Citation Nr: 22017129 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 13-11 692 DATE: March 24, 2022 ORDER Service connection for a cardiovascular disorder is denied. FINDINGS OF FACT 1. The Veteran served on active duty from May 1970 to January 1972 with period of active duty for training (ACDUTRA) and inactive duty training (INACDUTRA) in the Reserve through 1995; he has been 100 percent disabled based on unemployability since June 2005. 2. The Veteran did not serve in Vietnam and herbicide agent exposure has not been shown. 3. A CV disorder, to include hypertensive heart disease (HHD) and valvular heart disease (VHD), was not shown in service or within one year of service, symptoms have not been continuous since service and the current CV disorders are not causally or etiologically related to service, to include exposure to toxic munitions, and are not caused or aggravated by a service-connected disability. CONCLUSION OF LAW A CV disorder was not incurred in service, not presumed to have been incurred in service, and is not secondary to a service connected disability. 38 U.S.C. §§ 1110, 1131, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.307, 3.309, 3.310 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSION This case has been remanded several times, including most recent in August 2021. It now returns for further appellate action. Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. The Veteran claims that service connection is warranted for a CV disorder because it is related to toxic munitions exposure during service in 1971. In the alternative, he claims that it is secondary to his service-connected disabilities. The record reflects a current diagnosis of HHD and VHD. Therefore, the first element of direct service connection is met. As to the second element of direct service connection an in-service incurrence the service treatment records (STRs) do not reflect complaints of, treatment for, or a diagnosis of any CV disorder. None of the various service examinations or Reports of Medical History indicate any CV complaints, findings, or diagnoses. Therefore, the medical evidence does not support direct service connection as an in-service incurrence has not been shown. To the extent that the Veteran contends that the current CV disorders are related to toxic munitions exposure during service, even conceding such exposure, the medical evidence weighs against service connection on this basis. In this regard, the only medical opinion on point, a March 2021 VA opinion report, weighs against the claim. Specifically, the March 2021 VA examiner opined that HHD and VHD are not due to the documented toxic chemical munitions exposure in 1971 because they are both due to the Veteran's hypertension. This evidence weighs against the appeal based on munitions exposure. There is no medical opinion in favor of the claim on this basis. As to secondary service connection, as noted, the Veteran has been diagnosed with HHD and VHD. The record also reflects that he is service-connected for posttraumatic stress disorder (PTSD), degenerative disc disease (DDD) and degenerative joint disease (DJD) of the cervical spine, bilateral pes planus, chondromalacia patella of the left knee, left shoulder strain, degenerative arthritis of the right shoulder, and DJD of the left knee. Therefore, the first and second elements of secondary service connection are met. With regard to whether the current CV disorders were caused or aggravated by the service-connected disorders, the three medical opinions obtained over the years all weigh against the claim and no medical opinion weighs in favor. Specifically, a January 2020 VA examiner opined that none of the Veteran's service-connected disabilities was a known causative or aggravating factor for HHD. Similarly, a March 2021 VA examiner opined that HHD and VHD were separate and unrelated to service-connected PTSD, DJD/DDD of the cervical spine, bilateral pes planus, DJD and chondromalacia of the left knee, left shoulder strain and degenerative arthritis of the right shoulder. The examiner reasoned that the CV disorders are instead related to the Veteran's hypertension (which is not service connected). This evidence weighs against the appeal. Next, a November 2021 VA examiner noted that HHD and VHD were separate and unrelated to the Veteran's service-connected disabilities. The examiner stated that HHD referred to a constellation of changes that occurred in the left ventricle, left atrium and coronary arteries as a result of chronic blood pressure elevation. The examiner also reflected VHD causes included as a congenital condition, caused by infections, degenerative conditions (wearing out with age), and conditions linked to other types of CV disease. The examiner specifically noted that the Veteran's CV conditions were not caused by PTSD or musculoskeletal conditions such as the Veteran's service-connected disabilities. The examiners all opined that the Veteran's CV disorders were less likely than not proximately due to, the result of, or aggravated by a service-connected disability. The November 2021 VA examiner reasoned that, after review of the claims folder, there was no credible objective evidence of aggravation beyond natural progression of HHD or the VHD due to the service-connected disabilities. It was specifically noted that the CV examinations reflected that the Veteran's CV conditions were stable on oral medications. Further, echocardiograms from 2008, 2019 and 2021 continued to note mild/trace VHD and LVH. There was no evidence of cardiac intervention to include exacerbations, flare ups or increased treatment due to the service-connected disabilities. In sum, the examiner found no evidence of aggravation beyond natural progression identified. As the medical evidence does not establish a link between the current CV disorders and any service-connected disability, this evidence does not support the appeal on a secondary basis. As to presumptive service connection, no chronic disease or injury was shown in service. There is no evidence of any CV complaints, findings, or symptoms in the STRs. Therefore, the medical evidence does not support presumptive service connection on a "chronic disease or injury shown in service" basis. Next, the medical evidence does not support presumptive service connected based on continuity of symptomatology since service. Specifically, the record reflects that the Veteran's CV disease was first diagnosed in 2008, and he was discharged from active duty in 1972 with no notion of any CV problems, symptoms, findings, or diagnosis. Moreover, he was not serving in the Reserve at this time. Finally, the January 2020 VA examiner opined that there was no medical evidence of any continuity of symptomatology since service. As such, the medical evidence does not support service connection on a "continuity of symptomatology" basis. Further, the disorder did not manifest itself to a degree of 10 percent or more within one year from the date of separation of active service. The Veteran separated from service in 1972 but did not note CV symptoms until 2008. This evidence does not support presumptive service connection on a "manifest within one-year from separation" basis. Further, the January 2020 VA examiner opined that there was no medical evidence supporting any finding that a CV disorder was diagnosed within one year of service separation. Importantly, the Veteran does not contend that he had a CV disorder during active service, within one year of active service, or continuous CV symptoms since discharge from active service. Therefore, the medical evidence does not support presumptive service connection on any basis. The Board has considered the Veteran's lay statements that his CV disorders are related to his service-connected disabilities, or that it is caused by toxic munitions exposure in 1971. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. However, he is not competent to offer an opinion as to the etiology of his current CV disorders due to the medical complexity of the matters involved. Such competent evidence has been provided by the service records, clinical evidence, and examinations obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above, the preponderance of the evidence is against the claim for service connection and there is no doubt to be otherwise resolved. As such, the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Redman, 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.