Citation Nr: 21025978 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 20-04 461A DATE: April 29, 2021 ORDER Entitlement to service connection for aortic sclerosis with mild pulmonary and tricuspid regurgitation (claimed as ischemic heart disease) to include as due to exposure to herbicides is denied. FINDING OF FACT 1. The preponderance of the evidence shows that the Veteran does not have ischemic heart disease. 2. The Veteran’s aortic sclerosis with mild pulmonary and tricuspid regurgitation was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury or disease to include claimed exposure to Agent Orange. CONCLUSION OF LAW The criteria for service connection for aortic sclerosis with mild pulmonary and tricuspid regurgitation are not met. 38 U.S.C. §§ 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1969 to September 1973, including in the Republic of Vietnam. His decorations include the Bronze Star Medal. This matter is before the Board of Veteran’s Appeals (Board) on appeal from a November 2018 rating decision by a Department of Veteran’s Affairs (VA) Regional Office (RO). This matter was remanded by the Board in January 2021 for further development. Service Connection The Veteran contends that his current aortic sclerosis with mild pulmonary and tricuspid regurgitation (heart condition) is a direct result of “exposure to Agent Orange [during] Vietnam service.” See 7/5/2018 fully developed claim. Service connection is established 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 of 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). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Service connection may also be granted on a presumptive basis for diseases associated with herbicide exposure under 38 C.F.R. § 3.309, such as ischemic heart disease, if a Veteran: (1) served in the Republic of Vietnam between January 1962 and May 1975, (2) served between April 1968 and August 1971 in or near the Korean Demilitarized Zone; (3) served near the base perimeter of certain Thailand Air Force Bases during the Vietnam War era, or (4) regularly and repeatedly operated, maintained, or served aboard aircraft known to have been used to spray a herbicide agent during the Vietnam War Era. 38 C.F.R. § 3.307 (a)(6). Notwithstanding the foregoing provisions regarding presumptive service connection, a Veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). 1. Entitlement to service connection for aortic sclerosis with mild pulmonary and tricuspid regurgitation (claimed as ischemic heart disease) to include as due to exposure to herbicides The Veteran was diagnosed with aortic sclerosis with mild pulmonary and tricuspid regurgitation during a November 2015 VA primary care appointment. As a result, the first element of service connection has been met. The Veteran’s military personnel records demonstrate that he was stationed in Vietnam during active service from August 1970 to August 1971. See DD Form 214. Thus, in-service herbicide agent exposure is legally presumed. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307 (a)(6)(iv). This satisfies the second element of service connection, an in-service injury. Turning to the third element of nexus, in some circumstances, a disease associated with exposure to certain herbicide agents, such as ischemic heart disease, will be presumed to have been incurred in service even though there is no evidence of that disease during the period of service at issue, unless there is affirmative evidence to establish that the disease is due to an intercurrent injury or disease. 38 U.S.C. § 1116 (a); 38 C.F.R. §§ 3.307 (a)(6), 3.307(d)(1), 3.309(e). The Veteran underwent a VA examination in October 2018 in which the examiner opined that the Veteran’s aortic sclerosis with mild pulmonary and tricuspid regurgitation was not a form of ischemic heart disease. The examiner opined that the Veteran’s heart condition was related to a “calcified aortic valve, valve regulation.” The Veteran also denied cardiac symptoms, chest tightness, and dyspnea. He exercises 4 to 5 days per week with no issues. The examiner did note the Veteran had a heart murmur but concluded, “there’s no evidence of [ischemic heart disease] at this time.” Since the Veteran’s current heart condition is not a form of ischemic heart disease, it is not considered to be one of the enumerated diseases. 38 U.S.C. § 3.309(e), NOTE 2 (“the term ischemic heart disease does not include…any other condition that does not qualify within the generally accepted medical definition of Ischemic heart disease”). To the extent that the Veteran asserts that aortic sclerosis with mild pulmonary and tricuspid regurgitation are ischemic heart disease, he has not shown the medical expertise, training, or experience to give a competent diagnosis or medical opinion. The VA examiner’s opinion, on the other hand, is based on medical training and experience and is competent medical evidence on the question. In the absence of contrary competent evidence, the Board finds that the Veteran does not have ischemic heart disease and the presumption of service connection due to herbicide exposure does not apply. Additionally, the Veteran’s service treatment records are silent for complaints or treatment for a heart condition. The Veteran’s March 1969 entrance examination did not note any issues relating to the Veteran’s heart. The Veteran had a flight examination in June 1969 were his heart was noted to be normal and no defects were found. However, in a June 1969 clinical record, the Veteran was noted to have “bradycardia and arrythmia not outside normal limits.” No further treatment was provided for this finding. The Veteran had another flight physical in June 1970, November 1971, and November 1972 where his heart was again marked as normal and no additional defects were found. In his June 1973 separation examination, the Veteran’s heart was marked as “normal” and no further defects were found. The first mention of the Veteran’s heart condition in the record is in January 2012 during a VA environmental registry examination. Here, the Veteran asserted that he was thought to have an enlarged heart in service during a flight physical, but he was not sure how the doctor came to this conclusion. As shown above, there are no notations of an enlarged heart during any of the Veteran’s flight examinations on record. Additionally, as stated above no diagnosis for the Veteran’s heart condition was given until November 2015. The available evidence thus preponderates against finding manifestations sufficient to identify a chronic heart condition in active-duty service, or within one year thereafter. This service connection is not warranted on a presumptive basis. 38 C.F.R. §§ 3.307, 3.309. The Veteran did not state that his heart condition began in service nor did he report continuous symptoms of a heart condition since active-duty service. The evidence does not show continuous symptoms of a heart condition since service. Thus, service connection is not warranted on the basis of continuity of symptomatology. 38 C.F.R. § 3.303(b). The Veteran may still establish nexus by a preponderance of the evidence on a direct basis. In January 2021 the Veteran underwent a VA examination in which the examiner opined that the Veteran’s heart condition was not related to active duty service. The examiner noted that the Veteran’s entire record had been reviewed to include his statement regarding having an enlarged heart and Agent Orange exposure. The examiner stated that there was no evidence of aortic sclerosis during active service. The examiner further stated that the Veteran was first diagnosed with his heart condition 42 years after his separation from service. In conclusion the examiner opined, “there’s no medical evidence in all available records between 1973 and 2015, to support a nexus between any injury or event during service to development of aortic sclerosis 42 years” after service. This would include the Veteran’s assertion regarding his enlarged heart, Agent Orange exposure, and the June 1969 note referencing bradycardia and arrythmia. As there is no evidence to support that the Veteran’s heart condition began in service nor was a result of Agent Orange exposure, service connection on a direct basis is not warranted. 38 C.F.R. §§ 3.303. In making the above determinations, the Veteran’s lay contentions were considered. However, the record does not suggest he is a trained medical professional and as a result, he is not medically competent to provide a medical etiology opinion for his heart condition as it relates to Agent Orange exposure, no matter how sincere. While a lay person is competent to provide opinions on some medical issues, the specific disability in this case falls outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The preponderance of the evidence is against the claim and the doctrine of reasonable doubt is not for application. 38 C.F.R. § 3.102. The claim is denied. LAURA E. COLLINS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.