Citation Nr: 21024686 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 16-07 470 DATE: April 23, 2021 ORDER Entitlement to service connection for a respiratory disability is denied. Entitlement to a rating greater than 10 percent prior to October 7, 2020 and greater than 30 percent thereafter for supraventricular tachycardia is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against a finding that a respiratory disability is etiologically related to service. 2. Prior to October 7, 2020 the Veteran has not had more than 4 episodes per year of paroxysmal atrial fibrillation or supraventricular tachycardia. 3. Since October 7, 2020, the Veteran is in receipt of the maximum schedular rating for supraventricular tachycardia under the applicable diagnostic code and there is no evidence of any symptomatology warranting a separate and/or higher rating under the rating schedule. CONCLUSIONS OF LAW 1. The criteria for service connection for a respiratory disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for a rating greater than 10 percent prior to October 7, 2020 and greater than 30 percent thereafter for supraventricular tachycardia have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.104, DC 7010. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1976 to November 1990. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an October 2012 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA). The Board remanded these issues in October 2018 for further development. The Board finds there has been substantial compliance with the October 2018 remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). These matters are properly before the Board for adjudication. The Board notes that the issue of entitlement to separate evaluations for lower extremity radiculopathy associated with lumbar strain was remanded in the October 2018 decision. In an October 2020 rating decision, the RO granted service connection for radiculopathy of the left and right lower extremity associated with lumbar strain, effective August 7, 2012. Thus, the issue is no longer on appeal. 1. Entitlement to service connection for a respiratory disability The Veteran contends that service connection for a respiratory illness is warranted. 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. § 1131; 38 C.F.R. § 3.303 (a). 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). Service connection for a disability requires evidence of: (1) a current disability; (2) a disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service treatment records indicate that the Veteran underwent treatment during service for cough, upper respiratory infection, pharyngitis, and bronchiolitis. A chest X-ray in December 1982 demonstrated scattered calcified granulomata. A July 1987 chest X-ray was taken after the Veteran presented with inspiratory rales. The findings were old granuloma disease and no acute cardiopulmonary disease. On periodic examination in January 1988, the examiner noted an inspiratory wheeze in the left lung, which he suggested was related to cigarette smoking. He noted that chest X-ray indicated old granulomatous disease. Chest X-ray in July 1990 revealed an old nodule in the right upper lobe. The Veteran’s lungs were otherwise hyperlucent and clear. A January 2012 VA treatment record indicates an irregular right lung nodule; the provider noted that neoplasia was not excludable, and recommended CT scan. The Veteran’s post-service medical treatment records contain no evidence of a diagnosed respiratory illness during the period on appeal other than a June 2011 Medication Management note that shows the Veteran was treated for acute bronchitis and that was prescribed albuterol and doxycycline. The Veteran underwent an in-person VA examination in October 2020. The examiner reviewed the Veteran’s medical records, lay statements, and claims file and concluded that the Veteran does not have a current respiratory disability or a disability that resolved during the relevant period on appeal. The VA examiner noted the Veteran’s history of pneumonia and old calcified granulomas noted on his chest x-ray in service. The examiner opined that there is insufficient evidence of a current condition or diagnosis for a respiratory disability. The examiner explained the Veteran’s imaging records showed no active lung condition and testing has ruled out asthma and chronic obstructive pulmonary disease. Furthermore, the examiner opined that the Veteran’s claimed respiratory illness was less likely related to his in-service treatment for various respiratory illnesses. Here, the expert reviewed the clinical evidence in its entirety, and following informed consideration, opined that the there was no evidence to support the Veteran’s claim was caused by or aggravated by in-service treatment for cough, upper respiratory infection, pharyngitis, and bronchiolitis. The record does not contain any contradicting opinions. Importantly, no competent opinion was submitted by the Veteran or his attorney supporting his claim during the period between the October 2018, the date the Board remanded this claim and the current decision. The Board finds the January 1988 finding that the Veteran’s inspiratory wheeze in the left lung, which the examiner suggested was related to cigarette smoking. For claims filed after June 9, 1998, the law prohibits service connection of a death or disability on the basis that it resulted from an injury or disease attributable to the use of tobacco products by a Veteran during active service. 38 U.S.C. § 1103; C.F.R. § 3.300. Consideration has been given to the Veteran’s contentions that his disability is related to his service. Although laypersons, such as the Veteran, are sometimes competent to provide opinions on certain medical questions, the specific issue in this case falls outside the realm of common knowledge of a lay person as it involves making definitive clinical diagnoses based on knowledge of respiratory medicine. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). While the Veteran is certainly competent to report that he experiences symptoms of difficult breathing problems, he is not competent to link those complaints to a particular etiology. His assertions are therefore not competent evidence of asbestos exposure or a medical nexus. Accordingly, the Board finds that the claim of entitlement to service connection for a respiratory illness must be denied under any theory of entitlement. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim of entitlement to service connection, that doctrine is not applicable. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; see also Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001). 2. Entitlement to a rating greater than 10 percent prior to October 7, 2020 and greater than 30 percent thereafter for supraventricular tachycardia The Veteran contends a rating greater than 10 percent prior to October 7, 2020 and greater than 30 percent thereafter for supraventricular tachycardia is warranted. Disability ratings are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. Evaluations are based upon lack of usefulness of the part or system affected, especially in self-support. 38 C.F.R. § 4.10. Where there is a question as to which of two disability ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability is resolved in favor of the veteran. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where a claimant appeals the denial of a claim for an increased disability rating for a disability for which service connection was in effect before he filed the claim for increase, the present level of disability is the primary concern, and past medical reports should not be given precedence over current medical findings. Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994). Where VA’s adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or staged ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007). When evaluating disabilities of the cardiovascular system under DCs 7000-7007, 7011, and 7015-7020, it must be ascertained in all cases whether or not cardiac hypertrophy or dilatation (documented by electrocardiogram (EKG), echocardiogram (ECG), or X-ray) is present and whether or not there is a need for continuous medication. 38 C.F.R. § 4.100. METs testing is also required in all cases except: (1) when there is a medical contraindication; (2) when the left ventricular ejection fraction has been measured and is 50% or less; (3) when chronic congestive heart failure is present or there has been more than one episode of congestive heart failure within the past year; (4) when a 100% evaluation can be assigned on another basis. Id. If left ventricular ejection fraction (LVEF) testing is not of record, the cardiovascular disability must be evaluated based on the alternative criteria unless the examiner states that the LVEF test is needed in a particular case because the available medical information does not sufficiently reflect the severity of the veteran’s cardiovascular disability. Pursuant to DC 7010, a 10 percent rating is assigned for supraventricular arrhythmias manifested by permanent atrial fibrillation (lone atrial fibrillation), or one to four episodes per year of paroxysmal atrial fibrillation, or other supraventricular tachycardia documented by an ECG or Holter monitor. A 30 percent rating, which is the maximum rating, is assigned for paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than 4 episodes per year documented by an ECG or Holter monitor. 38 C.F.R. § 4.104, DC 7010. On VA examination in September 2012, the Veteran was diagnosed with supraventricular arrythmia. There were no episodes of episodes of paroxysmal atrial fibrillation in the past 12 months. The examiner determined the Veteran did not have ischemic heart disease, myocardial infarction, congestive heart failure, heart valve conditions, infectious heart conditions, cardiac hypertrophy, or pericardial adhesions. There was no evidence of cardiac hypertrophy or dilatation. An exercise stress test conducted in December 2010 showed the Veteran performed a 10.1 METs level. The Veteran denied experiencing symptoms with any level of activity during an interview-based METs test. The VA examiner opined that the exercise stress test results most accurately reflected the Veteran’s cardiac level. The Veteran underwent an October 2020 VA examination. The examiner diagnosed the Veteran with supraventricular tachycardia which manifested by more than four episodes of paroxysmal atrial fibrillation as documented by EKG. An October 2020 echocardiogram showed evidence of cardiac hypertrophy. The examiner determined the Veteran did not have ischemic heart disease, myocardial infarction, congestive heart failure, heart valve conditions, infectious heart conditions, or pericardial adhesions, however. The examiner stated there were no additional diagnoses rendered. The Veteran reported experiencing occasional palpitations. Based on an interview-based METs test, the examiner opined the Veteran’s METs level is greater than 7 to 10. This METs level has been found to be consistent with activities such as climbing stairs quickly, moderate bicycling, sawing word, and jogging (6 mph). After reviewing the evidence, the Board finds that the Veteran is not entitled to a rating greater than 10 percent prior to October 7, 2020 and greater than 30 percent thereafter for supraventricular tachycardia. The weight of the evidence demonstrates that the Veteran’s heart disability does not fulfill the criteria for a disability rating of 30 percent prior to October 7, 2020. Under DC 7010, a higher 30 percent disability rating requires evidence of paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than 4 episodes per year documented by an ECG or Holter monitor. The 2012 VA examination conducted has not revealed any episode of supraventricular tachycardia or paroxysmal atrial fibrillation. The Board also considered alternative DCs which may be applicable to the Veteran’s heart disability. DC 7011 for ventricular arrhythmias was the only other applicable DC, because the Veteran does not have valvular heart disease, endocarditis, pericarditis, pericardial adhesions, syphilitic heart disease, arteriosclerotic heart disease, myocardial infarction, hypertensive heart disease, hyperthyroid heart disease, atrioventricular block, a heart valve replacement, a coronary bypass surgery, implantable cardiac pacemakers, cardiac transplantation, or cardiomyopathy. See 38 C.F.R. § 4.104. However, even under DC 7011, a 30 percent rating would be unwarranted prior to October 7, 2020 because the Veteran has always performed at a workload greater than 7 METs, and hasn’t had symptoms of dyspnea, angina, or syncope. A 30 percent rating is also unwarranted because there is no evidence of cardiac hypertrophy or dilation on any EKG, ECG, or x-ray. Thus, the Veteran is not entitled to a rating in excess of 10 percent under DC 7011 for his service-connected heart disability prior to October 7, 2020. Since October 7, 2020, the Veteran has been in receipt of the maximum schedular rating for his supraventricular tachycardia. Based on the evidence of record, the Board finds that a rating in excess of 30 percent for supraventricular tachycardia is not warranted at any time during the claim period. As noted above, the Veteran is already in receipt of the maximum schedular rating for his supraventricular tachycardia under DC 7010 during since October 7, 2020. Thus, this is the maximum rating allowable and a higher rating is not warranted under DC 7010 on the basis of the Veteran’s supraventricular tachycardia. The Veteran has not been diagnosed as having any other cardiac disabilities during the claim period. For the foregoing reasons, the Board finds that the service-connected supraventricular tachycardia, for which the Veteran is receiving a 10 percent rating prior to October 7, 2020 and the maximum schedular rating under the applicable diagnostic code thereafter, has not been shown to involve any other factors warranting evaluation under any other provisions of VA’s rating schedule. Therefore, a rating greater than 10 percent prior to October 7, 2020 and greater than 30 percent thereafter is not warranted for the Veteran’s service-connected supraventricular tachycardia. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mohammad Mahmoudi, 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.