Citation Nr: 21008129 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 09-41 312 DATE: February 11, 2021 ORDER Service connection for a heart condition to include CAD, status post myocardial infarction, IHD, benign functional heart murmur, and chronic tachycardia is granted. Service connection for diabetes mellitus type II (DMII) is denied. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, her heart condition to include CAD, status post myocardial infarction, IHD, benign functional heart murmur, and chronic tachycardia is at least as likely as not related to an in-service injury, event, or disease. 2. The Veteran’s DMII was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for heart condition are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for DMII are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 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 in the United States Army from May 1979 to July 1984. These matters come to the Board of Veterans’ Appeals (Board) on appeal from rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded these matters in an April 2018. Following additional review of the matters the Board found it necessary to remand again. This matter was last before the Board in July 2020, at which time the Veteran’s claim was remanded. The Board finds that its remand instructions were substantially complied with. Stegall v. West, 11 Vet. App. 268 (1998). 1. Service connection for a heart condition The Veteran asserts that her heart condition is etiologically related to her active military 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). There is no dispute as to whether the Veteran has a current diagnosis of a heart condition. The medical evidence of record shows diagnosis of coronary artery disease (CAD), status post myocardial infarction, ischemic heart disease (IHD), benign functional heart murmur, and chronic tachycardia. As to an in-service incurrence, the Veteran’s service treatment records show abnormal ECG, benign functional heart murmur, and chest pain. The remaining question for the Board is whether the Veteran’s diagnosed heart conditions are causally related to her in-service abnormal ECG and benign functional heart murmur. The Board finds that the evidence weighing in favor and against the Veteran’s claim is at least in relative equipoise. Evidence weighing against the Veteran’s claim is a December 2019 examination report. In finding that the Veteran’s heart condition is not related to active service, the examiner noted there is only a couple of complaints of abnormal ECG and benign functional heart murmur while in service and not further complaints, so it was likely an acute process. Evidence weighing in favor of the Veteran’s claim is a September 2020 VA medical opinion. The examiner noted in-service Injury, Event or Illness of Heart murmur vs Functional in 11/14/1979, benign functional heart murmur in 02/21/1980 and pain in right chest in 02/01/1984. It was noted that the Veteran had no issues related to the claimed heart condition prior to military service as evidenced by the enlistment examination. The examiner stated that the current diagnosis of CAD, s/p myocardial infarction, IHD, benign functional heart murmur and chronic tachycardia is related to the Heart murmur vs Functional in November 1978, benign functional heart murmur in February 1980 and pain in right chest in February 1984 noted in the service treatment records. The examiner concluded that therefore the diagnosed CAD, s/p myocardial infarction, IHD, benign functional heart murmur and chronic tachycardia is at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed clinical onset of the heart condition during service. It was stated that a nexus has been established and that the diagnosed CAD, s/p myocardial infarction, IHD, benign functional heart murmur and chronic tachycardia is directly associated to the claimed clinical onset of the heart condition during service In finding that the Veteran’s heart condition is related to active service, the examiner noted in-service treatment of ECG, benign functional heart murmur, and pain in the right chest are related to the current diagnosed heart conditions. Following the September VA medical opinion, the RO requested an in-house VA examiner to review the opinion in October 2020. The review was requested because the RO decision maker was unable to understand the heart diagnosis being linked to the in-service benign functional heart murmur. The VA examiner stated she could not determine what diagnosis if any the LHI contract examiner is trying to link to the Veteran’s benign function murmur. The examiner further stated that functional murmurs do not cause any of the diagnoses given in the September 2020. The Board finds the two opinions to be probative as both contain rationales based on an accurate review of the record. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C § 5107. In view of the foregoing, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s heart condition to include CAD, status post myocardial infarction, IHD, benign functional heart murmur, and chronic tachycardia are the result of military service. In cases where the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-54 (1990). 2. Service connection for diabetes mellitus type II (DMII) The Veteran asserts that her DMII is a result of her active military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. 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). The Board concludes that, while the Veteran has a current diagnosis of DMII, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis began during service or is otherwise related to an in-service injury, event, or disease. A review of the Veteran’s service treatment records do not show any findings or diagnosis of diabetes in service. VA treatment records show the Veteran was not diagnosed with diabetes until October 1999. While the Veteran is competent to report having experienced symptoms of diabetes consistently since service, she is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of her service. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). VA examination opinions in December 2019 and September 2020 establish that the Veteran’s diabetes is less likely than not related to an in-service injury, event, or disease. The December 2019 examiner, following review of the record and physical examination of the Veteran, noted there are no medical records showing diagnosis or treatment for DMII during active duty. The examiner further noted there are no records showing symptoms of DMII beginning in service such as elevated fasting blood sugars on labs during service. The Veteran discharged in 1984 and was not diagnosed with DMII until 1999. The September 2020 examiner, following review of the record, noted the service treatment records do not indicate the Veteran was diagnosed or had DMII during service. The earliest documentation of blood sugar is nutritional screening with glucose results of 93 as of March 1993. The examiners’ combined opinions and rationales are probative, because they are based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Following consideration for a disability resulting from a disease or injury incurred in service, the Board takes note of a chronic disease presumed to be related to service. Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). As discussed in the evidence above, the Veteran’s DMII was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. The Board finds, for the reasons discussed, the preponderance of the evidence weighs against finding that the Veteran’s diagnosis of migraine headaches began during service or is otherwise related to an in-service injury, event, or disease. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Lang, Attorney Advisor 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.