was received and as noted above, the Veteran died shortly thereafter. However, the June 2020 VA examiner addressed the claim. He stated the available records do not support that the Veteran had a diagnosis of spondylosis during his lifetime. He noted imaging studies of the spine are not available and spondylosis is not listed in the problem list provided in the medical records. Further, he indicated a review of the VA Boston primary care clinic notes does not reveal spondylosis as an active problem. The Board finds service connection for a disorder characterized by spondylosis is not warranted. The record is not clear as to the specific condition the Veteran was claiming related to spondylosis. Moreover, the medical evidence does not support that the Veteran sought treatment during his lifetime for a disorder related to spondylosis and an active spondylosis diagnosis is not listed in the medical records. Furthermore, even if there was functional impairment of the lumbar spine, on further consideration, there is not even an indication that the condition is related to service. Thus, the preponderance of the evidence is against the claim and the benefit-of-the-doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As such, service connection for a disorder characterized by spondylosis is not warranted. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Isaacs, 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.