Citation Nr: 21008122 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 08-38 100 DATE: February 11, 2021 ORDER Entitlement to service connection for an enlarged heart (cardiomegaly) condition is denied. Entitlement to service connection for a heart murmur condition is denied. FINDINGS OF FACT 1. The Veteran’s enlarged heart is not productive of a disability for which service connection may be granted. 2. The Veteran’s heart murmur is not productive of a disability for which service connection may be granted. CONCLUSIONS OF LAW 1. The criteria for service connection for an enlarged heart have not been met.38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). 2. The criteria for service connection for a heart murmur have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from July 1973 to July 1976. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a March 2009 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In February 2014, the Veteran testified before the undersigned Veterans Law Judge during a Board video conference hearing. The Board notes these matters were previously before the Board in June 2013, April 2014 and July 2015 but was remanded for additional development. In a September 2016 Board decision, the Veteran’s service connection claims for a heart murmur and enlarged heart were denied. The Veteran appealed the September 2016 Board decision to the United States Court of Appeals for Veteran’s Claims (Court) in June 2017. In a joint motion for partial remand (JMPR), the Court vacated of the September 2016 Board decision and remanded the matters for an adequate VA examination for the Veteran’s heart murmur and enlarged heart. Accordingly, the Board remanded the Veteran’s claims consistent with the parties’ agreement in the June 2017 JMPR. These matters were again remanded in July 2018 and February 2019. In a November 2020 supplemental statement of the case (SSOC), his service connection claims for a heart murmur and enlarged heart disability were again denied. These matters are again before the Board for adjudication. Service Connection 1. Enlarged heart 2. Heart murmur The Veteran seeks service connection for an enlarged heart disability. Specifically, he asserts that at separation from the U. S. Army, he was told to go to the hospital because something was wrong with his heart. He stated that the medical providers found that he had an enlarged heart. See February 2014 Board Hearing. With regards to his heart murmur, he specifically asserts that he was told by a commanding officer that he had a heart murmur in service. See March 2010 Statement in Support of Claim. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after service, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). In order to establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) the 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 “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Service connection for certain chronic diseases, including certain heart disorders, may also be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). The cornerstone of a claim for disability compensation is the existence of a current disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). However, the Board has reviewed the record on appeal and can find no indication that the Veteran currently has a heart disability for which service connection can be granted. The Board acknowledges that the Veteran has been diagnosed with an enlarged heart and a heart murmur. However, such conditions are merely clinical finding and not a disability for VA purposes. VAOPGCPREC 82-90, 61 Fed. Reg. 20,440, 20, 445 (May 7, 1996). Further, there is currently no provision in the rating schedule to compensate for an enlarged heart or a heart murmur. 38 C.F.R. §§ 4.9, 4.104 (2019). Cf. Marcelino v. Shulkin, No. 16-2149, 2018 U.S. App. Vet. Claims LEXIS 64, at (Vet. App. Jan. 23, 2018). A review of his STRs also does not reflect that he complained of or was treated for any heart condition in service. There is also no evidence that he was diagnosed with any heart disability in service. While the Veteran contends that three to four days before separating from service, he was notified by his noncommissioned officer in charge (NCOIC) that something was wrong with his heart and to go back to medical, there remains no evidence or medical notation in his STRs or military personnel file of an abnormal report or evaluation of his heart prior to separation. Moreover, the Veteran’s separation examination noted a normal heart examination and the Veteran endorsed that his physical condition has not changed since his last final type medical examination. Subsequent post-service medical records also do not demonstrate that the Veteran’s enlarged heart has resulted in a diagnosable cardiac disability. Specifically, a cardiology stress test consultation following an abnormal EKG in September 2006 showed no evidence of any ischemic heart disease. See May 2013 CAPRI. Additionally, an October 2011 VA doctor noted the presence of the Veteran’s left ventricular hypertrophy, but subsequently noted that he had no significant valvular heart disease. A February 2015 computed tomography (CT) of his thorax further showed his heart was globally normal with no pericardial effusion, no filling defects of the central pulmonary arteries, and no aneurysmal dilation of the aorta or central pulmonary arteries. See September 2015 CAPRI. Pertaining to the Veteran’s enlarged heart, an October 2015 VA examiner noted the findings showing a left ventricular hypertrophy (LVH) in October 2011 and a myocardial infarction in July 2015. However, the VA examiner stated that his LVH was due to his obesity and that his myocardial infarction was due to an episode of transient hypotension from his medication for his benign prostatic hyperplasia (BPH). Additionally, a February 2018 VA examiner noted that his enlarged heart was due to his diabetes and obesity. The VA examiner also referenced the Veteran’s June 1977 chest x-ray findings indicating that his cardiac silhouette exhibited slight prominence of its transverse diameter and that it was probably at the upper limits of normal or borderline in size. However, the VA examiner stated that finding was still considered to be normal and that he was without symptoms until September 2006 when he was admitted to a VA medical center and treated for unstable angina. A November 2020 VA examiner, Dr. J. V-M., further reviewed the Veteran’s history of his heart conditions and stated that the June 1977 radiologist did not give an outright abnormal diagnosis of cardiomegaly and that his heart size was considered to be at the upper limits of normal. Dr. J. V-M. also stated that his chest x-rays in 2006, 2014, and 2018 did not show cardiomegaly and that enlargement of the left atrium was only described on the echocardiogram in 2018. Dr. J. V-M. Based on these findings, Dr. J. V-M stated that his cardiomegaly has not really existed. Dr. J. V-M further stated that the Veteran developed severe obesity, severe and uncontrolled diabetes, moderate hypertension, smoked, drank alcohol, and did some illicit drugs until 2004. The Veteran also had poorly uncontrolled diabetes and hypertension dating to at least the early 2000s. Dr. J. V-M stated that these factors as well as his elevated lipids resulted in his sub-endocardial infarction in 2005. Of importance, Dr. J. V-M noted that the Veteran was able to achieve 12.8 METS on the exercise treadmill test in September 2006 which was absolutely normal. Ultimately, Dr. J. V-M stated that regardless of little technical details, the fact is that whatever minor or borderline conditions the Veteran had, the functional result was zero as of September 2006, half a year after his small subendocardial myocardial infarction. Dr. J. V-M. further noted that he had absolutely normal aerobic exercise capacity. In concluding, Dr. J. V-M. stated that the Veteran had no real cardiac issues upon discharge from service and that it was not until much later that he began to “manifest the effects of hypertension, diabetes mellitus, and COPD in his heart (mild concentric LVH and LA enlargement).” Similarly, the Veteran’s heart murmur has not resulted in a disability upon which service connection may be granted. As indicated in a June 1978 VA examination for his heart murmur, the VA examiner noted the Veteran was able to climb 1 ½ flights of stair and walk the distance equivalent to two or three city blocks on a level surface before any dyspnea is experienced and he had no cardiac thrust. Moreover, in a May 2005 private treatment record, the Veteran reported having a heart murmur, but no heart defect was noted on examination. A February 2018 VA examiner further stated that the Veteran’s treatment records shows grade II/IV systolic murmur and that a grade II systolic murmur was heard during that VA examination. The VA examiner explained that murmurs can be related to need for increased blood flow to the heart as in pregnancy and exercise. The VA examiner also differentiated between the grade of heart murmurs stating that Grade I – II murmur are very faint and often missed on physical examinations and that higher-grade murmur are very loud. Grade I or II murmurs are also benign and do not cause harm and comes and go. While the VA examiner stated that heart murmurs can indicate a heart valve disease, the VA examiner stated the Veteran did not have a current heart valve disability. Additionally, in the November 2020 VA examination, Dr. J. V-M. reviewed the Veteran’s history of heart murmur and stated that while he may have had a heart murmur in his childhood to early teenage years, these were most frequently functional or “innocent murmurs” which disappears in time. Dr. J. V-M. further stated that several echocardiograms done later in life did not show any valvular disease or congenital disease. As previously discussed, the Dr. J. V-M stated that whatever minor or borderline conditions the Veteran had, his functional results were zero as of September 2006, half a year after his subendocardial myocardial infarction and that he had normal aerobic exercise capacity. Based on the foregoing medical evidence, the Board finds that the Veteran’s enlarged heart and heart murmur has not been productive of a heart disability for which service connection may be granted. While the Veteran’s claims file does reflect a diagnosis of a myocardial infarction, a February 2018 VA examiner attributed it to an episode of transient hypotension from his medication for his benign prostatic hyperplasia (BPH). More importantly, the medical evidence simply does not establish that his enlarged heart or heart murmur caused any other disabilities. Rather, the medical evidence tends to show that his uncontrolled diabetes, hypertension, and COPD caused his left ventricular hypertrophy condition. No evidence to the contrary has been submitted. The Board has further considered the Veteran’s lay statements regarding the onset of his enlarged heart and heart murmur. However, as previously stated, a heart murmur and enlarged heart in and of itself, is not a disability. VAOPGCPREC 82-90, 61 Fed. Reg. 20,440, 20,445 (May 7, 1996). Moreover, he has not demonstrated any specialized knowledge or expertise to indicate he is capable of rendering a competent diagnosis of a disability related to his enlarged heart or heart murmur. As such, the determination of a diagnosis falls outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, in the absence of proof of a present disability, there can be no valid claim (Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992)). For these reasons, the Board finds that the preponderance of the evidence of record is against a finding that the Veteran’s enlarged heart or heart murmur has resulted in a disability as defined by VA regulation. As such, entitlement to service connection for an enlarged heart or heart murmur is denied. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Xiong, 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.