Citation Nr: 21025728 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 15-17 363 DATE: April 28, 2021 ORDER Entitlement to service connection for a heart condition is denied. REMANDED Entitlement to service connection for a seizure disorder is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for headaches is remanded. FINDING OF FACT The preponderance of the evidence is against a finding that the Veteran’s heart condition is related to active duty service. CONCLUSION OF LAW The criteria for service connection for a heart condition, have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 5103(a), 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.307, 3.309, 3.310, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in active duty service with the Navy from January 1981 to March 1989. This matter is on appeal from a July 2013 rating decision. The Veteran was afforded a November 2019 hearing before the undersigned Judge. A transcript of the hearing has been associated with the claims record. The Board remanded this appeal in March 2020 for additional development. Service Connection Service connection is granted on a direct basis when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). The Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. See Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465, 469 (1994). In relevant part, 38 U.S.C. § 1154 (a) requires that the VA give “due consideration” to “all pertinent medical and lay evidence” in evaluating a claim to disability. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. 38 U.S.C. § 5107 (b); see Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102. The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). Heart condition The Veteran contends that their heart condition is related to their active duty service. Review of the medical treatment record shows in June 2005 the Veteran underwent a procedure to have a pacemaker inserted. A January 2007 private provider gave the Veteran an impression of sick sinus syndrome. At a March 2019 VA examination, the examiner diagnosed the Veteran with intermittent atrial fibrillation and heart block status post pacemaker insertion and “mildly abnormal myocardial perfusion rest/stress test of uncertain significance.” As such, the Board finds the Veteran with a current disability. Review of the Veteran’s service treatment records (STRs) show the Veteran at the December 1980 enlistment examination and February 1981 examination for submarine duty denied heart issues to include palpitation or heart trouble. At a September 1984 reenlistment examination, the Veteran reported that they were in good health and denied any heart issues to include palpitations and heart trouble. In October 1988, the Veteran was noted to have been “working all day and all night working on the [Landin Craft Utility] (LCU)”; the treating provider noted that witnesses observed the Veteran “acting normally when he passed out on the LCU…reportedly was shaking all over his body.” The Veteran was hospitalized and given a diagnosis of generalized tonic clonic seizure disorder of idiopathic nature. During his hospitalization, the Veteran reported a history of “spells” as a child; the treating providers documented the Veteran reported a history of seizures, headaches and passing out starting from either age 5 or age 10 until age 13.The Veteran during this period of treatment did not report any issues with his heart to include palpitation. No head trauma or injury was documented by the medical reports. Review of the medical treatment record shows in a June 2005, the Veteran was seen for consultation for syncope and paroxysmal atrial fibrillation. The treating physician noted the Veteran was brought to the emergency room after a syncopal episode and shortness of breath; it was noted that when emergency medical personnel arrived, the Veteran was hypotensive and in atrial fibrillation. The Veteran was noted later to become presyncopal with observed sinus rhythm with ventricular asystole for 30 seconds. The physician noted the Veteran’s “interesting history of having ‘seizure disorder’” dating to the1980s, with treatment from anti-seizure medication until 1996. The physician further noted the Veteran in the past had been evaluated for palpitations that primarily occurred with exertion; the Veteran stated that such symptoms to include palpitation and atrial fibrillation “were very similar to what he had in the past”, however the Veteran did not provide any specific date or detail of such occurrences and the physician further stated “these had never been documented before.” The Veteran at this visit stated that he had been previously evaluated twice by a cardiologist, most recently in 1999 where he was told that everything was “okay.” The physician stated the Veteran had no prior history of exertional chest pain, dyspnea on exertion, orthopnea or PND, and noted the Veteran led a very active lifestyle, if not limited in athletic activities because of “provocation of his palpitations.” The physician found no other ongoing medical problems other than 3 to 4 years of mild hypertension controlled by medication and no prior surgical procedures other than an inguinal herniorrhaphy “many years ago.” Upon physical examination, the Veteran’s heart demonstrated regular rate and rhythm with no significant murmur, gallop, click or rub. Upon EKG testing the physician found sinus rhythm demonstrate normal AV conduction with mild concentric hypertrophy of the left ventricle with diastolic noncompliance with the left ventricle. The physician gave an impression of syncope due to high degree AV block; paroxysmal atrial fibrillation; and hypertensive heart disease. The physician found the Veteran required permanent pacing and a pacemaker was installed the following day. In January 2007 the Veteran was seen by the private provider for evaluation. The treating provider noted the Veteran’s pacemaker installation in June 2005 following an episode of ventricular asystole and that “[the providers] have not seen [the Veteran] in over a year.” The Veteran stated that he recently noticed some palpitation and became concerned. The Veteran described his palpitations as “occasional, forceful and somewhat irregular beating of the heart” that lasted a few brief moments and resolves spontaneously. The Veteran stated that this occurs on a daily basis and typically when at rest; the provider noted that this did not appear to be sustained or associated with symptoms of near-syncope or syncope. Physical examination found the Veteran’s heart demonstrated regular rate and rhythm with normal S1 and S2 and no significant murmur, gallop, click or rub. Electrocardiogram and echocardiogram testing were normal. The provider gave the Veteran an impression of symptomatic PVCs; sick sinus syndrome, status post permanent pacing; and hypertension. The provider explained to the Veteran “the benign nature of his PVCs…at this point [the Veteran] does not require specific treatment…this seem to reassure him.” In October 2007 the Veteran reported that yesterday he developed a headache with some diminished left-sided visual field and paresthesias and weakness on the left side and face. The Veteran also stated having symptoms of light-headedness and palpitations. MRI testing of the Veteran’s brain showed a normal CT scan with no evidence of acute intracranial pathology, infarction, hemorrhage or mass. On May 19, 2010, the Veteran presented to the emergency room with a chief complaint of elevated blood pressure started from the previous night with symptoms of dizziness, light-headedness, nausea, shortness of breath, and sinus headaches. Review of the Veteran’s cardiovascular systems was negative for chest pain and leg swelling, and the Veteran’s heart demonstrated normal rate and regular rhythm. X-rays of the Veteran’s chest found no acute process. The Veteran was diagnosed with dizziness and hypertension; the Veteran was discharged and instructed to followup with his private provider. In a May 26, 2010 followup with the private provider, the provider noted the Veteran’s recent visit to the emergency room for an episode of hypertension and associated lower substernal chest pain. The provider noted that the emergency room found no markers to suggest and acute coronary syndrome, and the Veteran in general has demonstrated excellent control of blood pressure with no recurrence in chest pain. The provider assessed the Veteran with noncardiac chest pain; hypertensive heart disease controlled by medication; and sick sinus syndrome post permanent pacing that was currently stable. The provider explained to the Veteran that there was no evidence of significant cardiac pathology to explain the Veteran’s recent symptoms which “reassured [the Veteran].” In June 2011, the Veteran reported that he recently moved, and the treating provider noted the Veteran reported a history of heart palpitation. In August 2011 the Veteran reported that he previously was unable to afford medication for pacemaker and treating arrhythmia. The provider assed the Veteran with arrhythmia with anticoagulation. In a March 2012 private cardiac management visit, the Veteran denied specific chest pain, orthopnea, PND, or palpitation. The Veteran stated that he had a pacemaker installed in 2005 for sinus pauses and since then has not experienced any further episodes of syncope. The provider noted the Veteran has had a documented paroxysmal atrial fibrillation, but no history of myocardial infarction angioplasty, or bypass surgery. The Veteran also denied any further episodes of palpitation or syncopal episodes. Upon physical examination, the provide found the Veteran’s S1 and S2 to be present with EKG testing showing sinus with no acute ST changes. The provider gave the Veteran an impression of pacemaker placement; tachybrady syndrome; history of paroxysmal atrial fibrillation; history of TIA; goiter; and hypertension. In an April 2012 visit for pacemaker management, the private provider noted the Veteran had no episode of fibrillation. The Veteran reported no complaints to include no shortness of breath, chest pain, PND, orthopnea, pedal edema or palpitations. The provider gave an assessment of dual chamber pacer placement in 2005 for recurrent syncope and found it “appears that it is fixed.” In August 2012, the Veteran was seen with a reported history of pacemaker, arrhythmia and hyperglycemia. The Veteran reported feeling well with no chest pain or shortness of breath in the past 6 months. Physical examination of the heart demonstrated regular rate and rhythm. In a July 2014 statement, the Veteran asserted that his present medical circumstances and pacemaker insertion were related to his medical emergency that resulted in his medical discharge in May 1989. The Veteran stated that he suffered a seizure but was denied a rated medical discharge. The Veteran asserted that during his medical episode, the records “show no one really knew.” The Veteran asserted that the medical records at the time document treating the Veteran for a “seizure” however that later medical treatment determined that the Veteran actually had a heart condition requiring a pacemaker. The Veteran contends that during his enlistment, “the palpitations, heart/blood pressure symptoms were missed, ignored or not taken seriously by medical checkups and testing” and that there were opinions that showed his conditions were aggravated by his service. As such, the Veteran contends that his misdiagnosis and mishandling of his case denied him disability and worsened his condition where he had to cut back on activities and could not work certain jobs. The Veteran stated that in 2005 “the same attack occurred” requiring emergency care and operation. The Veteran asserted the treating physician “discovered that the condition dating back to October 1988 in the military was my heart” and required emergency insertion of a pacemaker. The Veteran noted that he was not a medical professional but stated “after hearing my cardiologist doctor link that the real attack on the ship on duty in the Mediterranean sea in 1988 to the heart conditions and that the military misdiagnosed my condition…I have felt submitting this written request was appropriate and necessary.” In a May 2015 statement, the Veteran stated that his current medical issues and challenges started with “that fateful day” after participating in operations. The Veteran asserts that his documentation links his current medical conditions to that event. At an April 2018 conference with a decision review officer (DRO), the Veteran stated that he does not have a seizure disorder nor is receiving treatment for a seizure disorder. The Veteran stated that his current provider has told him that instead the Veteran had sick sinus syndrome where the chambers of the heart do not communicate with the other chambers and “backs up the flow of blood and causes his body to shut down.” The Veteran stated that he was misdiagnosed in the military. In a separate April 2018 statement, the Veteran stated that his provider stated that the sick sinus syndrome was previously undetected during his service. The Veteran asserted that leading up to his medical emergency in 1988, he was having “periodic symptomatic episodes of fluttering palpitations, dizziness, shortness of breath, brief headaches and near fainting.” The Veteran noted that none of these symptoms were length enough to require a trip to sick call and that the current mission he was assigned to at the time did not allow quick access to medical care. The Veteran stated that during his treatment and hospitalization in 1988, the Veteran shared symptoms of “the unknown [sick sinus syndrome]” with doctors but his heart concerns were overlooked or not looked into; instead the doctors treated and assessed the Veteran with seizures. The Veteran stated that he was able to pass numerous physical examinations held during enlistment and his reenlistment in December 1984 “even while dealing with palpitations and headaches and dizziness.” The Veteran stated that these symptoms relating to sick sinus syndrome were never tested, reviewed or discussed. The Veteran stated that his provider’s diagnosis “indicates the treatment for seizures clearly missed the mark and was misdiagnosed as the actions of the heart.” The Veteran noted that the provider indicated “after two previous attacks requiring treatment in the ICU…in April 1994 and June 22, 2005” that it was determined that these attacks mirrored the 1988 attack. The Veteran stated the May 2010 office visit was new evidence to confirm the sick sinus syndrome diagnosis and “links it to pass issues from youth to adult.” The Veteran was afforded a March 2019 VA examination. The examiner diagnosed the Veteran with intermittent atrial fibrillation and heart block status post pacemaker insertion and “mildly abnormal myocardial perfusion rest/stress test of uncertain significance.” The Veteran reported that he started having palpitations when “I ran for the exam to reenlist in the 1980s” and that the symptoms would come and go after that. The Veteran stated that he passed out in service in 1988 and was discharged. The Veteran next stated that the next year after his separation “it happened again, and then again in about 2 years I was working….and fell out on the tools with no warning. I would wake up on the floor.” The Veteran next stated that in 2005 he was driving at night delivering newspapers when he felt palpitations and a headache; the Veteran stated that he was able to get to an emergency room before passing out. The Veteran stated that at the time “they said my heart stopped and I could have died”; the Veteran noted that a pacemaker was put it right away. Following the pacemaker insertion, the Veteran stated that he has palpitations from time to time but no longer passes out, however he does note constant chest pain that worsens with deep breaths and exercises. The examiner found the Veteran’s diagnosed heart condition was less likely than not related to his service. The examiner stated the Veteran’s “current report of palpitations and syncope beginning during service” was considered as well as “the absence of documentation of complaints, evaluation, treatment or diagnosis of a cardiac dysrhythmia condition during service until 2005 (16 years after separation).” The examiner stated that cardiogenic syncope and loss of consciousness due to seizure activity could have similar symptoms and appearance. The examiner stated that “it is possible that a misdiagnosis occurred during service in 1988, but in my opinion, it is less likely as not.” The examiner stated that syncope related to the heart occurs “because the brain has insufficient blood and oxygenation…brain function resumes soon after oxygenation is restored.” The examiner next explained that loss of consciousness due to a generalized seizure is commonly followed by a postictal state “in which the return of normal mentation is generally delayed by seconds to minutes to hours or even days, often with confusion and suppressed alertness.” The examiner noted that medical documentation in 1988 observed the Veteran to have “two to three hours of a postictal confusion.” The examiner stated that headaches were common in postictal period, but not after cardiogenic syncope; noting the Veteran reported headaches “particularly in the days prior to and after the loss of consciousness in 1988.” As such, the examiner did not find sufficient evidence to indicate the Veteran’s current cardiac condition was incurred by active duty service or that a chronic condition continued from active duty service to the present. In a May 2019 statement, the Veteran stated that the last opinions “distanced and assessed [his claimed issues] as not connected or related to the active duty situation…if that is true, why did they decided to end my career?” The Veteran asserted that the decisions were “not there. This did not happen to them. I was there and know exactly what happened…” The Veteran stated that “medical issue were missed, failed and misdirected treatment even improperly medicated for a condition that turned out to be completely wrong”; the Veteran stated that if the pervious assessment suggested no connection to his active duty service accident, “that would suggest that not only did you misdiagnose me and miss terribly in my treatment…” At the Veteran’s November 2019 hearing, when asked if he reported any heart problems when entering the service, the Veteran testified: “The only thing we made note of was what my grandmother shared via verbal information.” The Veteran noted that although “they persisted to want to know more information…all I know is what my grandmother told me” and at the time of his entry into service, he was fine and was not having any issues. The Veteran stated that following his collapse in 1988 and discharge in 1989, the Veteran stated that the same problem recurred in 1994 where he was walking up the steps to a courthouse, “literally collapsed and fell down the steps”, requiring him to go to the emergency room. The Veteran noted that medical records of this event were destroyed and no longer available; but stated that at the time the treating doctor told the Veteran “this is a situation with your heart that needs to be monitored” and after treatment and “kind of starting…living life again…it didn’t take long for it to happen again.” The Veteran’s representative asserted that all these events were cardiac in nature. The Veteran next testified that in 2005 his symptoms recurred to include headache, palpitation and collapsed publicly. The Veteran stated that an ambulance was called, and the treating private provider found the Veteran’s heart was out of rhythm and would require a pacemaker. The Veteran stated that at his June 2005 cardiac consultation “I was taken off of the seizure medication because the doctor said you didn’t need seizure medication…all the time that you were on this seizure medication you were taking it for nothing” and that the provider told him that he did not need the medication and that the problems was with the heart. The Veteran noted that there was a gap in the medical treatment record between 1998 through 2005 and testified that during this period “I could only seek treatment for things that I could pay for…during those periods of time I had no access to any type of medical care. I had no insurance, I had not money, I had a few jobs.” The Veteran stated that he currently had periodic palpitations but that since the pacemaker insertion the treating provider stated that everything looks good and gave a positive prognosis. The Veteran was afforded a March 2020 VA opinion by the same examiner who provided the March 2019 VA examination. The examiner first found no evidence of a heart condition prior to or during the Veteran’s service. The examiner then found that a seizure disorder most likely caused the Veteran’s loss of consciousness and hospitalization in 1988 and that it was less likely as not that a heart disorder was in any way related to the loss of consciousness and hospitalization in 1988. The examiner noted there was detailed medical documentation in October 1988 of the Veteran’s loss of consciousness preceded by aura and observed “shaking all over his body”. The examiner noted that the Veteran 25 minutes after the episode was “semi-awake, mumbling, but able to respond to commands…”; and after an hour and 15 minutes, was more alert and verbally responsive, but unable to give the time and place, and complained of frontal headache. The examiner stated that 3 days after the incident, an EEG report returned abnormal findings suggestive of epilepsy and diagnosed the Veteran with idiopathic seizure. The examiner noted that during this period it was documented that the Veteran’s cardiac monitor was continued and there was no evidence or documentation that abnormal cardiac rhythms were detected. The examiner stated that the findings and observations in 1988 were “classic for seizure activity” and found it very unlikely the episode was related to a cardiac arrhythmia. The examiner noted the Veteran was in a semi-oriented state more than an hour after the episode, which was common in a post-itcal state following a seizure but very uncommon following syncope-related to arrythmia unless there was significant head trauma, to which the examiner did not find evidence of. The examiner stated that abnormal EEG findings were strongly associated with seizure symptoms and not with cardiac conditions; and noted the Veteran’s “concurrent history of prior similar episodes which were diagnosed as epilepsy strongly support that continued diagnosis.” The examiner next stated that the primary risk factors for chronic sinus node dysfunction that encompassed atrial fibrillation and sick sinus syndrome were age, or related to fibrosis, atherosclerosis, and inflammatory/infiltrative myocardial processes. The examiner stated that “it would be very unlikely for a 5 year old child to have atrial fibrillation or sick sinus syndrome without significant structural heart disease or a rare familial syndrome…similarly it would be very unlikely for a 28 year old to have that cardiac diagnosis without structural cardiac disease” and noted the condition was not diagnosed until 2005 when the Veteran was 45 years old. The examiner referenced that large epidemiologic studies have demonstrated the risk of developing sinus node dysfunction increased with each additional 5 years of age. The examiner further noted the Veteran had provided conflicting evidence regarding the history relating to the aspects of the events in the past; the examiner noted that they conducted a “detailed interview with the Veteran on 3/16/2019 during which I type into the computerized record the substance of his remarks regarding the history of all heart and headache-related symptoms, treatment and evaluations, as well as a detailed account of the 1988 event in service.” The examiner noted the Veteran at the November 2019 hearing testified that during the March 2019 examination “it wasn’t a really sit-down like we’re doing here right now, getting an extensive look at my medical history and allowing me to talk about how things have happened, to express what had happened in relationship to the heart. It was none of that…” The examiner stated, “I find no reason why I or the multiple examiners present for the 1988 exams would fabricate such detailed reports.” The Board notes in April 2018 the Veteran submitted an article that provided an overview of sick sinus syndrome to include symptoms and risk factors. The Board further notes that an adequate medical opinion should consist of a thorough review of the claims file and a discussion of the relevant evidence (including the disability in question), a consideration of the lay contentions of the veteran, and clear conclusions with a reasoned supporting rationale. Nieves-Rodriguez, 22 Vet. App. at 301. However, a medical opinion does not have to be perfect; and there is no requirement that a medical examiner comment on every piece of evidence in a claims file. See Monzingo v. Shinseki, 26 Vet. App. 97, 105 (2012). The law imposes no reasons-or-bases requirement on examiners. Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012). Where a medical opinion is lacking in detail, the Board is permitted to draw inferences based on the overall report, so long as the inference does not result in a medical determination. Id. at 294. Here, the March 2020 VA examiner noted that they reviewed the Veteran’s claims folder and medical history, considered his report of symptoms before rendering the medical opinion, and cited to the facts and medical record in support of their findings. The Board infers that the October 2020 VA examiner did not find the Veteran’s submissions to include the April 2018 article sufficiently important for the purposes of their analysis. The Board further finds that the April 2018 article submitted by the Veteran in support of his claim are insufficient to establish the required medical nexus between his heart condition and his active duty service. Medical treatise evidence can, in some circumstances, constitute competent medical evidence. See 38 C.F.R. § 3.159 (a)(1). However, treatise evidence must not simply provide generic statements that are not relevant to the veteran’s claim. Wallin v. West, 11 Vet. App. 509, 514 (1998). Instead, the treatise evidence, “standing alone,” must discuss generic relationships with such a degree of certainty that, under the facts of a specific case, there is at least plausible causality based upon objective facts, not an unsubstantiated lay medical opinion. Sacks v. West, 11 Vet. App. 314, 317 (1998). The Board finds that the article submitted by the Veteran has little probative weight because it does not specifically discuss a relationship between the Veteran’s heart condition and his service with a degree of certainty. See id. The Board also finds that the generalized article information is outweighed by the March 2020 VA medical opinion, which was rendered by a medical professional who reviewed the Veteran’s complete claims file, reflected on the specific facts of his case, considered pertinent medical research, and furnished a thorough rationale for their conclusions. See Nieves-Rodriguez, 22 Vet. App. 295. As the March 2020 VA examiner provided a detailed review and examination of the appellant’s claims file, made repeated references to pertinent past records to include the appellant’s STRs, and statements consistent with the evidence of record, the Board finds that the October 2020 VA examination report and medical records documenting the nature and extent of the appellant’s low back disability, to be the most probative evidence of record. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board acknowledges the Veteran’s statements and assertions that his heart condition is related to his military service. Certainly, he is competent to describe experiencing symptoms. To the extent that the Veteran contends that a medical relationship exists between his claimed current disability and service the Board acknowledges that the Veteran is competent to testify as to his observations. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Furthermore, lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) Nevertheless, a lay person, the Veteran does not have the training or expertise to render a competent opinion which is more probative than the VA examiner’s opinion on this issue, as this is a medical determination that is complex. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 309 (2007); Layno v. Brown, 6 Vet. App. 465, 469-71 (1994)). Here, the VA examiner considered the Veteran’s statements and reports of symptoms. The examiner still found that it was unlikely that his reported in-service symptoms were related to any current disability. The Board finds that the Veteran’s opinion is outweighed by the competent opinion of the VA examiner. See id. ; see also King v. Shinseki, 700 F.3d 1339, 1345 (Fed. Cir. 2012). The Board notes that review of the claims record show several inconsistencies in the Veteran’s reported history and symptoms of his claimed disability. The Veteran in July 2014 stated that during his enlistment, “the palpitations, heart/blood pressure symptoms were missed, ignored or not taken seriously by medical checkups and testing” and in an April 2018 statement that he was able to pass numerous physical examinations held during enlistment and his reenlistment in December 1984 “even while dealing with palpitations and headaches and dizziness”; however, the Veteran at his November 2019 hearing testified that when asked if he reported any heart problems when entering the service, the Veteran testified that “The only thing we made note of was what my grandmother shared via verbal information” and stated that he did not have any issues to report at the time of enlistment. The Veteran at the March 2019 VA examination stated that within a year of his separation from service he passed out, and then again 2 years later with the next in 2005; however the Veteran in April 2018 and in November 2019 stated that he suffered an attack only in 1994 to which he reported the medical records were destroyed and not available; the Veteran in June 2005 also reported that he had been treated twice by a cardiologist without specifying the reasons for treatment and the most recent in 1999 stating that he was told everything was ok. As addressed above, such inconsistencies undercut the credibility and probative weight given to the Veteran’s submitted statements and testimony. As such, the Board finds the Veteran’s statements to be outweighed by VA examinations of record performed by professionals. After review of the record, the Board finds the competent evidence of record is against a finding of service connection for the Veteran’s heart condition. Review of the Veteran’s STRs show no complaints, treatments or diagnosis relating to a heart condition. Review of the medical treatment record shows the earliest competent documentation relating to the Veteran’s heart condition was in 2005, years after the Veteran’s separation from service. The Veteran has stated in March 2019 that he experienced a heart-related attack within a year from separation of service and another one two years later; however the Veteran has not identified or provided records of this treatment to be associated with the record. The Veteran also has stated that in 1994 he suffered a similar attack but in November 2019 testified that records of this visit were destroyed and no longer available. The most probative opinion of the record made by the March 2020 VA examiner considered the Veteran’s report of symptoms but provided analysis of the case record to support their opinion that the Veteran’s current heart disorder was less likely than not incurred in or caused by the Veteran’s active duty service. The Veteran has stated that providers who treated him in June 2005 and May 2010 have told him that his heart condition was related to his service; however, review of the medical record of these visits do not show the providers made any documentation regarding the etiology of the Veteran’s heart condition. The Board notes that the provider in May 2010 noted that there was no significant cardiac pathology to explain the Veteran’s recent symptoms. The Veteran has not submitted any other opinions to be weighed against the VA examiner’s opinion. As such, the Board finds that the weight of the competent and probative evidence is against a finding of service connection for the Veteran’s heart condition. 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 claim, that doctrine is not applicable. 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). REASONS FOR REMAND The Board finds that remand is warranted for additional development. Seizure disorder The Veteran asserted his seizure disorder as related to his active duty service. The Veteran was afforded a March 2020 VA examination. The examiner found the Veteran with “no current diagnosis of a seizure disorder” but also stated that the seizure disorder clearly and unmistakably preexisted service and was not aggravated by service. In a following May 2020 VA examination, a separate examiner diagnosed the Veteran with “seizure disorder, asymptomatic”; however, the examiner does not address the findings made in the March 2020 VA examination. The Board notes that that the Veteran’s reported symptoms and diagnoses could have served as a current disability for service connection during the period of the appeal the disability was present. See McClain v. Nicholson, 21 Vet. App. 319, 322-23 (2007) (the fact that a disability has resolved during the appeal period does not preclude a finding of service connection for the disability). Thus, even assuming the Veteran’s claimed seizure disorder resolved during the appeal period, service connection may be available for the portion of the appeal period when the disabilities were present. As such, the Board finds that remand is warranted for an addendum opinion. Sleep apnea and Headaches The March 2020 VA examiner found it was less likely than not that the Veteran’s sleep apnea and headaches were related to the Veteran’s active duty service. The examiner noted that for the Veteran’s headaches, the “Veteran’s report of symptoms beginning and continuing after the October 1988 event” was considered. However, the Board notes that review of the record shows the Veteran has stated or testified that in October 1988 while suffering a seizure, the Veteran fell and hit is head on the floor and that his sleep apnea and headaches resulted from this injury. The March 2020 opinion does not specifically address or discuss the Veteran’s statements that he hit his head on the floor and the head injury resulted in or caused his sleep apnea and headaches. As such, the Board finds the opinions inadequate and remand warranted for addendum opinion. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all updated treatment records. 2. Return the claims file to the VA examiner who provided the March 2020 opinions for seizure disorder, sleep apnea, and headaches if available, for an addendum opinion. The need for another examination is left to the discretion of the examiner providing the opinion. The examiner should consider the findings of the May 2020 VA examinations. The claims file and copies of all pertinent records must be reviewed by the examiner in providing the addendum opinion. Based on this review of the record, and examination if provided, the examiner should provide opinions that respond to the following: (a.) Identify each current seizure disorder. If either disability existed during the appeal period but has resolved, this should be made clear. (b.) The examiner should record in detail the Veteran’s history of his seizure disorder and how they affect his ability to function. (c.) For any seizure disorder identified; the VA examiner should determine whether the identified condition that caused the October 1988 hospitalization during service clearly and unmistakably preexisted the Veteran’s service. If the examiner finds that it clearly and unmistakably preexisted the Veteran’s service, was it clearly and unmistakably not aggravated by service? (d.) If the examiner does not find the Veteran’s seizure disorder to preexist service, provide an opinion as to whether or not the Veteran’s seizure disorder is at least as likely as not (i.e., a probability of 50 percent or greater) is related to a period of active service. (e.) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s sleep apnea had its onset during, or is otherwise related to, his active duty service? (f.) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s headaches had its onset during, or is otherwise related to, his active duty service? (g.) In considering seizure disorder, the examiner should address the October 1988 medical reports; November 1989 medical board findings of “idiopathic seizure, EPTE, service aggravated” but also using a code that shows “EPTE, not aggravated by service”; the Veteran’s testimony in August 1989 and November 2019; and the submitted Veteran’s lay statements (h.) The examiner should also consider and discuss the Veteran’s statements and testimony made in April 2018 and November 2019; the March 2019 VA examination findings and statements; and December 2019 private physician letter regarding the Veteran’s claimed head injury from the October 1988 event in evaluating if the submitted statements and testimony are sufficient for reconsideration of the etiology opinions for sleep apnea and headaches. (i.) The examiner is also advised that the Veteran is competent to report in-service events and treatment, and her symptoms and history, and such reports and assertions must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. (j.) The examiner should provide a complete rationale for any opinion provided, and if the examiner is unable to provide any opinion request, then the examiner should state so and why. (k.) If the VA examiner is unable to provide an opinion without resort to speculation, he or she should explain whether the inability is due to the limits of the examiner’s medical knowledge, medical knowledge in general or there is evidence that, if obtained, would permit the opinion to be provided. A clearly stated rationale for any opinion offered should be provided. 3. After completion of the above and any additional development deemed necessary, the issues on appeal should be reviewed with consideration of all applicable laws and regulations. If any benefit sought remains denied, the Veteran should be furnished a supplemental statement of the case and be afforded the opportunity to respond. Thereafter, the case should be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Yang, Attorney-Advisor 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.