Citation Nr: 21039666 Decision Date: 07/01/21 Archive Date: 07/01/21 DOCKET NO. 13-12 562 DATE: July 1, 2021 ORDER Entitlement to service connection for mitral valve prolapse, to include as secondary to rheumatic fever is denied. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had mitral valve prolapse at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for entitlement to service connection for mitral valve prolapse, to include as secondary to rheumatic fever have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from July 1958 to February 1959. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2009 rating decision of the Department of Veterans Affairs Regional Office (RO) in Jackson, Mississippi, denying the claim currently on appeal. Additionally, evidence was submitted by the Veteran and the RO issued a rating decision in April 2011, denying the claim on appeal. The Veteran was afforded a hearing before the undersigned Veterans Law Judge in April 2015. A written transcript of this hearing has been prepared and incorporated into the evidence of record. In June 2015 and May 2018, the Board previously remanded these claims for further development. That development has been completed and the case has returned to the Board for further action. 1. Entitlement to service connection for mitral valve prolapse, to include as secondary to rheumatic fever The Veteran contends that his mitral valve prolapse is due to his service-connected rheumatic fever. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board's adjudication will consider only entitlement to secondary service connection. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). A lay witness is competent to testify as to the occurrence of an in-service injury or incident where such issue is factual in nature. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In some cases, lay evidence will also be competent and credible on the issues of diagnosis and etiology. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Specifically, lay evidence may be competent and sufficient to establish a diagnosis where (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 at 1377; see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). A layperson is competent to identify a medical condition where the condition may be diagnosed by its unique and readily identifiable features. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007). Additionally, where symptoms are capable of lay observation, a lay witness is competent to testify to a lack of symptoms prior to service, continuity of symptoms after in-service injury or disease, and receipt of medical treatment for such symptoms. Charles v. Principi, 16 Vet. App. 370, 374 (2002). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or was aggravated beyond its natural progress by service-connected disability. The Board concludes that the Veteran does not have a current diagnosis of mitral valve prolapse and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). A June 2009 echocardiogram showed a normal mitral valve apparatus. A private treatment record from November 2009 shows a diagnosis of mitral valve prolapse. A September 2010 VA examination did not show evidence of any valvular disease or damage. The Veteran states he believes that his heart valve problems were caused by his rheumatic fever. At the April 2015 Board hearing, the Veteran related that he has a heart valve problem. A February 2017 VA opinion states the Veteran's claimed mitral valve prolapse is less likely than not proximately due to or the result of the Veteran's service connected rheumatic fever because the examiner was unable to confirm a current chronic diagnosis with current available records and upon examination. The February 2017 VA examination noted diagnoses of coronary artery disease, paroxysmal atrial fibrillation, and atrial septal defect. The examination report noted the Veteran had no heart valve condition. The VA examiner opined in January 2018 that while rheumatic fever can sometime cause mitral stenosis which can increase risk for atrial fibrillation, the examiner stated he was unable to find a diagnosis of mitral valve prolapse in the c-file. A March 2019 private treatment record notes the Veteran's mitral valve is structurally normal. An addendum VA opinion was obtained in April 2021. The examiner opined the Veteran's claimed mitral valve prolapse was less likely than not due to or the result of the Veteran's service-connected rheumatic fever. The examiner reasoned that the medical evidence does not support that the Veteran has mitral valve prolapse. The examiner reviewed the Veteran's VA file and noted that in June 2009, the Veteran had normal mitral valve apparatus and valve excursion on echo. The 2009 VA examination did not find a diagnosis of mitral valve. A May 2009 private provider letter states, "your cardiac test for coronary artery disease and valvular heart disease have all been negative." The Veteran related at the September 2010 VA examination that he had an echo in 2008 in Memphis which showed a mitral valve that was mildly thick and sclerotic suggestive of mitral valve prolapse. The examiner noted the Veteran did have an echo in Jackson in June 2009 which showed a normal mitral valve apparatus and valve excursion. The examiner noted that a November 2009 private treatment note has mitral valve prolapse as a current diagnosis, however this is per the Veteran's report. The private treatment note's impression/plan, which is actual diagnoses by the cardiologist, show atrial fibrillation, a history of rheumatic fever, and ASD. There is no diagnosis of mitral valve prolapse by the cardiologist. A December 2009 note from the same cardiologist is silent for a mitral valve diagnosis and the Veteran's echo was normal except for atrial septal defect which is not the same as mitral valve prolapse. The heart catheterization did not show mitral valve prolapse either. The April 2021 VA examiner concluded there is no medical evidence presented to corroborate the Veteran having mitral valve prolapse. The Board finds the preponderance of the evidence is against finding that the Veteran has a current diagnosis of mitral valve prolapse. While a November 2009 private treatment note shows a diagnosis of mitral valve prolapse, the evidence of record does not support the Veteran has had a diagnosis of mitral valve prolapse. The April 2021 VA examiner noted the November 2009 private treatment note listed mitral valve prolapse as a diagnosis per the Veteran's report which is inconsistent with VA and private treatment records and the cardiologist note at the end of the same treatment record. At the end of the examination, the cardiologist did not list mitral valve prolapse as a diagnosis under impression/plan. Moreover, several VA examinations, private treatment records, and VA treatment records are either silent for a diagnosis of mitral valve prolapse or show a normal mitral valve apparatus. The April 2021 VA examiner considered the Veteran's entire file and gave a rationale as to why the Veteran does not have a diagnosis of mitral valve prolapse, specifically addressing the November 2009 private treatment note. Consequently, the Board gives more probative weight to the April 2021 VA examiner's findings. While the Veteran believes he has a current diagnosis of mitral valve prolapse, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education, and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Therefore, entitlement to service connection for mitral valve prolapse, to include as secondary to rheumatic fever, is not warranted. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Alexia E. Palacios-Peters, 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.