Citation Nr: 21032856 Decision Date: 05/28/21 Archive Date: 05/28/21 DOCKET NO. 17-32 893 DATE: May 28, 2021 ORDER Entitlement to service connection for cardiomyopathy (claimed as cardiovascular disease) is denied. FINDING OF FACT Cardiomyopathy did not have its onset during the Veteran's active service, and is not otherwise etiologically related to such service. CONCLUSION OF LAW The criteria for service connection for cardiomyopathy are not met. 38 U.S.C. §§ 1110, 5107 (2018); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active air service from February 1994 to July 2000 and from October 2007 to May 2008, with additional service in the Reserves. This case comes before the Board of Veterans' Appeals (Board) on appeal from a May 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge in September 2019. A transcript of that hearing has been added to the record. This case was previously before the Board in February 2020, at which time the appeal was remanded for additional development. The case has now been returned to the Board for further appellate action. Service Connection Cardiomyopathy The Veteran has asserted that his cardiomyopathy began during his time in service He testified at the September 2019 hearing that he was unable to complete a 2014 fitness test, and believes it was because of a heart condition. The Veteran has also asserted that he began to experience chest pains and fluttering while in active service, but felt that the symptoms were not severe enough to warrant seeing a doctor at that time. Service treatment records (STRs) are silent for complaints of, treatment for, or a diagnosis of any heart disability while the Veteran was in active service. At a March 2008 post-deployment health assessment conducted prior to the Veteran's April 2008 departure from Afghanistan, the Veteran reported that he was currently in very good health, and that he was not currently experiencing any physical health problems that made it difficult to work or perform daily activities. The Veteran reported that he was seen in medical on one occasion during his deployment; however, the reason for the visit was not noted. The Veteran specifically denied experiencing trouble breathing and chest pain or pressure. At an October 2008 post-deployment medical assessment following the Veteran's return from Afghanistan, the Veteran reported that he was currently in excellent health, and rated his general health to be better following deployment than it was prior to deployment. He denied experiencing any current, physical health problems. He denied experiencing trouble breathing, and chest pain or pressure. Post-service medical evidence of record shows that the Veteran was diagnosed with hypertension in early 2013, and began to receive treatment for such. The Veteran was seen at his primary care office in January 2014, at which time the Veteran's hypertension was noted to be well-controlled with medication, and the Veteran had a normal electrocardiogram (EKG). Sometime later in 2014, the Veteran began to experience symptoms of chest pain, shortness of breath, and heart palpitations. He underwent cardiac work-up as a result. An August 2014 Nuclear Myocardial Perfusion Imaging Study (MPI) was abnormal, and revealed low left ventricular ejection fraction (LVEF) of 40 percent, and lateral wall ischemia and apical infarct. A 2D transthoracic echocardiogram performed the same day revealed moderately reduced LVEF of 35-40 percent, grade I diastolic dysfunction, mild concentric left ventricular hypertrophy (LVH), and mild mitral regurgitation (MR). A 24-hour Holter Monitor Report from August 2014 was normal. An August 2014 EKG revealed sinus rhythm with Q waves in leads III and a ventricular fibrillation (VF), suggestive of an old inferolateral myocardial infarction, and inversions in leads III and a VF suggestive of ischemia. In October 2014, the Veteran underwent a cardiac catheterization procedure, which revealed normal coronary arteries. The Veteran's diagnosis at that time was non-ischemic cardiomyopathy. It was noted that if the Veteran's LVEF remained less than 35 percent, consideration would be given to implanting an automatic implantable cardioverter-defibrillator (AICD). There is no indication from the record that the Veteran reported having experienced chest pain or pressure while he was in active service at the time of his extensive cardiac work-up in August 2014 and October 2014. A review of the record shows that the Veteran has continued to receive treatment for his heart disability. However, there is no indication from the record that the Veteran's heart disability has been etiologically related to his active service. In April 2016, the Veteran was afforded a VA examination. At that time, the Veteran reported that he started to experience symptoms of his heart disability in 2013/2014. He reported that the symptoms began as shortness of breath with exertion, and random chest pains. He reported that he still occasionally experienced shortness of breath and chest pain every couple of months. The examiner noted the Veteran's diagnosis of cardiomyopathy. The VA examiner opined that it was less likely as not that the Veteran's cardiomyopathy was incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the VA examiner noted that there was no in-service record showing cardiac pathology, and the Veteran was not diagnosed with cardiomyopathy until 2014, after his separation from active service. At the September 2019 Board Hearing the Veteran testified that he was taking a beta blocker to manage his symptoms. Upon stating that the issue of failing the fitness test occurred during his time in the Reserves the Veteran was asked if he could recall any type of issue that occurred during his two stints of active duty. However, the Veteran could not recall a time during active duty when he went to the doctor with complains of chest pain. He did note that he was taking blood pressure medication while on active duty. In September 2020, the Veteran was afforded another VA examination. At that time, the Veteran reported that in 2014, he started failing his military runs and that he did not feel 100 percent when running. He reported that he felt like he was not getting totally oxygenated when breathing while running, and decided to have his heart checked. The examiner confirmed a diagnosis of cardiomyopathy, and noted additional diagnoses of old myocardial infarction, valvular heart disease, and congestive heart failure. The Veteran reported that other than an episode of chest pain in August 2019, for which he reported to the emergency department out of an abundance of caution, he had no current symptoms related to his heart disability. The examiner opined that it was less likely as not that the Veteran's heart disability was incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the examiner noted that the Veteran did not begin to experience symptoms until 2013, after his separation from service, and that he was not diagnosed with a heart disability until 2014. The examiner acknowledged the Veteran's report that he experienced chest pain during active service, but that his symptoms were not so severe as to cause him to seek medical attention. The examiner noted that since the discomfort reported by the Veteran was not significant enough to illicit an evaluation, it would be impossible to determine the cause of the symptoms, or confirm that they were related to a cardiac condition. However, the examiner did report that the symptoms may have been related to a strained muscle, inflammation of the chest cartilage, heartburn, or a viral infection; but that since it was not reported or evaluated, it would be impossible to state for sure. The examiner did not though, that it can be stated that the symptoms were unlikely cardiac in nature as the Veteran did not ultimately receive a diagnosis of cardiomyopathy until approximately five years following his separation from service. The Board finds that the September 2020 medical opinion is adequate. In this regard, the examiner thoroughly reviewed and discussed the relevant evidence, considered the contentions of the appellant, and provided a supporting rationale for the conclusions reached. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). As there is no medical opinion of record to the contrary, the September 2020 VA medical opinion is the most probative evidence of record. While the laypersons are competent to report observable symptoms, the Veteran is not competent to provide a medical opinion linking his current heart disability to his active service as that would require medical knowledge, training, and expertise and is simply 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). Therefore, the Veteran is not competent to provide an etiology opinion in this case. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for cardiomyopathy is not warranted. 38 U.S.C. § 5107 (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Andrew Ledman II 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.