Citation Nr: 21022930 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 18-40 260 DATE: April 19, 2021 ORDER Entitlement to service connection for hypertension, to include as due to herbicide exposure, is denied. Entitlement to service connection for atrial fibrillation, to include as due to herbicide exposure, is denied. FINDINGS OF FACT 1. The weight of the competent and credible evidence is against finding that the Veteran’s hypertension manifested in service or within one year of service; and hypertension is not etiologically caused by an in-service injury, event or disease. 2. The weight of the competent and credible evidence is against finding that the Veteran’s atrial fibrillation manifested in service or within one year of service; and atrial fibrillation is not etiologically caused by an in-service injury, event or disease, or otherwise etiologically secondary (caused or aggravated) to a service connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309 (2020). 2. The criteria for service connection for atrial fibrillation have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.309, 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from May 1966 to April 1968 with service in the Republic of Vietnam. These matters come before the Board of Veterans’ Appeals (Board) from a January 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Previously, the Veteran’s claims were most recently before the Board in December 2020 and were remanded for additional development. The Board finds there has been substantial compliance with the prior remand directives, and as such the claims are again properly before the Board. See Stegall v. West, 11 Vet. App. 268, 271 (1998). SERVICE CONNECTION A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. §§ 1110, 1131. To establish a right to compensation for a present disability, a Veteran must show: “(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” - the so-called “nexus” requirement. Shedden v. Principi, 381 F.3d 1163, 1167 Fed. Cir. (2004). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303(b). Service connection for a recognized chronic disease can also be established through continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (2013); 38 C.F.R. §§ 3.303 (b), 3.309. A disability which is proximately due to or the result of a service connected disease or injury shall be service connected. 38 C.F.R. § 3.310 (a). Any increase in severity of a non-service connected disease or injury that is proximately due to or the result of a service connected disease or injury, and not due to the natural progress of the nonservice connected disease or injury will be service connected. 38 C.F.R. § 3.310 (b). As to herbicide exposure, Veterans who, during active service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence of non-exposure. 38 U.S.C. § 1116; 38 C.F.R. § 3.307. The Veteran served in the Republic of Vietnam from May 1967 to April 1968. Thus, exposure to herbicides is presumed. If a veteran was exposed to a herbicide agent (to include Agent Orange) during active military, naval or air service and has contracted an enumerated disease to a degree of 10 percent or more at any time after service (except for chloracne and early-onset peripheral neuropathy which must be manifested within a year of the last exposure to an herbicide agent during service), the veteran is entitled to a presumption of service connection even though there is no record of such disease during service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309(e). The enumerated diseases are AL amyloidosis; chloracne or other acneform diseases; diabetes mellitus, type 2, Hodgkin’s disease, all chronic B-cell leukemias, multiple myeloma, non-Hodgkin’s lymphoma, early-onset peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), soft-tissue sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma), Parkinson’s disease, and ischemic heart disease. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307 (a)(6)(iii), 3.309(e), 3.313, 3.318. VA has determined there is no positive association between exposure to herbicides and any other condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See Notice, 68 Fed. Reg. 27630 -7641 (2003). Notwithstanding the foregoing, regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d); see also Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). In other words, a presumption of service connection provided by law is not the sole method for showing causation in establishing a claim for service connection for disability due to herbicide exposure. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). As discussed in greater detail below, the Veteran has a current diagnosis of hypertension and atrial fibrillation, both of which are not listed as part of the enumerated diseases noted in 38 C.F.R. § 3.309(e), as such presumptive service connection is not for consideration. Below, the Board will discuss consideration for direct service connection. 1. Entitlement to service connection for hypertension The Veteran contends that his current hypertension is related to exposure to herbicides while serving in the Republic of Vietnam. The Veteran is competent to describe his ongoing symptoms, in-service duties and his statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The question for the Board is whether the Veteran has a current diagnosis of hypertension that began during active service or is at least as likely as not caused by an in-service injury or disease, including exposure to herbicides. The Veteran has a current diagnosis of hypertension. Blood pressure measurements are expressed as diastolic divided by systolic pressure in mmHg. For VA compensation purposes, the term hypertension means that the diastolic blood pressure is predominantly 90 or greater; and isolated systolic hypertension means that the systolic blood pressure is predominantly 160 or greater with diastolic blood pressure less than 90. Note (1): hypertension or isolated systolic hypertension must be confirmed by readings taken two or more times on at least three different days. 38 C.F.R. § 4.104, Diagnostic Code 7101. The Veteran’s service treatment records (STRs) and service personnel records have been associated with the claims file. Personnel records note the Veteran served in the Republic of Vietnam from May 1967 to April 1968. At separation in April 1968 on the report of medical examination the Veteran’s blood pressure reading was 140/90. Clinical evaluation of the heart and vascular system was normal. Further, at separation in April 1968 on the report of medical history the Veteran denied palpitations or pounding of his heart, high or low blood pressure. The Board finds an in-service event based on the Veteran’s presumed in-service exposure to herbicides, but no indication that in-service the Veteran had a diagnosis of hypertension, or that blood pressure readings taken two or more times on at least three different days resulted in hypertension for VA purposes. VA and private treatment records have been associated with the claims file and note ongoing medication management and monitoring for his hypertension. Private treatment records in June 2007 note reports of moderately severe hypertension. These treatment records do not contradict the VA examinations and are absent indications of a relationship between the Veteran’s current hypertension and in-service disease or injury or onset of a disability. The Veteran was afforded a VA examination in November 2019. The examiner noted the Veteran currently has a diagnosis of hypertension based on VA criteria. The examiner noted an extensive review of the Veteran’s claims file, service treatment records and lay contentions. Treatment records note the Veteran takes continuous medication for hypertension. The Veteran does not have a history of a diastolic blood pressure elevation to predominantly 100 or more. Blood pressure testing noted readings of 135/67 and 130/70. The examiner noted that the Veteran’s hypertension does not impact his ability to work. The examiner found that the Veteran’s hypertension is less likely than not incurred in or caused by the claimed in-service injury, event or illness including exposure to herbicides. The examiner noted that the Veteran’s essential hypertension is under control on his current medication, and the etiology is unclear as it is in most cases. The Veteran’s risks factors associated with hypertension include age, obesity and a prior history of smoking. There is no medical evidence to support that the Veteran’s prior exposure to Agent Orange over 50 years ago was the cause of his current hypertension. The examiner noted a thorough review of the medical literature, including a reference from the Mayo Clinic on hypertension noting that as to primary (essential) hypertension there is no identifiable cause of the high blood pressure and this tends to develop gradually over many years. The medical literature noted that secondary hypertension is caused by an underlying condition and tends to appear suddenly and causes higher blood pressure than does primary hypertension. Various conditions and medications can lead to the development of secondary hypertension including obstructive sleep apnea, kidney problems, adrenal gland tumors, thyroid problems, birth deficits in blood vessels and medications. A review of the medical literature noted that high blood pressure has many risk factors including age as the risk of high blood pressure increases as you age, high blood pressure is common among individuals of African heritage, those with a family history as high blood pressure as it tends to run in families. Additionally, being overweight or obese is a risk factor for high blood pressure as the more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increase, so does pressure on your artery walls. Additionally, not being physically active increases your risk for high blood pressure, as does a diet high in sodium and too low in potassium which can cause increases in blood pressure. Also, drinking too much alcohol and high levels of stress are also noted risk factors for high blood pressure. The examiner found that the Veteran’s hypertension is less likely than not incurred in or caused by the claimed in-service injury, event or illness including exposure to herbicides. Then, the Veteran was afforded a VA opinion in January 2021. The examiner found that it is less likely than not that the Veteran’s hypertension had its onset in or is related to service, to include his presumed exposure to herbicides agents. The examiner noted that as discussed in the November 2019 VA examination and opinion there is no causal connection between herbicide exposure and hypertension. The examiner further, noted review of the 2018 report from the National Academies of Sciences, Engineering and Medicine which found that there is suggestive or sufficient evidence that exists linking hypertension and related illness in Veterans with Agent Orange exposure and other defoliants. The examiner noted consideration of this report, however found that the Veteran’s hypertension is most likely due to aging, obesity, salt intake, stress and a history of tobacco use. The examiner agreed with the conclusions of the November 2019 VA opinion and extensive review of the medical literature and associated risk factors for developing hypertension. The examiner further noted that there is no probative medical evidence that the Veteran’s herbicide exposure caused his hypertension noting no causal connection. In consideration of the 2018 NAS report the examiner found that it is less likely than not that he Veteran’s hypertension had its onset in or is related to service, to include in-service exposure to herbicides. The Veteran’s representative in March 2021 correspondence contends that service connection is warranted for hypertension to include as due to herbicide exposure. The Board has considered the Veteran’s and his representative contentions however, VA benefits may not be granted based on speculative opinions. Rather, opinions must be made by competent professionals and be based on a rationale that is clear to the Board. The Veteran’s representative is not competent to provide a medical opinion. Furthermore, even if the representative was found to be a competent source of opinion, evidence favorable to a veteran’s claim that does little more than suggest a possibility that his illnesses might have been caused by service or a service connected disability is insufficient to establish service connection. See Stegman v. Derwinski, 3 Vet. App. 228, 230 (1992). Lastly, the benefit of the doubt rule is for application when the evidence is in equipoise, which occurs only when there is an approximate balance between the positive and negative evidence. 38 C.F.R. § 3.102. That evidence must be both competent and credible. Here, there is no such balance of evidence. After consideration of all the evidence of record the Board finds that the weight of the evidence is against finding that service connection for hypertension is warranted. The Board concludes that service connection for hypertension on a direct basis is not warranted as the Veteran’s current hypertension was not caused by service. The Veteran’s lay statements regarding his current symptoms, in-service exposures and ongoing symptomology are credible. While the Veteran reports that his current hypertension is related to service and his service in the Republic of Vietnam, the record does not reflect that he has the requisite training or expertise to offer a medical opinion linking a current disability to service decades earlier and as such the Veteran is not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The reports of onset of hypertension in-service warrant low credible and probative weight as they are not consistent with the STRs at discharge from active duty when clinical evaluation was normal and his blood pressure reading did not meet the VA threshold for hypertension. The Board finds that the medical evidence is more probative and credible than the lay opinions of record. The competent medical evidence of record including the VA examination and opinions from November 2019 and January 2021 taken in their entirety are entitled to significant probative weight. The November 2019 examiner found that the Veteran’s hypertension is less likely than not incurred in or caused by the claimed in-service injury, event or illness including exposure to herbicides. The examiner noted that the Veteran’s essential hypertension is under control on his current medication, and the etiology is unclear as it is in most cases. The Veteran’s risks factors associated with hypertension include age, obesity and a prior history of smoking. The examiner noted no medical evidence to support that the Veteran’s prior exposure to Agent Orange over 50 years ago was the cause of his current hypertension. The examiner noted a thorough review of the medical literature, including a reference from the Mayo Clinic on hypertension noting that as to primary (essential) hypertension there is no identifiable cause of the high blood pressure and this tends to develop gradually over many years. The examiner noted a thorough review of the medical literature and reported risk factors for developing high blood pressure. The examiner found that the Veteran’s hypertension is less likely than not incurred in or caused by the claimed in-service injury, event or illness including exposure to herbicides. Additionally, the January 2021 VA opinion found that it is less likely than not that the Veteran’s hypertension had its onset in or is related to service, to include his presumed exposure to herbicides agents. The examiner noted that as discussed in the November 2019 VA examination and opinion there is no causal connection between herbicide exposure and hypertension. The examiner further, noted review of the 2018 report from the National Academies of Sciences, Engineering and Medicine which found that there is suggestive or sufficient evidence that exists linking hypertension and related illness in Veterans with Agent Orange exposure and other defoliants. The examiner noted consideration of this report, however found that the Veteran’s hypertension is most likely due to aging, obesity, salt intake, stress and a history of tobacco use. The examiner agreed with the conclusions of the November 2019 VA opinion and extensive review of the medical literature and associated risk factors for developing hypertension. The examiner further noted that there is no probative medical evidence that the Veteran’s herbicide exposure caused his hypertension noting no causal connection. In consideration of the 2018 NAS report the examiner found that it is less likely than not that he Veteran’s hypertension had its onset in or is related to service, to include in-service exposure to herbicides. The Board notes that STRs note at separation in April 1968 on the report of medical examination clinical evaluation of the heart and vascular system was normal with a blood pressure reading of 140/90. Further, at separation on the report of medical history the Veteran denied palpations or pounding of his heart, high or low blood pressure. The Board notes that at separation the Veteran’s blood pressure reading was 140/90, however these is no indication of hypertension based on readings taken two or more times on at least three different dates. Thus, while at separation the Veteran’s blood pressure reading was 140/90, there is no indication that he met the criteria for hypertension under VA regulations. See 38 C.F.R. § 4.104, Diagnostic Code 7101. The Board has considered the Veteran’s lay statements however, the Board gives more probative weight to the competent medical evidence. At separation, clinical evaluation of the Veteran was normal. Further, the Board gives significant probative weight to the November 2019 and January 2021 VA opinions. As such the Board finds that the Veteran’s current hypertension is less likely than not related to active service. As to presumptive service connection the Veteran’s hypertension did not manifest until many years post-service. The Board concludes that while the Veteran has hypertension, which falls within a chronic disease under 38 U.S.C. § 1101 (3)/38 C.F.R. § 3.309(a), however such was not chronic in service nor did such manifest to a compensable degree in service or within the presumptive period, and continuity of symptomatology is not established. The Veteran’s hypertension was not noted during service or within one year of separation. See Walker, 708 F.3d 1331. At separation on the report of medical examination in April 1968 clinical evaluation of the heart and vascular system was normal and blood pressure reading was 140/90, with no indications of readings taken two or more times on at least three different days indicating hypertension for VA purposes. Service records do not support an onset of the Veteran’s hypertension in active service. Based on the probative evidence of record the Board finds that the Veteran’s hypertension did not manifest within the one-year period after service and service connection is not warranted on a presumptive basis. Private treatment records note treatment for hypertension in 2007, which is over almost 40 years after his separation from service in 1968. In addition, in weighing the evidence of record the Board finds the competent and credible evidence of record is against finding continuity of symptomatology. As a result, service connection based on continuity of symptomology is not warranted. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for hypertension. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. 2. Entitlement to service connection for atrial fibrillation The Veteran contends that service connection is warranted for atrial fibrillation. The Veteran reports his current atrial fibrillation is related to his service in Vietnam and presumed exposure to herbicides. The Veteran is competent to describe his current symptoms, in-service events, and the occurrence of ongoing symptoms, and to this extent, these statements are credible. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The question for the Board is whether the Veteran has atrial fibrillation that began during service or is at least as likely as not caused by an in service, injury, or disease, to include exposure to herbicides. The Veteran has a diagnosis of atrial fibrillation. The Veteran’s STRs and service personnel records have been associated with the claims file. Personnel records note the Veteran served in the Republic of Vietnam from May 1967 to April 1968. At separation in April 1968 on the report of medical examination clinical evaluation of the heart and vascular system was normal with a pulse of 88. Further, at separation in April 1968 on the report of medical history the Veteran denied palpitations or pounding of his heart and high or low blood pressure. The Board finds an in-service event based on the Veteran’s presumed in-service exposure to herbicides, but no indication that in-service the Veteran had a diagnosis of atrial fibrillation or symptoms associated with such. A private opinion from September 2016 has been associated with the claims file. The Veteran’s primary care provider noted that the Veteran has atrial fibrillation which could be connected to his toxic exposure to Agent Orange during service in Vietnam. The Board finds this opinion is entitled to less probative weight as the private opinion does not meet the VA standard for service connection (at least as likely as not) and the opinion failed to provide a thorough and reasoned rationale for the conclusions reached. The Board has thoroughly considered the September 2016 private opinion but finds such is entitled to less probative weight. The Veteran was afforded a VA examination in November 2019. The examiner noted supraventricular arrhythmia. The examiner noted that the Veteran continues to be seen by VA and a private physician and he has reported no changes in his atrial fibrillation. Additionally, the examiner noted review of the September 2016 private opinion. The examiner noted that the Veteran’s heart condition does not qualify within the generally accepted medical definition of ischemic heart disease. The etiology of the Veteran’s supraventricular arrhythmia is unclear, as it is in most cases. The examiner noted the Veteran requires continuous medication for control of his heart condition. The Veteran does not have a myocardial infarction or congestive heart failure. The examiner noted atrial fibrillation, a cardiac arrhythmia which is intermittent with zero episodes in the past 12 months. The Veteran does not have any infectious heart conditions or pericardial adhesions. Physical examination noted heart rate of 86, a regular rhythm, with normal heart sounds and no jugular or venous distension. Auscultation of the lungs was clear, peripheral pulses were normal and there was no peripheral edema. There was evidence of cardiac dilatation on echocardiogram with arrhythmia and atrial fibrillation rate of 104. A repeat Holter monitor rest noted atrial fibrillation with a rate of 97. The examiner noted that the Veteran’s atrial fibrillation does not impact his ability to work. The Veteran has had a diagnosis of atrial fibrillation with treatment via medication since 2009. The Veteran’s cause of atrial fibrillation is unclear as it is in most cases, but the risk factors include hypertension, abnormal heart valves as well as atrial enlargement. The examiner noted that there is no medical evidence to support that the Veteran’s prior exposure to Agent Orange over 50 years ago was the cause of his current atrial fibrillation. The examiner noted a thorough review of the Veteran’s claims file, service treatment records and the Veteran’s contentions. The examiner found that the Veteran’s atrial fibrillation was less likely than not incurred in or caused by the claimed in-service injury, event or illness, to include exposure to herbicides. The examiner noted that the Veteran was diagnosed with atrial fibrillation and began taking continuous medication for control in 2009. The Veteran’s cause of his atrial fibrillation is unclear as it is in most cases, but risk factors for the Veteran include hypertension, abnormal heart valves as well as atrial enlargement. There is no medical evidence to support that the Veteran’s prior exposure to Agent Orange over 50 years ago was the cause of his atrial fibrillation. Additionally, the Veteran does not have coronary artery disease so a metabolic equivalents (METs) test is not indicated and a prior myocardial perfusion imagining (MPI) stress test in 2011 was normal, and as such repeat testing was not indicated as there was no change in the Veteran’s clinical condition. A review of the medical literature noted research from the Mayo Clinic notes causes of atrial fibrillation to be abnormalities or damage to the heart’s structure with possible causes being: high blood pressure, heart attack, coronary artery disease, abnormal heart valves, congenital heart defect, overactive thyroid gland, exposure to stimulants, sick sinus syndrome, lung disease, previous heart surgery, viral infections, stress due to surgery or illness and sleep apnea. The examiner noted that some people who have atrial fibrillations do not have any heart defects or damage which is a condition called lone atrial fibrillation. In lone atrial fibrillation, the cause is often unclear and serious complications are rare. VA and private treatment records have been associated with the claims file. A review of these records shows that private treatment records note newly recognized atrial fibrillation in November 2010. These treatment records do not contradict the VA examination and are absent indications between the Veteran’s current atrial fibrillation and an in-service disease or injury. After consideration of all the evidence of record the Board finds that the weight of the evidence is against finding that service connection for atrial fibrillation is warranted. The Board concludes that service connection for atrial fibrillation on a direct basis is not warranted as the Veteran’s current atrial fibrillation was not caused by service. The Veteran’s lay statements regarding his current symptoms, in-service exposures and ongoing symptomology are credible. While the Veteran reports that his current atrial fibrillation is related to service and is related to service to include exposure to herbicides, the record does not reflect that he has the requisite training or expertise to offer a medical opinion linking a current disability to service decades earlier and as such the Veteran is not competent to provide a nexus opinion in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The reports of onset of atrial fibrillation in-service warrant low credible weight as they are not consistent with the STRs at discharge from active duty when clinical evaluation of the heart and vascular system was normal. The Board finds that the medical evidence is more probative and credible than the lay opinions of record. The competent medical evidence of record including specifically the VA examination in November 2019 is entitled to significant probative weight. The VA examiner found that the Veteran’s atrial fibrillation was less likely than not incurred in or caused by the claimed in-service injury, event or illness, to include exposure to herbicides. The examiner noted that the Veteran was diagnosed with atrial fibrillation and began taking continuous medication for control in 2009. The Veteran’s cause of his atrial fibrillation is unclear as it is in most cases, but risk factors for the Veteran include hypertension, abnormal heart valves as well as atrial enlargement. There is no medical evidence to support that the Veteran’s prior exposure to Agent Orange over 50 years ago was the cause of his atrial fibrillation. The examiner noted a review of the medical literature noted research from the Mayo Clinic notes possible causes of atrial fibrillation to be abnormalities or damage to the heart’s structure with possible causes being: high blood pressure, heart attack, coronary artery disease, abnormal heart valves, congenital heart defect, overactive thyroid gland, exposure to stimulants, sick sinus syndrome, lung disease, previous heart surgery, viral infections, stress due to surgery or illness and sleep apnea. The Board finds that direct service connection is not warranted as the Veteran’s atrial fibrillation is not related to service. The Board notes that STRS note at separation examination in April 1968 clinical evaluation of the heart and vascular system was normal. Further, at separation on the report of medical history the Veteran denied palpations or pounding of his heart. The Board has considered the Veteran’s lay statements however, the Board gives more probative weight to the competent medical evidence, specifically the November 2019 VA opinion. As such the Board finds that the Veteran’s current atrial fibrillation is less likely than not related to active service. As to secondary service connection, the Board notes the Veteran and his representative have contended that his atrial fibrillation may be related to or caused by his hypertension. However, herein the Board has denied service connection for hypertension. As the Veteran is not currently service connected for hypertension consideration for secondary service connection is not warranted. The Board has considered the Veteran’s contentions but finds that secondary service connection is not warranted. As to presumptive service connection the Veteran’s cardiovascular-renal disease did not manifest until many years post-service. The Board concludes that while the Veteran has atrial fibrillation, which falls within a chronic disease under 38 U.S.C. § 1101 (3)/38 C.F.R. § 3.309(a), however such was not chronic in service nor did such manifest to a compensable degree in service or within the presumptive period, and continuity of symptomatology is not established. The Veteran’s atrial fibrillation was not noted during service or within one year of separation. See Walker, 708 F.3d 1331. At separation on the report of medical examination in April 1968 clinical evaluation of the heart and vascular system was normal. Service records do not support an onset of the Veteran’s atrial fibrillation in active service. Based on the probative evidence of record the Board finds that the Veteran’s atrial fibrillation did not manifest within the one-year period after service and service connection is not warranted on a presumptive basis. Private treatment records note treatment for atrial fibrillation in 2010, which is over 40 years after his separation from service in 1968. In addition, in weighing the evidence of record the Board finds the competent and credible evidence of record is against finding continuity of symptomatology. As a result, service connection based on continuity of symptomology is not warranted. (continued next page) In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for atrial fibrillation. Since the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107 (b); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990); 38 C.F.R. § 3.102. For these reasons, the claim is denied. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K.R. Kardian, 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.