Citation Nr: 21011411 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 17-64 139 DATE: March 1, 2021 ORDER Service connection for valvular heart disease is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, it is shown that his valvular heart disease is proximately caused by and aggravated by the service-connected Hodgkins disease and associated radiation treatment. CONCLUSION OF LAW The criteria for service connection for valvular heart disease have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran attended the United States Air Force Academy from June 1990 to May 1995. He further served on active duty from May 1995 to July 2015. In February 2021, a hearing was held before the undersigned Veterans Law Judge (VLJ). Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Secondary service connection is also warranted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Briefly, the threshold legal requirements for a successful secondary service connection claim are: (1) evidence of a current disability for which secondary service connection is sought; (2) a disability for which service connection has been established; and (3) competent evidence of a nexus between the two. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the appellant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Entitlement to service connection for valvular heart disease. The Veteran asserts that service connection is warranted for valvular heart disease, which he contends developed due to radiation treatment for service-connected Hodgkin’s disease. See November 2015 notice of disagreement. Considering the pertinent evidence in light of the governing legal authority, and resolving all reasonable doubt in the Veteran’s favor, the Board finds that service connection for valvular heart disease secondary to service-connected Hodgkin’s disease is warranted. As an initial matter, the Board notes that service as a cadet at the United States Military Academy is considered active duty military service. See 38 C.F.R. § 3.6(b)(4). Private treatment records show that the Veteran was diagnosed with a heart murmur in October 1985. Service treatment records (STRs) also show that the Veteran was diagnosed with flow heart murmur in May 1990, and that he was cleared for entrance to the United States Air Academy as a cadet. From November 1991 to December 1991, the Veteran underwent treatment for Hodgkin’s disease. An electrocardiogram (EKG) of the Veteran’s heart murmur conducted during this hospitalization showed a tri-leaflet aortic valve. On May 1995 entrance examination, the Veteran’s EKG showed a normal sinus rhythm, incomplete bundle branch block, early repolarization, and a borderline EKG. The Veteran’s STRs indicate he was diagnosed with aortic stenosis secondary to radiation induced valvulopathy in October 2012. In November 2012, the STRs note that the Veteran’s EKG showed fused leaflets, and it was unclear whether he had an underlying bicuspid valve as a cause. Notably, the clinician indicated that the Veteran’s medical records showed that the Veteran had a normal tri-leaflet aortic valve prior to radiation treatment. The clinician concluded that the Veteran had fused leaflets as a result of radiation therapy and was not a bicuspid aortic valve. Private treatment records show that the Veteran underwent an aortic valve replacement in December 2015. At this time, a permanent Pacemaker was required to treat a persistent high degree atrioventricular block. The Veteran is service-connected for residuals of Hodgins disease, which required radiation treatment. Such is sufficient to meet the first and second elements for secondary service connection. With regard to the remaining issue of whether a nexus exists between the Veteran’s current aortic valve disease and his service-connected Hodgkins disease, the Board finds it does. On June 2015 VA examination, the Veteran was diagnosed with valvular heart disease. The VA examiner noted that the Veteran was diagnosed with valvular heart disease in approximately September 2012. The VA examiner noted that the Veteran’s EKG showed aortic regurgitation, aortic stenosis, and abnormality of the bicuspid valve. The VA examiner opined that the Veteran’s valvular heart disease clearly and unmistakably existed prior to service and was clearly and unmistakably not aggravated beyond its natural progression by the radiation treatment for service-connected Hodgkin’s disease. The VA examiner stated for rationale that temporary aggravation was plausible, but there was no evidence of permanent aggravation of the valvular heart disease. In a January 2021 private medical opinion, the Veteran’s private cardiologist found that, after a thorough review of the Veteran’s medical record, it was his opinion that the Veteran’s current valvular heart disease was caused by the radiation treatment received for service-connected Hodgkin’s disease in August 1992. The private cardiologist noted that the Veteran presented with a normal functioning tri-leaflet aortic valve prior to radiation therapy in August 1992 during service at the U.S. Air Force Academy as a cadet. During the February 2021 Board hearing, the Veteran reported that several of his private medical clinicians had informed him that his current valvular heart disease was caused by the radiation treatment required for service-connected Hodgkin’s disease. The Veteran reported that the aforementioned radiation treatment occurred near his heart, which is where the tumor had been. The Veteran submitted a February 2021 private medical opinion at this time that was essentially the same as the January 2021 private medical opinion. After reviewing the evidence of record, the Board finds the January 2021 medical opinion from the private cardiologist to be highly probative. The private cardiologist based his opinion on a thorough review of the Veteran’s medical history and provided well-reasoned rationale. Furthermore, the Board finds the Veteran’s STRs indicating that the Veteran demonstrated a normal functioning tri-leaflet aortic valve prior to radiation therapy in August 1992 and then fused leaflets as a result of radiation therapy and was not a bicuspid aortic valve in November 2012 to be highly probative. Moreover, the Board finds the Veteran’s lay statements of record and hearing testimony to be competent and credible and are afforded much probative value. The Board acknowledges the June 2015 VA negative nexus opinion. However, the VA examiner did not address the December 1991 EKG demonstrating a normal tri-leaflet aortic valve prior to the radiation treatment for the service-connected Hodgkin’s disease. Moreover, the VA examiner found that the Veteran’s current valvular condition clearly and unmistakably existed prior to service; the Board finds that the Veteran’s current valvular disease was diagnosed in October 2012. As such, the Veteran’s valvular condition could not have been clearly and unmistakably diagnosed prior to active military service and was not noted on the entrance examination. As the June 2015 VA examination was based on an inaccurate factual premise, the medical opinion is afforded no probative value. Accordingly, the Board finds that the Veteran’s current valvular heart disease was proximately caused by or aggravated by the service-connected Hodgkin’s disease. Resolving reasonable doubt in the Veteran’s favor, service connection for a valvular heart condition is granted. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Griffin, 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.