Citation Nr: 22014157 Decision Date: 03/11/22 Archive Date: 03/11/22 DOCKET NO. 16-54 967 DATE: March 11, 2022 ORDER Entitlement to service connection for a heart disability, to include as secondary to the service-connected psychiatric disability, is denied. FINDING OF FACT A heart disability is not secondary to a service-connected psychiatric disability and is not otherwise related to service or any event, injury, or disease during service. CONCLUSION OF LAW The criteria for service connection for a heart disability, to include as secondary to the service-connected psychiatric disability, are not 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 had active service from October 1950 to August 1952. The Veteran died in January 2018. The Appellant is the Veteran's surviving spouse. In July 2018, she was substituted as the appellant in this appeal. The Appellant appeared at a December 2021 hearing before the undersigned Veterans Law Judge. The hearing transcript is of record. Entitlement to service connection for a heart disability, to include as secondary to the service-connected psychiatric disability The Appellant asserts that the Veteran is entitled to service connection for a heart disability because the claimed disability is the result of active service. The Veteran initially filed a claim for ischemic heart disease (IHD) claiming it as a result of herbicide agent exposure while serving in Korea. It is noted that the presumptive time period for herbicide agent exposure is after the Veteran separated from service. 38 C.F.R. §§ 3.3.07, 3.309. Furthermore, while some claims of exposure to herbicide agents during service in Korea can be presumed, that period is also after the Veteran's service in Korea. It was later asserted that the claimed disability was caused or aggravated by a service-connected psychiatric disability. Furthermore, there is no evidence of herbicide agent exposure during service. Therefore, the Board finds that the weight of the evidence is against a finding of herbicide agent exposure during service, and herbicide agent exposure during service cannot be presumed. Therefore, the Board finds that a claim for service connection for a heart disability related to herbicide exposure cannot be granted. 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) in-service incurrence or aggravation 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). Service connection may be established for a disability that is proximately due to, or aggravated by, a service-connected disability. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran had a disability that began during service or is at least as likely as not related to any injury, event, or disease during service, or was caused or aggravated beyond the natural progress by service-connected disability. The Board concludes that, while the Veteran has a diagnosis of a heart disability, the evidence of record persuasively weighs against finding that any psychiatric disability began during active service, or is otherwise related to any injury, event, or disease during service, or is caused or aggravated by a service-connected psychiatric disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995); 38 C.F.R. § 3.310(a). At a December 2021 hearing, the Appellant testified to observing the Veteran experience heart problems shortly after separation from service. The Appellant provided further testimony about observing the Veteran receive ongoing treatment for heart disabilities throughout his life. No testimony was provided on possible cause or aggravation by a service-connected psychiatric disability. The service medical records are incomplete. The only available record is an August 1952 separation examination. The Veteran was informed of the missing records in correspondence dated in April 2010, and he was informed of alternative forms of evidence that he could submit. The service separation examination did not indicate any complaints or treatment for a heart disability. In cases where part of the service records are lost or destroyed, there is a heightened obligation on the part of VA to explain findings and conclusions and to consider carefully whether reasonable doubt exists to resolve in favor of the Veteran. Cuevas v. Principi, 3 Vet. App. 542 (1992); O'Hare v. Derwinski, 1 Vet. App. 365 (1991). As a result of the absence of service records from the file, the Board's analysis has been undertaken with the heightened obligation in mind. The case law does not lower the legal standard for proving a claim for service connection, but rather increases the Board's obligation to evaluate and discuss in a decision all evidence that may be favorable to the claimant. Russo v. Brown, 9 Vet. App. 46 (1996). Private medical records dating from January 2003 show treatment for coronary artery disease (CAD) and other heart conditions. There is no medical evidence showing a diagnosis of any cardiovascular disability within one year of separation from service. In a May 2020 VA medical opinion, the examiner opined that the claimed disability was less likely than not proximately due to or the result of a service-connected disability. The rationale provided was that the heart disability was medically unrelated to anxiety. The examiner stated that a thorough review of medical literature did not demonstrate a causal relationship. The examiner found the ischemic heart disease (IHD) was the result of CAD. The examiner stated that CAD was due to smoking, high blood pressure, high cholesterol, diabetes or insulin resistance, and sedentary lifestyle. The examiner stated that a mental health condition does not cause IHD, and therefore a nexus had not been established. The May 2020 medical examiner also opined that the claimed disability was less likely than not the result of active service. The rationale provided was that it was not until several years after separation from service in 1998 that the Veteran was treated for CABG and diagnosed with a heart disability. The examiner noted that no records showed that CAD was an issue in 1986. The examiner noted the duration of time between active service and initial treatment for a heart disability and found that a nexus could not be established. In a November 2020 VA medical opinion, the examiner opined that the Veteran's heart disability was less likely than not aggravated by a service-connected psychiatric disability. The rationale provided was that while stress may have an association with the claimed disability, "ultimately it is a minor factor in actual medical decision making and practice." The examiner noted that the Veteran had several risk factors for the claimed disability which included hypertension, hyperlipidemia, a family history, and age. The examiner noted that the Veteran had well known and established major risk factors which could not be overlooked making the effect of a psychiatric disability as aggravating beyond natural progression less than a 50 percent probability. The Appellant believes the Veteran's heart disability was caused by service or aggravated beyond its natural progression by a service-connected psychiatric disability. The Appellant in this case is not competent to provide a nexus opinion regarding that issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and pathology. Therefore, it is outside the competence of the Appellant in this case because the record does not show that she has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Kahana v. Shinseki, 24. Vet. App. 428 (2011). The Board assigns more probative weight to the VA examiners because of their medical training and because they reviewed medical research in making the opinion. The Board finds that evidence outweighs any statements by the Veteran and Appellant. Accordingly, the Board finds that the weight of the persuasive evidence is against a finding that any heart disability was incurred in or aggravated by service, or was proximately due to, the result of, or aggravated by any service-connected disability. The Board finds that the evidence is not in relative equipoise and there is no reasonable doubt to resolve in favor of the Veteran. Therefore, the claim must be denied. 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.