Citation Nr: 22017652 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 05-21 961 DATE: March 25, 2022 ORDER Entitlement to service connection for a prostate condition, for substitution purposes, is denied. Entitlement to service connection for a cardiac condition, for substitution purposes, is denied. FINDINGS OF FACT 1. There is not an approximate balance of evidence for and against the Veteran's prostate condition to find that it began during active service or is otherwise related to an in-service injury or disease. 2. There is not an approximate balance of evidence for and against the Veteran's cardiac condition to find that it began during active service or is otherwise related to an in-service injury or disease, or is caused or aggravated by service-connected disability. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a prostate condition, for substitution purposes, have not been met. 38 U.S.C. §§ 1110, 1112, 1117, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. 2. The criteria for entitlement to service connection for a cardiac condition, for substitution purposes, have not been met. 38 U.S.C. §§ 1110, 1112, 1117, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service in the Army from September 1980 to April 1987, and from January 1991 to June 1991. He died in October 2018. The Appellant is the Veteran's surviving spouse. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama (Agency of Original Jurisdiction (AOJ)). This matter was previously before the Board in August 2017. The Board remanded to obtain outstanding service treatment records (STRs) and military personnel records. However, prior to these matters appearing before the Board once more, the Veteran died. Subsequently, the Board issued another decision in November 2018 dismissing the appeals. Since that time, the Veteran's surviving spouse requested to be substituted as the claimant in the Veteran's claims pending at the time of his death. This request for substitution was granted in an April 2020 correspondence. A review of the file reflects that additional STRs and military personnel records were obtained. To that end, the Board finds that the AOJ substantially complied with the remand directive in accordance with Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board notes that the Appellant has another appeal involving an issue of entitlement to compensation for disability under 38 U.S.C. § 1151 before the Board. This issue is under a separate docket number and will be separately adjudicated. Service Connection Service connection may be granted for a current disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110; 38 C.F.R. §§ 3.303. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. §§ 3.303(d). The requirement that a current disability exist is satisfied if the claimant had a disability at the time the claim for VA disability compensation was filed or during the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Establishing service connection generally requires evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In addition, for Veterans who have served 90 days or more of active service after December 31, 1946, there is a presumption of service connection for certain specified chronic diseases if the disability is manifest to a compensable degree within one year of discharge from service. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." Continuity of symptomatology after discharge is required where the condition noted during service is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those conditions explicitly recognized as chronic as per 38 C.F.R. § 3.309(a)). In addition to the methods outlined above, service connection may be established for a disability due to undiagnosed illness of a veteran who served in the Southwest Asia Theater of operations during the Persian Gulf War. In order to establish service connection on that basis, there must be objective indications of a chronic disability resulting from an illness or combination of illnesses manifested by one or more signs or symptoms such as fatigue, signs or symptoms involving the skin, headache, muscle pain, joint pain, neurological signs or symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper and lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, and menstrual disorders. The illness must become manifest during either active service in the Southwest Asia theater of operations during the Persian Gulf War or to a degree of 10 percent or more post-service, under the appropriate diagnostic code of 38 C.F.R. Part 4. By history, physical examination, and laboratory tests, the disability cannot be attributed to any known clinical diagnosis. There must be objective signs that are perceptible to an examining physician and other non-medical indicators that are capable of independent verification. There must be a minimum of a six-month period of chronicity. There must be no affirmative evidence that relates the undiagnosed illness to a cause other than being in the Southwest Asia Theater of operations during the Persian Gulf War. 38 U.S.C. § 1117; 38 C.F.R. 3.317. If signs or symptoms have been medically attributed to a diagnosed (rather than undiagnosed) illness, the Persian Gulf War presumption of service connection does not apply. VAOPGCPREC 8-98 (Aug. 3, 1998). A qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following): (A) an undiagnosed illness; (B) the following medically unexplained chronic multi-symptom illnesses that are defined by a cluster of signs or symptoms: (1) chronic fatigue syndrome; (2) fibromyalgia; (3) IBS; or (4) any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multi-symptom illness; or (C) any diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service-connection. 38 C.F.R. § 3.317 (a)(2)(i). For purposes of this section, the term 'medically unexplained chronic multi-symptom illness' means a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii). For purposes of this section, "objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). As addressed below, the Veteran had diagnoses of prostatitis, benign prostatic hypertrophy, congestive heart failure, paroxysmal atrial fibrillation and left ventricular hypertrophy which are known clinical diagnoses. As such, the provisions of 38 U.S.C. § 1117(d) do not apply in this case. Lay evidence is competent to establish the presence of observable symptomatology and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994). When a condition is capable of lay observation and may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature." Lay evidence can be competent and sufficient to establish a diagnosis when a layperson (1) is competent to identify the medical condition; or, (2) is reporting a contemporaneous medical diagnosis; or, (3) describes symptoms at the time which supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Although a lay person is competent in certain situations to provide a diagnosis of a simple condition, a lay person is not competent to provide evidence as to more complex medical questions. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Likewise, mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient. Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). A claimant bears the evidentiary burden to establish entitlement to the benefit sought. See Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (2009). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). The benefit of the doubt applies when the evidence for and against is in "approximate balance" or "nearly equal," but does not apply when the evidence persuasively favors one side or the other. Lynch v. McDonough, _ F4th_, 2021 U.S. App. LEXIS 37307, 2021 WL 5983923 (Fed. Cir. Dec. 17, 2021) (en banc). 1. Entitlement to service connection for a prostate condition, for substitution purposes The Veteran contended prior to his death that he developed a condition of the prostate that was etiologically related to his active duty service. He testified at his December 2016 hearing that he did not have any prostate problems prior to his active duty service and it was not until he came back from deployment that he began experiencing problems, including blood in his urine and semen. He further indicated he experienced cramps and pains and had difficulty urinating. The Veteran also reported being told his prostate-specific antigen (PSA) test levels were elevated at 9 ng/mL post-service. He speculated that his condition may have been due to his exposure to hazardous materials while serving in the Gulf War; he specifically mentioned exposure to sulfur, mercury, oil wells, and contaminated air following a scud missile attack. The evidence of record suggests that the Veteran had a condition of the prostate prior to his death. A VA examination was performed in April 2017, which recorded a diagnosis of prostatitis and benign prostatic hypertrophy in 1995. At the time of the examination, he continued to report symptoms of daytime frequency of 1-2 hours and interrupted stream. CAPRI VA treatment records dated prior to the Veteran's death document that he was taking medication for his prostate; these same records note "hypertrophy (benign) of prostate without urinary obstruction" and "benign prostatic hyperplasia" under his problem list. The Board accepts that prior to his death, the Veteran had a diagnosed prostate condition. STRs document, as the Veteran suggested, that he experienced episodes of urinary frequency and urgency during service. In January 1983, he sought medical treatment for blood in his urine and increased frequency. He complained about urinary urgency again in July 1983. In September 1983, the Veteran presented to sick call once more complaining about urinary frequency with suprapubic fullness and hematuria (blood in his urine). An August 1983 Report of Medical History includes the Veteran's endorsement that he experienced painful and/or frequent urination. The Board notes, however, these instances appear to have resolved, as the examiner who performed the February 1987 Report of Medical Examination evaluated the Veteran as clinically normal at separation. Additional STRs subsequently added to the record in October 2017 document that he continued to deny frequent or painful urination on Reports of Medical History dated November 1989 and April 1993. Nonetheless, the Board acknowledges these instances of urinary problems as in-service events. The examiner who performed the April 2017 VA examination opined it was less likely than not that the Veteran's prostate condition was incurred in or caused by his active duty service. She rationalized, "The Veteran's urological complaints from the early 1980s which, while recurrent, were short-term conditions which resolved. The resolution of these conditions are supported by routine military medical exams with normal rectal exams, normal GU exam, and normal urinalysis [November 8, 1989] and [April 20, 1993]. With those exams the Veteran also completed a Report of Medical History, where the Veteran specifically denied 'frequent or painful urination.' Earliest objective evidence of prostate condition/symptoms are contained in [December 12, 1994] note where PSA and prostate ultrasound were ordered. While the Veteran in the VA hearing asserted onset with Gulf War service/military service and in statements during exam that the symptoms dated back to 1992, these assertions of the Veteran are not supported by objective medical evidence showing no urinary symptoms and normal prostate exams through 1993. Additionally, PSA was normal until elevations were noted in 1998. While I do give significant weight to the subjective assertions of the Veteran, the objective evidence does not support the assertion that the Veteran's condition was incurred in or caused by military service. Additionally, medical knowledge and literature does not support prostate disease as a result of [Southwest Asia] service or exposures so it is also less likely than not that the Veteran's prostate conditions, which can be said to have onset sometime between [April 20, 1993] and [December 12, 1994], was the result of [Southwest Asia] exposures." The Board finds that there is not an approximate balance between the positive and negative evidence of record to warrant entitlement to service connection for a prostate condition for substitution purposes. In coming to this conclusion, the Board acknowledges that the Veteran maintained that his symptoms of a prostate condition began during his active duty service and continued until his death. The Board has considered the Veteran's claim under the provisions of 38 C.F.R. §§ 3.303(b) and 3.309(a) pertaining to continuity of symptomatology. However, the Veteran was not diagnosed with a "chronic" disease as set forth in 38 C.F.R. § 3.309(a). As such, any of his assertions alone cannot support an award of service connection pursuant to the presumptive provisions of 38 C.F.R. § 3.309(a). The Veteran, as a layperson, is competent to report the symptoms he has experienced. See Layno, 6 Vet. App. at 470; Jandreau, 492 F.3d at 1377. However, while the Veteran is competent to report having experienced symptoms since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of a particular condition for VA compensation purposes. The issue is medically complex, as it requires diagnostic medical testing to determine. Jandreau, 492 F.3d at 1377 n.4. The evidence of record supports the finding that the Veteran experienced symptoms including urinary frequency, urgency, and blood in his urine during service; these facts are undisputed, as his STRs document instances of this symptomatology. However, the Veteran's statement suggesting he continuously experienced these symptoms post-service is inconsistent with the evidence of record. See 38 C.F.R. § 3.303(b). His STRs include a February 1987 Report of Medical Examination wherein the Veteran was evaluated as clinically normal at separation. He also denied frequent or painful urination on Reports of Medical History dated November 1989 and April 1993. Thus, the Veteran has provided inconsistent statements and greater probative weight is provided to his statements in 1989 and 1993 which were made to examiners evaluating his physical fitness and made contemporaneous to his physical evaluations. His later recollections were made many years later and not consistent with his prior recorded statements. The VA examiner also documented, after thorough review of the record and based on her medical expertise, that the Veteran did not experience elevated PSA levels until 1998, 7 years after separation. Though the Veteran maintained that he experienced symptoms of a prostate condition continuously during and since service, the record does not support this finding. The more contemporaneous record (specifically, his STRs including the Reports of Medical History and separation Report of Medical Examination) finds that he denied experiencing symptoms including frequent or painful urination. The correct factual basis, therefore, is that the Veteran did not appear to experience continuous and persistent symptoms of a prostate condition within one year post-separation. Although lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence, the lack of contemporaneous medical evidence can be considered and weighed against a veteran's lay statements. See Buchanan, 451 F.3d at 1336-37. The Veteran also speculated that his condition may have been due to his exposure to hazardous materials while serving in the Gulf War, specifically mentioning exposure to sulfur, mercury, oil wells, and contaminated air following a scud missile attack. The evidence of record does not support the finding that the Veteran had medical expertise and as such, he was not competent to render such an opinion. See Jandreau, 492 F.3d at 1377 n.4. The Board also finds that the opinion rendered by the examiner who performed the April 2017 examination is adequate. The examiner considered not only the Veteran's in-service instances of urinary frequency, blood in urine, and urgency, but she also considered his alleged exposure to Southwest Asia contaminants and explained that the medical literature does not support a correlation. The probative value of a medical opinion comes from its reasoning. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The "factually accurate, fully articulated, sound reasoning for the conclusion" contributes probative value to a medical opinion. Id. On the other hand, a medical opinion based on an inaccurate factual predicate has reduced probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). In this matter, the examiner cited objective clinical findings from the record in support of her position (namely, his PSA levels) and considered the specific facts of the case (based on a correct factual basis). The Board therefore affords more probative weight to this VA opinion than the Veteran's contentions. For these reasons, the Board must deny the Appellant's claim, as the balance of evidence weighs strongly against finding entitlement to service connection for a prostate condition. 2. Entitlement to service connection for a cardiac condition, for substitution purposes The Veteran contended prior to his death that he developed a cardiac condition that was etiologically related to his active duty service. He testified at his December 2016 hearing that he did not have any cardiac problems prior to his active duty service; his health declined after he came back from the desert. He speculated that his condition may have been due to his exposure to hazardous materials while serving in the Gulf War; he specifically mentioned exposure to sulfur, mercury, oil wells, and contaminated air following a scud missile attack. He also reported having lung problems and suspected his chronic obstructive pulmonary disease (COPD), for which he was service-connected, caused his cardiac problems. The evidence of record suggests that the Veteran had a heart condition prior to his death. A VA examination was performed in April 2017, which recorded a diagnosis of congestive heart failure, paroxysmal atrial fibrillation, and left ventricular hypertrophy. His CAPRI VA treatment records also include congestive heart failure and paroxysmal atrial fibrillation on his "problem list." These records also document consistent problems associated with his heart. The Board accepts that prior to his death, the Veteran had a diagnosed cardiac condition. STRs corroborate the Veteran's contentions. Complaints of chest pain and tightness span several years in his STRs; some entries are noted in January 1982, April 1982, August 1981, and May 1984. One entry dated October 1980 documented that the Veteran complained of "constantly blacking out" over the weekend and described the events preceding the black out as a racing heart, fast breathing, numbness and tingling in his hand, and hot flashes of face, all followed by vision "blindness;" these events required him to sit down for several minutes. It appears that the physician speculated the Veteran may have been experiencing hyperventilation. On an August 1983 Report of Medical History, the Veteran reported experiencing pain or pressure in his chest, as well as palpitations and/or pounding heart; he marked "do not know" when asked if he experienced heart trouble. The accompanying Report of Medical Examination documented a clinically normal evaluation for his heart. Additionally, STRs subsequently added to the record in October 2017 document that he denied experiencing pain or pressure in his chest, as well as palpitations and/or pounding heart on Reports of Medical History dated November 1989 and April 1993. Nonetheless, the Board acknowledges these instances of chest pain and tightness as in-service events. The examiner who performed the April 2017 VA examination opined it was less likely than not that the Veteran's cardiac condition was incurred in, due to, or the result of exposure to mercury/sulfur in service and/or Southwest Asia. She rationalized, "While the Veteran asserts a long history of cardiac symptoms, none of those symptoms are attributable to a cardiac condition until 2009. The Veteran underwent repeated testing which showed no cardiac disease until 2009. In 2009, he was diagnosed with paroxysmal atrial fibrillation and left ventricular hypertrophy. The atrial fibrillation led to rapid ventricular response resulting in congestive heart failure. STRs are negative for cardiac disease. He had repeated cardiac testing without diagnosis of or evidence of cardiac disease until 2009. The Veteran's only cardiac testing abnormality in service were two EKG's, both in 1982, which showed sinus arrhythmia which is not a pathologic condition or disease but an incidental finding which is considered within normal range. Veteran with normal EKGs [May 16, 1984, April 20, 1993, May 8, 1995, and September 25, 2002] (all except the last one are in STRs or VA/military treatment facility documentation, last one in ER note from Columbus Medical Center and was not done due to cardiac complaint). Cariology evaluation was negative in 2005. Not until 2009 does the Veteran's current cardiac conditions become evident. Regarding potential mercury and sulfur exposure, it is less likely than not that either of these exposures are the cause or contributed to his current heart conditions. Mercury is not associated with heart disease. While sulfur does have some potential cardiac toxicities, those potential cardiac toxicities are hypotension, depressed cardiac output, [and] bradycardia. The Veteran does not have hypotension or bradycardia. The Veteran does have depressed cardiac output (the underlying cause of CHF), but this has been identified as the result of tachycardia in the form of rapid ventricular response to atrial fibrillation. Additionally, the decreased cardiac output was not present until 24 years after his exposures, making it unlikely any sulfur exposure is related to his decreased cardiac output." She also expressed it is less likely than not that the Veteran's heart conditions were proximately due to or the result of his service-connected conditions including COPD, rationalizing that none of his service-connected conditions are known to cause paroxysmal atrial fibrillation with congestive heart failure. The examiner also opined that the Veteran's heart conditions were not aggravated beyond their natural progression by his service-connected conditions, stating, "the Veteran's atrial fibrillation with [congestive heart failure] due to elevated heart rate from atrial fibrillation has followed its natural course, therefore there is not evidence of permanent aggravation by outside source or condition." The Board finds that there is not an approximate balance between the positive and negative evidence of record to warrant entitlement to service connection for a cardiac condition for substitution purposes. In coming to this conclusion, the Board acknowledges that the Veteran maintained that his symptoms of a cardiac condition began during his active duty service after his return from deployment and continued from that time until his death. The Board has considered the Veteran's claim under the provisions of 38 C.F.R. §§ 3.303(b) and 3.309(a) pertaining to continuity of symptomatology. However, congestive heart failure, paroxysmal atrial fibrillation and left ventricular hypertrophy are not listed as "chronic" diseases as set forth in 38 C.F.R. § 3.309(a). As such, any of his assertions alone cannot support an award of service connection pursuant to the presumptive provisions of 38 C.F.R. § 3.309(a). The Veteran, as a layperson, is competent to report the symptoms he has experienced. See Layno, 6 Vet. App. at 470; Jandreau, 492 F.3d at 1377. However, while the Veteran is competent to report having experienced symptoms since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of a particular condition for VA compensation purposes. The issue is medically complex, as it requires diagnostic medical testing to determine. Jandreau, 492 F.3d at 1377 n.4. The evidence of record supports the finding that the Veteran experienced symptoms including chest pain and tightness during service; these facts are undisputed, as his STRs document instances of this symptomatology. However, the Veteran's statement suggesting he continuously experienced these symptoms post-service is inconsistent with the evidence of record. See 38 C.F.R. § 3.303(b). His STRs include a February 1987 Report of Medical Examination wherein the Veteran was evaluated as clinically normal at separation. He also denied experiencing pain or pressure in his chest on Reports of Medical History dated November 1989 and April 1993. Thus, the Veteran has provided inconsistent statements and greater probative weight is provided to his statements in 1989 and 1993 which were made to examiners evaluating his physical fitness and made contemporaneous to his physical evaluations. His later recollections were made many years later and not consistent with his prior recorded statements. The examiner also documented, after thorough review of the record and based on her medical expertise, that the Veteran's only cardiac testing abnormality in service were two EKG's, both in 1982, which showed sinus arrhythmia which is not a pathologic condition or disease but an incidental finding which is considered within normal range. She reiterated it was not until 2009 that his cardiac condition became apparent. Though the Veteran maintained that he experienced symptoms of a cardiac condition continuously during and since service, the record does not support this finding. The more contemporaneous record (specifically, his STRs including the Reports of Medical History and separation Report of Medical Examination) finds that he denied experiencing symptoms including pain or pressure in his chest. The correct factual basis, therefore, is that the Veteran did not appear to experience continuous and persistent symptoms of a cardiac condition within one year post-separation. Although lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence, the lack of contemporaneous medical evidence can be considered and weighed against a veteran's lay statements. See Buchanan, 451 F.3d at 1336-37. The Veteran also speculated that his cardiac condition may have been due to his exposure to hazardous materials while serving in the Gulf War, specifically mentioning exposure to sulfur, mercury, oil wells, and contaminated air following a scud missile attack. The evidence of record does not support the finding that the Veteran had medical expertise and as such, he was not competent to render such an opinion. See Jandreau, 492 F.3d at 1377 n.4. The Board also finds that the opinion rendered by the examiner who performed the April 2017 examination is adequate. The examiner considered not only the Veteran's in-service instances of chest pain and tightness, but she also considered his alleged exposure to Southwest Asia contaminants and explained that the medical literature does not support a correlation. The probative value of a medical opinion comes from its reasoning. Nieves-Rodriguez, 22 Vet. App. 295, 304 (2008). The "factually accurate, fully articulated, sound reasoning for the conclusion" contributes probative value to a medical opinion. Id. On the other hand, a medical opinion based on an inaccurate factual predicate has reduced probative value. Reonal, 5 Vet. App. at 461 (holding that the Board may reject a medical opinion based on an inaccurate factual basis). In this matter, the examiner cited objective clinical findings from the record in support of her position (namely, the outcomes of his EKGs) and considered the specific facts of the case (based on a correct factual basis). The Board therefore affords more probative weight to this VA opinion than the Veteran's contentions. She also provided an opinion that addressed aggravation and secondary service connection, considering whether his service-connected conditions proximately caused or aggravated any cardiac condition, finding that they did not. The opinion of the examiner holds more probative value than the speculations of the Veteran, given that she possesses medical training and expertise and he did not. See Layno, 6 Vet. App. at 470; Jandreau, 492 F.3d at 1377. For these reasons, the Board must deny the Appellant's claim, as the balance of evidence weighs strongly against finding entitlement to service connection for a cardiac condition. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Victoria A. Banis, 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.