Citation Nr: 22010993 Decision Date: 02/25/22 Archive Date: 02/25/22 DOCKET NO. 17-25 562 DATE: February 25, 2022 ORDER Entitlement to service connection for a heart disability, claimed as ischemic heart disease (IHD), is denied. REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. FINDING OF FACT The evidence of record persuasively weighs against finding that a heart disability began during active service or is otherwise related to any event, injury, or disease during service. CONCLUSION OF LAW The criteria for service connection for a heart disability, claimed as IHD, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from March 1974 to July 1975. These matters come before the Board of Veterans' Appeals (Board) on appeal from an October 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Huntington, West Virginia. The Veteran presented testimony at a videoconference hearing before the Board in July 2021. A transcript of that hearing is of record. 1. Entitlement to service connection for a heart disability, claimed as IHD The Veteran contends that he is entitled to service connection for IHD because the claimed disability is the result of active service. More specifically, he alleges that complaints of chest pain during service were early signs of a current heart disability. Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. To establish service connection requires evidence of: (1) a current disability; (2) incurrence or aggravation in service of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to any event, injury, or disease during service. The Board concludes that, while the Veteran has a current diagnosis of non-ischemic dilated cardiomyopathy, and evidence shows complaints of chest pain in service, the evidence of record persuasively weighs against finding that the diagnosis of non-ischemic dilated cardiomyopathy began during service or is otherwise related to any event, injury, or disease during service. A February 2012 Disability Benefits Questionnaire (DBQ) noted a 1990 diagnosis of severe hypertension and a 2010 diagnosis of congestive heart failure. In a January 2013 VA examination report, the examiner opined that the claimed disability was less likely than not related to chest complaints in service. It was noted that the Veteran did not have IHD, but was found to have non-ischemic dilated cardiomyopathy. The examiner concluded that was likely due to cocaine use and malignant hypertension. The rationale for that the problem in service was due to a scar, musculoskeletal, or pericarditis. "In current medical records no one of this [sic] problems play a role, pericardio was normal by Echo, and current problem is likely due to his malignant HTN and substance abuse, as documented by treating physicians." The examiner's opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In a June 2014 Heart Conditions DBQ, the examiner listed the Veteran's heart conditions as non-ischemic cardiomyopathy diagnosed in July 2013, congestive heart failure, and implanted automatic implantable cardioverter defibrillator diagnosed in October 2011. The examiner indicated that the Veteran did not have a diagnosis of IHD. In a July 2014 private medical letter, D.S., R.N. opined that the Veteran's heart problems began while he was in active service. D.S., R.N. noted that they had known the Veteran for over 20 years and were aware of his heart problems. "After reviewing his military records with him I saw that he had sought medical treatment several times for chest pain, which eventually lead to a diagnosis of endocarditis, then congestive heart failure." It is noted that no medical records were provided that would exhibit that the Veteran was under D.S., R.N.'s care or had been treated by that R.N. No support or medical rationale was provided for the finding that the complaints in service led to the current diagnosed heart disabilities. As a result, the private medical letter is found to be of little probative value. VA treatment records show the Veteran was not diagnosed with severe hypertension in 1990 and congestive heart failure in 2010, decades after separation from service. While the Veteran is competent to report having experienced symptoms of chest pain since service, he is not competent to provide a diagnosis in this case or determine that the symptoms were manifestations of a heart disability. The issue is medically complex, as it requires interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The record contains conflicting medical opinions regarding whether the Veteran's heart disability is at least as likely as not related to any event, injury, or disease, during service, including reports of chest pain in service. The private opinion appears to be based on the Veteran's self-reported medical history in addition to whichever medical records were provided to D.S., R.N., which is inconsistent with VA treatment records connecting the Veteran's chest complaints in service to other conditions, and the current heart disability to hypertension and cocaine use. That opinion also did not contain a rational explaining the basis of the opinion. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Reonal v. Brown, 5 Vet. App. 458 (1993). Consequently, the Board gives more probative weight to the January 2013 VA medical opinion which was provided after examination and medical history review, and included a rationale to explain the opinion. The Veteran believes his heart disability is related to an event, injury, or disease during service. The Veteran in this case is not competent to provide a medical etiology opinion regarding this issue. The issue is medically complex, as it requires the interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the January 2013 and June 2014 VA medical findings. Accordingly, the Board finds that the preponderance of the evidence is against the claim for service connection for a heart disability. The Board finds that the evidence is not in relative equipoise such that service connection can be granted. Therefore, the claim is denied. REASONS FOR REMAND 1. Entitlement to service connection for a left knee disability is remanded. 2. Entitlement to service connection for a right knee disability is remanded. The Veteran asserts that he is entitled to service connection for a bilateral knee disability because the claimed disability is the result of active service. More specifically, the Veteran asserts that physical training for service, which involved running and walking, caused strain to his knees that lead to the development of the current disability. At the July 2021 Board hearing, the Veteran testified that his knee problems began 25 years ago and that he believes it came from running all the time in service for training. He stated that he could not say that he experienced problems with his knees while in-service, but he believes that is where the current disability started. He also stated that he was verbally told by a physician's assistant that the stress he placed on his knees while in service caused the current knee problems. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a bilateral knee disability because no VA examiner has opined whether the diagnosed degenerative joint disease of the bilateral knees is related to active service. Therefore, remand is necessary to obtain an opinion. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination with a medical doctor to determine the nature and etiology of left knee and right knee disabilities. The examiner should review the claims file and note that review in the report. All indicated tests should be conducted. The examiner should discuss and consider the Veteran's lay statements regarding the history and continuity of symptomatology. The examiner should provide an explanation for all conclusions. The examiner should opine whether it is at least as likely as not (50 percent probability or greater) that any right or left knee disability is related to service. The examiner should discuss the matter thoroughly and provide a rationale for the opinion. If the examiner determines that any right and left knee disabilities are not the result of active service, but can more likely be attributed to some other cause, the examiner should so state, taking into account the Veteran's full post-service work and medical history. The examiner cannot rely solely on silence of the service medical records for a diagnosis or treatment to support a negative opinion. The examiner is advised that the Veteran is competent to report symptoms and history, and those statements by the Veteran must be specifically acknowledged and considered in formulating any opinions. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Cross, 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.