Citation Nr: 21008326 Decision Date: 02/16/21 Archive Date: 02/16/21 DOCKET NO. 13-26 972 DATE: February 16, 2021 ORDER The claim of entitlement to service connection for a low back disability is denied. The claim of entitlement to service connection for a neck disability is denied. The claim of entitlement to service connection for a right knee disability is denied. The claim of entitlement to service connection for a left knee disability is denied. The claim of entitlement to service connection for bilateral hearing loss is denied. The claim of entitlement to service connection tinnitus is denied. The claim of entitlement to service connection for a heart disability is denied. FINDINGS OF FACT 1. The Veteran’s back disability is not related to his active duty service. 2. His neck disability is not related to his active duty service. 3. His right knee disability is not related to his active duty service. 4. His left knee disability is not related to his active duty service. 5. His hearing loss is not related to traumatic noise exposure during service. 6. His tinnitus is not related to service. 7. His diagnosed coronary artery disease and status post myocardial infarction are not related to heart murmur diagnosed during service, or otherwise related to his service. CONCLUSIONS OF LAW 1. The criteria are not met for service connection for a back disability. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria are not met for service connection for a neck disability. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310. 3. The criteria are not met for service connection for a right knee disability. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309. 4. The criteria are not met for service connection for a left knee disability. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309. 5. The criteria are not met for service connection for bilateral hearing loss. 38 U.S.C. §§ 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.385. 6. The criteria are not met for service connection for tinnitus. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309. 7. The criteria for service connection for a heart disability have not been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.311. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1972 to October 1974. Thereafter, he served in the Reserves. This appeal is from October 2012 and September 2013 rating decisions. In an October 2018 decision, the Board denied service connection for the back, neck, and bilateral knees. These denials were appealed to the U.S. Court of Appeals for Veterans Claims, which granted a joint motion of the parties to vacate them on the basis that the duty to assist had not been met. Specifically, the record suggested there were outstanding VA treatment records that were not associated with the claims file. In January 2020, the Board remanded the back, neck, and bilateral knees to the AOJ (agency of original jurisdiction) to obtain those records, which has been accomplished. Also, in the October 2018 decision, the Board remanded the Veteran’s claims for service connection for bilateral hearing loss, tinnitus, and a heart disability for additional development, which has been substantially completed. The Veteran has not raised any issue with the development taken, or alleged that any of the VA examination reports received since the October 2018 decision are inadequate. Accordingly, the Board may proceed with considering the merits of these appeals. Service Connection Service connection is granted for any current disability that is the result of a disease contracted or an injury sustained while on active duty service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for a disease diagnosed after discharge, where all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection also is permissible on a secondary basis for disability that is proximately due to, the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310. To prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and, (3) nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). As a threshold matter, the Board notes that the Veteran’s STRs are unavailable for review and have been found by the AOJ to be missing. The Board notes that the AOJ took the proper steps to locate the records and to notify the Veteran that they were not found. 1. The claim of entitlement to service connection for a low back disability is denied. The Veteran seeks service connection for a low back disability. He asserts it is related to an injury incurred due to his proximity to an explosion. In the alternative, he argues that he entered service with a preexisting back disability that was aggravated by his service. He reports that he has had back trouble since his service. The record shows the Veteran is diagnosed with degenerative joint disease of the lumbar spine. In regard to an incident or injury during service, the Veteran’s STRs are unavailable and presumed missing. There are, however, records available from 1975 and 1976 that are relevant, and which suggest the Veteran injured his back prior to service in a motor vehicle accident (MVA). But, as there is no entrance examination, there is no evidence that this condition was noted at this time and also considered to be a defect or disability. Further, as there are no records from active duty, there is no way to determine whether any such preexisting disability underwent an increase in severity. Accordingly, the Board finds the Veteran was sound upon his entrance into active duty service, and that the presumption of soundness applies. Accordingly, his arguments pertaining to aggravation of a preexisting disability are mooted. The Veteran has provided testimony that he was injured in an explosion at the Tower of London in July 1974. He reports that he was thrown approximately 30 feet when the blast occurred. He has submitted statements from his wife, brother, and friend, all of which indicate they knew the Veteran at the time of the incident and knew he had gotten hurt, or that he had spoken about the incident to them over the years. Based on this evidence, and in resolving doubt in his favor, the Board finds he was likely at the Tower of London when the explosion occurred. He separated from service in October 1974. However, after careful review, the Board finds the evidence does not establish that the Veteran was injured during the explosion. The record contains his Reserves STRs from just following active service. In April 1975, he reported having ongoing low back pain. He further reported that he hurt his back in a car accident in January 1972, and had been getting treatment for it since then, and might require surgery. An April 1975 letter from the Veteran’s then-treating physician indicated that the Veteran had been seeing that doctor for a “fairly serious” low back condition related to the January 1972 MVA, and that he had been diagnosed with spondylolysis of the L4 vertebra and a pars interarticularis separation of L5 vertebra with spondylolisthesis at the time of the accident. The letter continues that this old injury had been recently aggravated due to heavy lifting, and that the Veteran would need six months to bring it “under control.” An August 1975 radiologic report showed pars interarticularis defect at the L5 with spondylolisthesis. The August 1975 examination report shows an abnormal clinical evaluation of the spine because of the spondylolisthesis. The Veteran reported that his back had improved, and surgery was not necessary, but he was found not qualified for service, and advised to seek medical attention. In January 1976, he again reported that his back injury was from the MVA but had improved. The examining physician indicated that the Veteran had a back injury from the MVA but had been on active duty for two years after the injury without problems, and that it was not then-currently disabling. At no time did he mention being thrown 30 feet or suffering from a blast injury to examining and treating physicians. The Board finds that these Reserve STRs and the April 1975 letter from his treatment provider are more probative than the more recent statements made in connection with this claim in regard to the circumstances surrounding his back injury. The contemporaneous evidence, created with the purpose of ascertaining his then-state of physical fitness, shows he and medical personnel attributed his back pain to an MVA that occurred in 1972, over three years prior to the first available examination, and not to being thrown 30 feet in an explosion that occurred less than one year earlier. It shows aggravation of that injury due to a lifting injury, again with no mention of having recently been thrown 30 feet. Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the veteran); Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (observing that recourse to the Federal Rules of Evidence may be appropriate if it assists in the articulation of the reasons for the Board’s decision); see also LILLY’S: AN INTRODUCTION TO THE LAW OF EVIDENCE, 2nd Ed. (1987), pp. 245-46 (statements made to physicians for purposes of diagnosis and treatment are exceptionally trustworthy since the declarant has a strong motive to tell the truth in order to receive proper care). None of the Reserves records mention anything about any possible injuries from being thrown due to an explosion. The Board may use this silence in the medical records as contradictory evidence if the record is complete in relevant part and if the Board finds that the alleged injury ordinarily would have been recorded had it occurred. Kahana v. Shinseki, 24 Vet. App. 428 (2011). See also Bardwell v. Shinseki, 24 Vet. App. 36 (2010). Here, although his active duty STRs are missing, there are Reserves STRs that are dated starting from less than a year after the blast. They contain medical examination and medical history reports from April 1975, August 1975, and January 1976, and specifically address the Veteran’s back, including when and how it was injured. These history and medical reports are complete for that period of time, and thoroughly completed. Given the gravity of the injury as currently reported—as mentioned, he asserts he was thrown approximately 30 feet—the Board finds this would have been recorded or mentioned by clinicians. His treating physician who had worked with him since the MVA did not mention being thrown as a possible contributor to his symptoms or diagnosis in April 1975. Indeed, as discussed, the Veteran at that time reported that he had injured his back in an MVA years prior, not in an explosion mere months before. The Board finds this evidence to substantially weigh against the Veteran’s current statements attributing back injury to events the day of the explosion at the Tower of London. Further, the statements from the Veteran’s wife, brother, and friend do not adequately establish that he actually injured his back in the explosion. They did not witness the incident. They are not competent to report the Veteran’s personal history, but, in any event, their statements do not contain any details of how he was injured or what symptoms he had. Accordingly, although competent to report his own personal history, the Board does not find the reports of a back injury during the Tower of London bombing to be credible. Evidence more contemporaneous to the event does not mention it at all, and instead attribute the Veteran’s back problems to an MVA that did not occur during active duty. A blast injury likely would have been noted in the 1975 or 1976 reports and the Veteran’s reports from that time period, both because of the reported severity of the blast impact and that it had recently occurred, especially if it had caused him to have back problems, which he asserts since the filing of his claim that it did. The Board notes that the Veteran’s current treating physician provided positive nexus opinions relating the back to the blast, in October 2013 and February 2016, which are essentially the same. His doctor indicated that the bombing was a catastrophic injury for which the Veteran was treated at the hospital for amnesia and a concussion, and that treatment records “after the bomb blast” noted back pain. She opined that his current disability was related to the bombing. The Board notes that this opinion is inadequate and based on an inadequate factual background. Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005). The record does not show head injury, and the Veteran has not so alleged. He has never reported going to the hospital, but rather he has indicated that he went to sick bay or saw a corpsman after driving himself back to base. Further, the Veteran clarified during his personal hearing that his treating physician had copies of the same Reserves STRs that are of record. The Reserves records are dated starting approximately nine months after the bomb blast, longer than implied by the language of the treating physician’s opinion, which instead suggests there were records showing immediate complaints related to the bombing. Further, these records “after the bomb blast” to which she is referring do not mention the bomb blast, but rather refer to a pre-service MVA as the cause for the back pain. Finally, the opinion is based on the Veteran’s statements that he was injured in the bomb blast, which the Board has not found credible. Accordingly, this medical opinion does not establish a nexus to his service. The Board acknowledges the Veteran’s statements asserting continuity of symptoms since service, however, as discussed above, does not find that an injury occurred during service. The symptoms he had in 1975 were attributed to an MVA that did not occur during active duty. The Board has considered whether service connection is warranted on a presumptive basis for degenerative joint disease, which is arthritis, and which is considered a chronic disability. A service connection claim may be presumptively met for certain chronic diseases that manifest in service or within one year following separation from service unless the condition is clearly attributable to causes other than service. 38 C.F.R. § 3.309(a). Here, the Veteran does not contend nor does the evidence reflect that he was diagnosed with degenerative arthritis in service or within one year of service. Nor is there evidence to establish continuity of symptomatology, as the back pain the Veteran reported post active military service in August 1975 was attributed to spondylolysis and pars interarticularis, which was not noted at the January 1976 examination, and which has not been shown during the appeal period as a current disability. 38C.F.R.§3.303(b). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Board acknowledges the Veteran’s statements regarding a relationship between his back and his service, but has not found them credible as to the injury incurred. Further, he has not been shown to have the training or expertise to competently offer an opinion on the etiology of his back disability. Accordingly, the Board finds the preponderance of the evidence weighs against this claim, and it must be denied. The Board notes the Veteran had been provided a VA examination, and the resulting opinion was that the Veteran’s current disability is related to the MVA discussed in his Reserves STRs. This is not adequate as it is based on an inaccurate factual premise, that he had the MVA during service. The Board considered whether an updated VA examination was required prior to denying this claim, and finds that obtaining a medical opinion is not required. An examination is required when there is (1) evidence of a current disability, or persistent or recurrent symptoms of a disability, (2) evidence establishing an “in-service event, injury or disease,” or a disease manifested in accordance with presumptive service connection regulations occurred which would support incurrence or aggravation, (3) an indication that the current disability may be related to the in-service event, and (4) insufficient evidence to decide the case. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Here, the evidence does not establish an in-service event, or a disease manifested in accordance with presumptive service connection regulations, and therefore there is no indication of a relationship to service. Id. Accordingly, a medical opinion need not be obtained. 2. The claim of entitlement to service connection for a neck disability is denied. 3. The claim of entitlement to service connection for a right knee disability is denied. 4. The claim of entitlement to service connection for a left knee disability is denied. The Veteran asserts that his neck and bilateral knee disabilities resulted from his back disability resulted from the Tower of London bombing. In the alternative, he asserts that his neck is related to his back. The record shows the Veteran has a current neck disability of cervical stenosis with spondylosis and cervical myelopathy. He has arthritis in both knees. Initially, the Board finds that secondary service connection cannot be established via relationship to the back, as the Board has denied entitlement to service connection for the back. 38 C.F.R. § 3.310. In regard to whether the Veteran injured his neck and knees during the Tower of London bombing, the Board finds the preponderance of the evidence weighs against that. The Veteran has not provided any details of how he injured his neck or knees in the blast, or on whether he had any lingering symptoms thereafter. During his hearing, he testified that he was able to drive back to base and was treated for cuts and scratches, which is inconsistent with his assertion that the blast threw him 30 feet, causing injury to the neck, back, and knees. The April and August 1975, and January 1976, Reports of Medical History, do not show neck or knee complaints, but do show complaints regarding back trouble, vision trouble, head injury, and hay fever, among other complaints, which suggests he would likely have reported neck symptoms had they been present. AZ v. Shinseki, 731 F. 3d 1303, 1318 (Fed. Cir. 2013). Further, as discussed above, it is likely that the injury of being thrown due to a bomb blast within the preceding year or two would have been noted in his records. Kahana, supra. The statements from his brother, wife, and friend establish that he was at the Tower of London but do not establish a neck or knee injury. Similar to the back, the Board does not find that the evidence is at least in equipoise as to whether an injury to the neck or knees occurred during service. Without evidence of an injury during service, the Board need not proceed to whether there is a relationship between the current disability and the injury. 5. The claim of entitlement to service connection for bilateral hearing loss is denied. The Veteran is seeking service connection for hearing loss. For VA purposes, impaired hearing is considered a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or, when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. The Veteran is currently diagnosed with bilateral hearing loss. He attributes his hearing loss to traumatic noise exposure from doing construction work with the Seabees and the Tower of London bombing. The record shows he was a journalist during service, which is not commonly associated with acoustic trauma. However, his statements regarding working with the Seabees is credible, and there is nothing in the record that directly contradicts that. Further, he has been found to have likely been at the Tower of London bombing, which would likely cause acoustic trauma. The Board finds he has sufficiently shown that an acoustic injury occurred during service. Here, as discussed above, his STRs are unavailable, and therefore evidence on his hearing during that time are unavailable. His Reports of Medical History from April 1975, August 1975, and January 1976 do not contain complaints of hearing trouble. He was given a hearing test within the year following separation from service, in August 1975, which showed the following results: HERTZ Aug. 1975 500 1000 2000 3000 4000 RIGHT 10 5 5 / 10 LEFT 15 10 10 / 10 These results are normal, and do not show a hearing loss disability was diagnosed within a year of separation. The January 1976 examination contains the following hearing test results: HERTZ Jan. 1976 500 1000 2000 3000 4000 RIGHT 5 5 5 5 5 LEFT 5 5 10 10 5 The September 2012 VA examiner opined against a relationship to service, noting that his hearing was normal in January 1976, which was the last hearing test conducted for his service in the Reserves. The April 2019 VA examiner also opined against a relationship to service. She noted that he was a journalist in service, which has a lower probability of noise exposure, but also that he had been exposed to the bomb blast. She indicated that noise has a cumulative effect on the inner ear causing increased loss with greater exposure and that damage to the ears as a result of hazardous noise is measurable on an audiogram when the hazardous noise stops. She indicated review of the hearing tests from 1975 and 1976, and that his hearing thresholds were normal at each frequency in those tests, which were taken after he had ceased being exposed to the military noise. She indicated that the normal tests are evidence of having not sustained cochlear damage due to the in-service noise exposure. She indicated that despite the perceived loudness of the event, the effects of the bombing on the inner ears were objectively measured and shown to be insignificant on the anatomy of the ear. The examiner considered the Veteran’s statements of feeling like his hearing was impacted, but indicated that the hearing tests objectively show there was no cochlear damage. The examiner indicated that “awareness” of acoustic injury is subjective and, while injury or damage may not be noticed until after noise exposure, the testing done thereafter in this case objectively shows that there was not any damage done to his hearing by the claimed exposures. The Board finds this opinion is probative and weighs against service connection. There are no positive opinions linking hearing loss to his service. The Board has considered his statements regarding the etiology of his hearing loss but finds them less probative that the April 2019 VA examiner’s opinion, which explains why his in-service noise exposure is less likely than not the cause of his current hearing loss. The Board notes that she incorrectly identifies the hearing tests as occurring during active duty, but that this error does not affect the probity of her opinion, which is well-reasoned and premised on the fact that the tests after the noise exposure did not show damage. Monzingo v. Shinseki, 26 Vet. App. 97 (2012). The Veteran has not been shown to have the training or expertise to competently opine on the cause of his hearing loss. Indeed, the VA examiner explained why the Veteran’s theory of causation is less likely. The Veteran has not raised any objection to this most recent opinion. The Board notes that the Veteran was advised in the July 2020 SSOC (supplemental statement of the case) that the evidence did not show a relationship to service, but nothing has been received in response to this opinion. Accordingly, the preponderance of the evidence weighs against service connection. 6. The claim of entitlement to service connection tinnitus is denied. Tinnitus is defined as “a noise in the ears, such as ringing, buzzing, roaring, or clicking. It is usually subjective in type.” Dorland’s Illustrated Medical Dictionary, 1956 (31st ed. 2007). Because tinnitus is “subjective,” its existence is generally determined by whether the veteran claims to experience it. For VA purposes, tinnitus has been specifically found to be a disorder with symptoms that can be identified through lay observation alone. See Charles v. Principi, 16 Vet. App. 370 (2002). The Veteran complains of tinnitus and has been diagnosed with it. He asserts it is related to traumatic noise exposure during his service. Both VA examiners have attributed tinnitus to hearing loss; that is, it has been found to be caused by his hearing loss. Because hearing loss is not service connected, tinnitus cannot be secondarily service connected. 38 C.F.R. § 3.310. The April 2019 VA examiner also opined against a relationship to noise in service. She noted that none of the records she reviewed showed complaints of tinnitus, which generally manifests at the time of the noise exposure. She indicated he had not reported that it began during or right after service, but more recently. She indicated that as the time between the noise exposure and the onset of the symptoms occur, the possibility that it has been triggered by other causes increases, and for that reason, she opined that it was less likely that his tinnitus was related to noise exposure during service. The Board finds this opinion probative, as it is based on a review of the record and citation to medical literature, and that it outweighs the Veteran’s statements regarding a relationship, as he has not been shown to have the training or expertise to offer such an opinion. The Veteran may establish service connection via showing a continuity of symptomatology, as tinnitus is considered an “organic disease of the nervous system,” and therefore chronic. Certain chronic diseases, including tinnitus, are presumed to be related to service if shown in service or within a year of separation. 38 C.F.R. § 3.303(b). Walker, supra. Here, as mentioned above, the STRs are missing. Nonetheless, the Veteran has not asserted that his tinnitus began in service or within a year of separation. At the September 2012 VA examination, he said “many years,” but also that it began 4 to 5 years prior. In a November 2012 email, he said that he “now” had tinnitus from being around heavy construction, which he did not notice until recent years. In April 2013, he reported that he thought the blast caused his tinnitus, but he did not report when it started. In June 2013, he reported that he did not remember having it earlier than two years prior. At an April 2016 private hearing appointment, he denied having tinnitus. During his May 2016 hearing, he reported that he could not say that it started during his active duty service. This evidence does not establish tinnitus started in service and has continued since then; rather, it shows that it had an onset in 2007 or 2008, at the earliest. Accordingly, service connection may not be established via presumption of chronicity. In sum, the record is not in equipoise as to whether tinnitus is related to service, and this claim must be denied. 7. The claim of entitlement to service connection for a heart disability is denied. The Veteran asserts that his current heart disability is related to his service. He was diagnosed with a heart valve defect and heart murmur in service. He asserts he had continuing symptoms in the heart from service until his current diagnosis. He asserts, in the alternative, that his current diagnosis is related to exposure to herbicides or ionizing radiation. He is diagnosed with coronary artery disease (CAD), and he is status post myocardial infarction. His STRs show that, in September 1974, just prior to separation from active duty, he was referred for evaluation for a heart murmur and click. The record notes that he was healthy and asymptomatic. Examination revealed no S3 or S4 sounds but loud systolic ejection click, and no diastolic murmur was noted. He was diagnosed with a bicuspid aortic valve, and given prophylaxis against subacute bacterial endocarditis. His April 1975 report of medical history shows he complained of a history of heart trouble. The examining clinician clarified that he was diagnosed with heart murmur. In August 1975, he reported history of heart trouble, and was noted to have a history of heart murmur, which the examining clinician noted was probably functional. In January 1976, he again reported a history of heart trouble, and the examining clinician again clarified he had a history of functional heart murmur that was not then-currently disabling. The August 1975 and January 1976 reports of medical examination shows normal clinical evaluations of the heart, including thrust, size, rhythm, and sounds. The remaining inquiry is whether there is a relationship between his current disability, and the murmur diagnosed during service. The April 2019 VA examiner noted the Veteran reported that he had chest pain while in service, and evaluation revealed a “heart problem,” but he denied being prescribed any medication or being medically discharged from the service. He reported that he did not have any trouble with his heart until 2007, when he was evaluated for chest pain. She opined against a relationship. She noted that review of the evidence show that his heart was evaluated during service due to auscultation of abnormal heart sounds, but that he was asymptomatic for any other issues. She noted that his STRs show he was diagnosed with bicuspid heart valve, but that he has had multiple cardiac evaluations since separation from service, and bicuspid heart valve has not been shown again. She indicated that a normal aortic heart valve has three parts, but that rarely, while in the womb, the heart only develops two parts instead of three, and that is called a bicuspid valve. Bicuspid valves are congenital. She indicated the Veteran still had the abnormal heart sounds today, which were documented in the STR, but that there is no structural abnormality of the heart. Rather, his abnormal heart sounds are just a normal variant for the Veteran. She noted that the available records showed no indication of CAD during service or in the year following separation. She noted that the record shows the onset of CAD was in February 2007, which is 30-years after separation, and therefore she found it less likely than not that his current disabilities are related to service. The Board finds this opinion probative. The Board has considered whether service connection is warranted on a presumptive basis for CAD based on continuation of symptoms. The Veteran has reported that he had chest pain during service and continued to have those symptoms until diagnosed with CAD in 2007. Unfortunately, establishing a link to service is only applicable to disabilities that have been explicitly recognized as “chronic” under 38 C.F.R. § 3.309(a). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In any event, CAD was not diagnosed during service or in the years thereafter, and it has not been related to the heart murmur diagnosed during service, so a continuity of symptoms has not been established. The Veteran has complained of persistent chest pain, but he has not been shown to have the training or expertise to identify the cause of any chest pain that he had prior to CAD’s diagnosis in 2007. Nor does he have the training or expertise to relate his current CAD to the heart murmur diagnosed during service. These theories have been investigated by the VA examiner and found less likely. As mentioned above, the Veteran has not raised any issue with April 2019 VA examination or opinion. The Board finds the VA examination opinion more probative than the Veteran’s statements regarding a relationship to service. In regard to the Veteran’s aortic valve, the Board finds that service connection for bicuspid valve is not warranted. Primarily, it is no longer a current diagnosis, which is required for service connection. Secondarily, it is a congenital defect for which service connection is not available. 38 C.F.R. § 3.303(b). The Board also does not find service connection for CAD or status post myocardial infarction to be warranted based on potential exposures. The Veteran’s current heart disabilities are considered ischemic heart disease, for which service connection is presumed in Veteran’s who have been exposed to certain herbicides. 38 C.F.R. §§ 3.307(a)(6), 3.309(e). The Veteran has asserted a the “possibility” of being exposed to herbicides, as he was around transport planes while serving during the Vietnam Era. However, he served in Europe, and not in or near Vietnam, the Korean DMZ, or any air force bases in Thailand, for which there are provisions regarding presumed and accepted herbicide exposure. His service does not meet the criteria to benefit from those provisions, and he has not otherwise shown that he was exposed. Accordingly, service connection based on exposure to herbicides is denied. He has reported that his heart disability could be related to radiation exposure while serving in Edzell, Scotland. He has submitted information that shows potential radioactive waste at Edzell. He has also submitted a medical study regarding cardiac disabilities brought on by radiation therapy used to treat cancer. There are special developmental procedures for claims based upon exposure to ionizing radiation. 38 C.F.R. § 3.311. For radiogenic diseases, which does not include CAD and status post myocardial infarction, development must be undertaken to determine a level of exposure. 38 C.F.R. § 3.311(b)(1), (b)(2). For claims based upon diseases that are not considered radiogenic diseases, VA must develop the claim under the provisions if competent evidence has been received that the claimed condition is a radiogenic disease. 38 C.F.R. § 3.311(b)(4). Here, there is no competent evidence that the Veteran’s CAD is related to possible radiation exposure during service. None of his cardiac treatment records show or suggest that the Veteran’s CAD was induced by any such exposure. The medical article the Veteran submitted regarding a relationship between different cardiac disabilities and radiation therapy does not adequately address the facts of this case with any degree of medical certainty to reasonably suggest that his CAD was caused by potential exposure in service. Indeed, that study pertained to exposure in a clinical setting in patients suffering from cancer, as opposed to environmental exposure to a young man who was accepted into military service and not suffering from cancer. Sacks v. West, 11 Vet. App. 314, 317 (1998). There is simply no competent evidence showing or strongly suggesting that the Veteran’s CAD is related to any possible radiation exposure, let alone to exposure during service, and it cannot be granted on this basis. Accordingly, service connection is not warranted for heart disability. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Gibson 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.