Citation Nr: 21025674 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 15-36 320 DATE: April 28, 2021 ORDER Service connection for hypertension is denied. Service connection for a heart disorder is denied. FINDINGS OF FACT 1. The Veteran had active service in Southwest Asia theater of operations during the Persian Gulf War. 2. The Veteran’s hypertension and heart disorder, variously diagnosed, are not undiagnosed illnesses or medically unexplained chronic multisymptom illnesses. 3. Hypertension is not shown to be causally or etiologically related to any disease, injury, or incident during periods of active duty from August 1980 to August 1983 and from December 1985 to May 1990, and did not manifest to a compensable degree within one year of separation from such periods of active duty. 4. Clear and unmistakable evidence establishes that hypertension pre-existed the period of active duty from January 2003 to March 2004 and was not aggravated beyond the natural progression therein. 5. A heart disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service, did not manifest to a compensable degree within one year of separation from active duty, and is not caused or aggravated by a service-connected disability. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension have not been met. 38 U.S.C. §§ 1101, 1110, 1111, 1112, 1117, 1153, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306, 3.307, 3.309, 3.317. 2. The criteria for service connection for a heart disorder have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1117, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from August 1980 to August 1983 and from December 1985 to May 1990, with prior inactive service. He also served in the Florida Army National Guard from September 1983 to October 1985, with periods of active duty for training from May 19, 1984, to June 2, 1984, and from March 30, 1985, to April 14, 1985, and a period of active duty service from January 2003 to March 2004, with service in the Southwest Asia theater of operations. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in June 2011 by a Department of Veterans Affairs (VA) Regional Office. In April 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In July 2019 and December 2020, the Board remanded the case for additional development and it now returns for further appellate review. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff’d, 78 F.3d 604 (Fed. Cir. 1996). Every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). Therefore, where there is evidence showing that a disorder manifested or was incurred in service, and this disorder is not noted on the veteran’s entrance examination report, this presumption of soundness operates to shield the veteran from any finding that the unnoted disease or injury preexisted service. Gilbert v. Shinseki, 26 Vet. App. 48 (2012); Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991); 38 C.F.R. § 3.304(b). Such presumption is only rebutted where the evidence clearly and unmistakably shows that the veteran’s disability (1) existed before acceptance and enrollment into service and (2) was not aggravated by service. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Bagby, 1 Vet. App. at 227; VAOPGCPREC 3-2003 (July 16, 2003). The two parts of this rebuttal standard are referred to as the “preexistence prong” and the “aggravation prong.” Horn v. Shinseki, 25 Vet. App. 231, 234 (2012). To satisfy this second-prong requirement for rebutting the presumption of soundness, the government must show by clear and unmistakable evidence either that there was no increase in disability during service or that any increase in disability was “due to the natural progression” of the condition. Joyce v. Nicholson, 443 F.3d 845, 847 (Fed. Cir. 2006). Under 38 U.S.C. § 1153, a preexisting injury or disease will be considered to have been aggravated by active military, naval, or air service, where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. The occurrence of symptoms, in the absence of an increase in the underlying severity, does not constitute aggravation of the disability. Davis v. Principi, 276 F.3d 1341, 1345 (Fed. Cir. 2002); 38 C.F.R. § 3.306 (a). Evidence of the veteran being asymptomatic on entry into service, with an exacerbation of symptoms during service, does not constitute evidence of aggravation. Green v. Derwinski, 1 Vet. App. 320, 323 (1991). If the disorder becomes worse during service and then improves due to in-service treatment to the point that it was no more disabling than it was at entrance into service, the disorder has not been aggravated by service. Verdon v. Brown, 8 Vet. App. 529 (1996). Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as cardiovascular-renal disease, to include hypertension, to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309(a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for a disability due to a qualifying chronic disability of a veteran who served in the Southwest Asia Theater of operations during the Persian Gulf War provided that such disability became manifest during either active service in the Southwest Asia Theater of Operations during the Persian Gulf War or to a degree of 10 percent or more, under the appropriate diagnostic code of 38 C.F.R. § Part 4, not later than December 31, 2021, and by history, physical examination, and laboratory tests, the disability cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1). In the instant case, the record reflects that the Veteran served in Southwest Asia from October 2003 to February 2004 during the Persian Gulf War. A chronic qualifying disability means a chronic disability resulting from an (A) undiagnosed illness; (B) the following medically unexplained chronic multisymptom illnesses that are defined by a cluster of signs or symptoms: (1) chronic fatigue syndrome; (2) fibromyalgia; (3) irritable bowel syndrome; or (4) any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multisymptom illness; or (C) any diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. 38 C.F.R. § 3.317 (a)(2)(i). However, as hypertension and the Veteran’s heart disorders, diagnosed as noted further herein, are not undiagnosed illnesses or medically unexplained chronic multisymptom illnesses. Thus, the foregoing provisions are inapplicable to the instant claims. Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310(b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Initially, the Board notes that the Veteran’s service treatment records (STRs) from his first period of service are unavailable and those from his second period of service are incomplete, which he was advised of in a March 2011 letter. In such cases, VA has a heightened duty to explain its findings and conclusions, and to consider carefully the benefit of the doubt rule. 38 U.S.C. § 5107(b); O’Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). However, there is no presumption, either in favor of the claimant or against VA, arising from missing records. Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005). Also, such does not lower the legal standard for proving a claim for service connection, but rather increases the Board’s obligation to evaluate and discuss in its decision all the evidence that may be favorable to the veteran. Russo v. Brown, 9 Vet. App. 46 (1996). 1. Entitlement to service connection for hypertension. In this case, the Veteran contends his hypertension had its onset during his first period of active duty service from August 1980 to August 1983 and was aggravated by subsequent periods of active duty. In support of his claim, he submitted opinions from his private physician, Dr. M.A., in February 2015 and May 2019. In the former statement, Dr. M.A. stated that the Veteran suffered from a variety of medical conditions, to include hypertension, which could be attributable to Gulf War Syndrome, and, in the latter statement, he opined that the Veteran’s hypertension is more likely than not caused by the highly stressful mental and physical demands of military service. In this regard, the Agency of Original Jurisdiction (AOJ) initially found the Veteran’s hypertension clearly and unmistakably pre-existed his entrance into his second period of service beginning in December 1985. Given this finding, the AOJ requested that a VA examiner, following physical examination of the Veteran in September 2015, provide a medical opinion as to whether the Veteran’s pre-existing hypertension was clearly and unmistakably aggravated by his subsequent periods of service. The VA examiner responded with an unfavorable opinion and, consequently, the AOJ denied the claim. However, as observed by the Board in July 2019, while the Veteran reported a history of hypertension on his October 1985 report of medical history, he clarified that he was told that he had high blood pressure for two days in 1981 during a period of stress. Further, in March 1990, he reported that he occasionally had high blood pressure and, at a February 2015 RO hearing, he indicated that he took medication for high blood pressure in the 1990’s. Here, the Board finds such reports of elevated blood pressure readings do not rise to the level of a diagnosis of hypertension as such must be confirmed by readings taken two or more times on at least three different days for VA disability purposes. In addition, the evidence does not include the Veteran’s entrance examination from his second period of service and, therefore, a notation of hypertension cannot be shown at such time. Further, the record does not contain any medical evidence demonstrating a diagnosis of hypertension for VA purposes prior to his second period of active duty service; rather, the record reflected that such was initially diagnosed in September 2002. Thus, the Board remanded the claim to obtain addendum opinion addressing the etiology of the Veteran’s hypertension. Thereafter, in December 2019, the Veteran underwent a VA examination and an addendum opinion was provided. At such time, the examiner opined that it was less likely than not that the Veteran’s hypertension was incurred in or caused by his first period of service from August 1980 to August 1983. In this regard, he noted that the Veteran’s reported history of two days of elevated blood pressure is insufficient to establish a diagnosis or etiology of hypertension during service. The examiner further found that the reported blood pressure readings were not documented in the STRs, all blood pressure readings during the Veteran’s first period of active duty from 1980 to 1983 were normal, and there was no narrative notes indicating any concern for elevated blood pressure readings. He further found that there was no evidence of onset or manifestations of elevated blood pressure within one year of separation from such period of service. The examiner also opined that it was less likely than not that the Veteran’s hypertension was incurred in or caused by his second period of service from December 1985 to May 1990. In this regard, he noted that the Veteran testified that he had intermittent spikes of his blood pressure during his second period of active duty while stationed in Germany; however, he found that such history is insufficient to establish a diagnosis or onset of hypertension during service. Rather, he found that the STRs from such period of service revealed normal blood pressure readings and no narrative notes that document a spike in blood pressure. Finally, the examiner opined that, as relevant to his second period of service from December 1985 to May 1990 and his third period of service from January 2003 to March 2004, the Veteran’s hypertension, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. In this regard, he indicated that temporary aggravation is plausible, but there is no evidence of permanent aggravation of the pre-existing hypertension. The examiner further indicated that the earliest documented record of hypertension was in September 2002 and the current medical literature did not support any aggravation due to the Veteran’s period of active duty service from January 2003 to March 2004. However, in December 2020, the Board found the December 2019 addendum opinion to be inadequate to decide the claim. In this regard, in rendering an unfavorable opinion in regard to whether the Veteran’s hypertension had its onset in, or is otherwise related to, his first period of active duty from August 1980 to August 1983, the examiner relied upon the absence of any indication of elevated blood pressure readings in his STRs. However, as previously noted, such STRs are unavailable. Additionally, the December 2019 VA examiner appeared to have opined both that the Veteran’s hypertension pre-existed his second period of service from December 1985 to May 1990 and was not aggravated therein, and also was not incurred therein, which suggests that it did not pre-exist such period of service. Also, in offering an unfavorable opinion as to incurrence, the examiner again relied upon the absence of any indication of elevated blood pressure readings in his STRs. However, as previously noted, such STRs are incomplete. Furthermore, in the December 2019 VA examiner’s opinion that the Veteran’s hypertension, which clearly and unmistakably pre-existed his third period of service from January 2003 to March 2004, and was clearly and unmistakably not aggravated therein, he found that temporary aggravation is plausible, but there was no evidence of permanent aggravation of the pre-existing hypertension. However, he did not discuss the differences between temporary and permanent aggravation or the significance of such temporary aggravation on the Veteran’s hypertension. Finally, the Board the December 2019 VA examiner did not address the aforementioned favorable opinion from Dr. M.A. rendered in May 2019 as directed in the July 2019 Remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). Thus, the Board remanded the case to obtain another addendum opinion addressing such matters. Thereafter, in February 2021, another VA examiner reviewed the record and opined that the Veteran’s hypertension was less likely than not incurred in or caused by his first period of military service from August 1980 to August 1983. In support of such opinion, he found that there was no evidence of hypertension while the Veteran was in service during such time period as he was not diagnosed with such disorder until September 2002. The examiner indicated that, while the Veteran reported a history of two day so high blood pressure in 1981 without medication on an October 1985 examination, such did not establish hypertension. Further, in regard to the aforementioned May 2019 favorable opinion, the examiner found that such was not germane to the instant inquiry as the Veteran was not diagnosed with hypertension until 2002 and the provider did not begin seeing him until 2008. Furthermore, he found such opinion to be broad, general, and without substantiation. Moreover, the examiner found that, though the mental and physical stress of military life is acknowledged, the Veteran became hypertensive during a period long outside of active duty, in 2002. The examiner also opined that the Veteran’s hypertension was less likely than not incurred in or caused by his first period of military service from December 1985 to May 1990. In this regard, for the same reasons articulated in the foregoing paragraph, he found that the Veteran was not hypertensive prior to such period of service as such was not diagnosed until September 2002. The examiner further found that blood pressure readings in June 1987, March 1988, November 1989, March 1990, and June 1991 were normal, and examinations conducted in April 1990 and October 1994 were negative for high blood pressure. Thus, the examiner found that the Veteran clearly not hypertensive for the timeframe from December 1985 to May 1990. He again discounted the aforementioned May 2019 favorable opinion for the same reasons articulated in the foregoing paragraph. The examiner also concurred with the December 2019 opinion that found that the Veteran’s hypertension, which clearly and unmistakably existed prior to his period of service from January 2003 to March 2004, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. Specifically, as he previously articulated, the Veteran’s hypertension was diagnosed in September 2002, and there was no evidence of aggravation of such disorder beyond its natural course during the timeframe from January 2003 to March 2004. In this regard, the examiner noted that there was no evidence of end-organ damage due to hypertension, and his blood pressure readings were 112/79 and 118/82 in September 2003. He also observed that post-deployment health assessments completed in 2004 did not show any evidence of aggravation of hypertension. In this regard, the examiner explained that the natural course of hypertension often requires medication changes or dose adjustments. Thus, he found that there was no evidence of progression of the Veteran’s hypertension beyond its natural course due to any cause. While the examiner indicated that he could not address what the December 2019 VA examiner meant by temporary aggravation, he explained that stress, anxiety, exercise, hydration status, etc., can cause an autonomic response and very temporarily elevate blood pressure. However, once the stimulus abates, the blood pressure returns to normal. The examiner indicated that the “fight or flight” or “white coat hypertension” responses do not constitute aggravation of the baseline of essential hypertension. Thus, he found that the December 2019 VA examiner may have been describing a situation where blood pressure was elevated for a period of time, and then returned to normal without adjusting medication. The examiner further stated that, even adding medication or changing doses while in service would not necessarily constitute aggravation; rather, end-organ damage and loss of control of blood pressure with rapidly changing requirements would be considered aggravation and would not likely be temporary. Thus, the examiner concluded that there is no evidence of aggravation beyond the baseline of the Veteran’s essential hypertension, to include as due to the stress of military service as described in the May 2019 opinion. The Board affords great probative weight to the February 2021 VA examiner’s opinion as such considered all pertinent evidence of record, to include the Veteran’s contentions and his relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). In contrast, the Board affords no probative weight to Dr. M.A.’s February 2015 and May 2019 opinions as the former is couched in speculative terms, and both are conclusory in nature without a rationale for the opinion. Id. The Board also considered the Veteran’s assertions as to the etiology of his hypertension; however, as a lay person, he does not have the requisite training and experience necessary to address such a complex medical matter. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the diagnosis and etiology of such disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the Veteran’s opinions as to the onset and etiology of his hypertension is not competent evidence and, consequently, is afforded no probative weight. Furthermore, the evidence of record fails to demonstrate that hypertension manifested to a compensable degree within one year of separation from his periods of active duty from August 1980 to August 1983 and from December 1985 to May 1990. Specifically, in reaching such determination, the Board again affords great probative weight to the February 2021 VA examiner’s opinion that such disorder did not manifest until September 2002. Additionally, while the Veteran reported the onset of such disorder prior to such date, and alleged a continuity of elevated blood pressure readings since such periods of service, such earlier diagnosis is not borne out by the contemporaneous evidence of record and he is not competent to diagnose hypertension. Consequently, presumptive service connection for such disorder is not warranted. Therefore, the Board finds that hypertension is not shown to be causally or etiologically related to any disease, injury, or incident during periods of active duty from August 1980 to August 1983 and from December 1985 to May 1990, and did not manifest to a compensable degree within one year of separation from such periods of active duty, and clear and unmistakable evidence establishes that hypertension pre-existed the period of active duty from January 2003 to March 2004 and was not aggravated beyond the natural progression therein. Thus, service connection for such disorder is not warranted. In reaching such decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim for service connection for hypertension. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. 2. Entitlement to service connection for a heart disorder, claimed as ischemic heart disease, to include as secondary to service-connected disability and/or as due to exposure to environmental hazards. The Veteran contends his current heart disorder is proximately due to his hypertension or chronic fatigue syndrome or, in the alternative, is due to exposure to environmental hazards coincident with his service in Southwest Asia, which includes his acknowledged exposure to burn pits. In support of his claim, he submitted opinions from his private physician, Dr. M.A., in February 2015 and May 2019. In the former statement, Dr. M.A. stated that the Veteran suffered from a variety of medical conditions, to include coronary artery disease (CAD), which could be attributable to Gulf War Syndrome, and, in the latter statement, he opined that the Veteran’s CAD is more likely than not aggravated by his hypertension. As an initial matter, the Board finds that, as the Veteran’s hypertension and chronic fatigue syndrome are not service-connected, secondary service connection for his heart disorder is prohibited as a matter of law. Sabonis v. Brown, 6 Vet. App. 426 (1994). Further, with respect to direct service connection, the Veteran’s available STRs do not reveal any complaints, treatment, or diagnoses referable to a heart disorder; rather, the record reflects that such was diagnosed in approximately 2008. However, in light of the fact that the record reflected a current diagnosis of a heart disorder and the Veteran had documented service in Southwest Asia, the Board remanded the claim in July 2019 in order to obtain an opinion addressing the etiology of such claimed disorder. Thereafter, in December 2019, following an interview with the Veteran, a review of the record, and a physical examination, the examiner noted diagnoses of CAD, acute, subacute or old myocardial infarction, stable angina, congestive heart failure, and hypertensive heart disease. In this regard, she found that the Veteran’s diagnosis of CAD/ischemic heart disease, which was the result of hyperlipidemia and aggravated by his hypertension, led to his other heart disorders. In January 2020, the examiner further opined that the Veteran’s heart disorder was not related to his military service. In support of such opinion, she noted that there is no medical literature to support a finding that such disorder is related to the Veteran’s in-service exposure to environmental hazards coincident with his service in Southwest Asia. The Board affords great probative weight to the December 2019/January 2020 VA examiner’s opinion as such considered all pertinent evidence of record, to include the Veteran’s contentions and his relevant medical history, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez, supra; Stefl, supra. In contrast, the Board affords no probative weight to Dr. M.A.’s February 2015 and May 2019 opinions as the former is couched in speculative terms, and both are conclusory in nature without a rationale for the opinion. Id. The Board also considered the Veteran’s assertions as to the etiology of his heart disorder; however, as a lay person, he does not have the requisite training and experience necessary to address such a complex medical matter. Jandreau, supra. In this regard, the diagnosis and etiology of such disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. Woehlaert, supra. Accordingly, the Veteran’s opinions as to the onset and etiology of his heart disorder is not competent evidence and, consequently, is afforded no probative weight. Furthermore, the evidence of record fails to demonstrate that cardiovascular-renal disease manifested to a compensable degree within one year of separation from his periods of active duty from August 1980 to August 1983, December 1985 to May 1990, and January 2003 to March 2004, and the Veteran has not alleged a continuity of relevant symptomatology after service; rather, he reports the onset of such disease in approximately 2008, which is supported by the contemporaneous treatment records. Consequently, presumptive service connection for such disorder is not warranted. Therefore, the Board finds that a heart disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service, did not manifest to a compensable degree within one year of separation from active duty, and is not caused or aggravated by a service-connected disability. Thus, service connection for such disorder is not warranted. In reaching such decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the preponderance of the evidence is against the Veteran’s claim for service connection for heart disorder. As such, that doctrine is not applicable in the instant appeal, and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. M. Kelly, 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.