Citation Nr: 21029712 Decision Date: 05/14/21 Archive Date: 05/14/21 DOCKET NO. 15-27 856 DATE: May 14, 2021 ORDER Service connection for a heart disability diagnosed as bicuspid valve prolapse with heart valve replacement is denied. FINDING OF FACT The preponderance of the evidence indicates that the Veteran's bicuspid valve prolapse with heart valve replacement was not caused by nor is it otherwise related to service. CONCLUSION OF LAW The criteria for service connection for bicuspid valve prolapse with heart valve replacement and congestive heart failure are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1991 to June 1994. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In January 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. The Board previously remanded this appeal in June 2019 and January 2021. Service connection for bicuspid valve prolapse with heart valve replacement Unfortunately, following a review of the record, the Board finds that service connection for a heart disability diagnosed as bicuspid aortic stenosis status post aortic valve replacement is not warranted, as the evidence weighs against a finding that it was incurred in service. Generally, establishing service connection requires competent evidence of: (1) a current disability; (2) an in-service precipitating disease, injury, or event; and (3) a causal relationship, i.e., a nexus, between the current disability and the in-service event. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). In this case, the evidence shows that the Veteran was diagnosed with bicuspid valve prolapse for which he underwent a heart valve replacement in 1995, and that he currently has congenital bicuspid aortic stenosis secondary to mechanical aortic valve implantation. See, e.g., August 1995 Private Hospital Attestation Report; June 2015 VA Treatment Note. Parenthetically, the Board notes that while the Veteran has claimed congestive heart failure, the record indicates that he does not have that condition. See September 2014 VA Cardiology Treatment Note. Additionally, the record supports in-service incurrence of symptoms potentially related to a heart disability, including dizziness, headaches, and fatigue. See March 1994 and April 1994 Service Treatment Records (STRs). Nevertheless, because the competent and probative medical evidence fails to establish a nexus between the Veteran's current heart disability and his service, service connection for congenital bicuspid aortic stenosis secondary to bicuspid aortic valve prolapse with mechanical aortic valve implantation is not warranted. In this regard, the Board finds the most probative evidence of nexus to be the October 2020 and January 2021 VA opinions that cumulatively found the Veteran's bicuspid aortic valve to be a congenital defect was less likely than not incurred in or aggravated by his active service, and is unrelated to any signs or symptoms documented in the STRs. Specifically, in the October 2020 and January 2021 opinions, the VA examiner explained that a normal aortic valve has three leaflets/cusps, though some people are born with only two, and that nothing will change the number of cusps. The examiner did note that bicuspid valves are more prone to calcification than normal tricuspid valves, and that calcification leads to narrowing (stenosis) and an inability to completely close (incompetence or reflux). However, while the calcification or degeneration could be considered a congenital disease, the examiner explained that no activity affects the progression, and that there is no life-style modification which aggravates or delays the progression of the degeneration. For example, the examiner noted that in-service mechanisms that cause or aggravate musculoskeletal degeneration, including impact, overloading, and forced motion beyond normal range of motion, do not affect the heart valves. Therefore, the examiner found that there was no aggravation of the Veteran's congenital heart defect due to military service. Regarding the possibility of an onset during service, the examiner concluded that the Veteran's heart condition did not first clinically manifest in service because of an absence of a heart murmur in the STRs and because the STRs did not show symptoms of dyspnea and chest pain. Moreover, to the extent that the STRs did show orthostasis and symptoms of fatigue, nausea, dizziness, and/or headaches just prior to the Veteran's separation, the examiner found based on a review of the STRs that those symptoms were acute and attributable to strep throat, mononucleosis, another viral illness, and/or tension headaches diagnosed in service. In providing the foregoing opinions, the examiner addressed the Veteran's lay contentions, as well as positive evidence of record, including a January 2019 private physician's statement that the Veteran's condition gradually developed over a period of years prior to its discovery in 1995. However, the examiner explained that calcification builds up and degeneration occurs over a patient's entire life and military service neither prevents nor aggravates the natural progression. The examiner further supported the opinions with rationale including in-depth discussions of relevant medical literature and references to the Veteran's medical history and relevant clinical evidence in the record. Thus, the Board finds the cumulative opinions to be probative and persuasive. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Moreover, the cumulative October 2020 and January 2021 VA opinions are consistent with the STRs, which do not show any diagnosed heart condition in service, and the Veteran's statements in August 1995 upon seeking treatment for symptoms ultimately attributed to his bicuspid valve defect, that he was discharged from the Army a year prior and "was well until about a week ago" when he started with chest tightness and dyspnea. As those 1995 statements were made in furtherance of treatment, they are deemed particularly probative and weigh against a finding that any of the documented symptoms in the STRs at the end of the Veteran's period of service continued until his diagnosis in August 1995. Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made to clinicians for purposes of diagnosis and treatment are exceptionally trustworthy because the declarant has a strong motive to tell the truth in order to receive proper care). The Board does not doubt the sincerity of the Veteran's belief that his current heart disability was incurred in or aggravated by service. However, he has not demonstrated that he possesses sufficient medical knowledge and training to diagnose himself, provide etiological opinions, and attribute symptoms he experienced to specific disabilities. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). And, unfortunately, the competent and probative medical evidence weighs against his assertion. In sum, as the only competent and adequate medical opinion of record weighs against the Veteran's claim, the Board finds that the claim of entitlement to service connection for a heart disability diagnosed as congenital bicuspid aortic stenosis and bicuspid valve prolapse with heart valve replacement must be denied. S. C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Fagan 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.