Citation Nr: 25003002 Decision Date: 03/03/25 Archive Date: 03/03/25 DOCKET NO. 18-34 849 DATE: March 3, 2025 ORDER Entitlement to service connection for an aortic valve condition, status post an aortic valve replacement, is granted. FINDING OF FACT The Veteran's aortic valve condition was incurred during service. CONCLUSION OF LAW The criteria for entitlement to service connection for an aortic valve condition, status post an aortic valve replacement, have been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from February 1968 to December 1971 and August 1972 to August 1979. This matter comes before the Department of Veteran Affairs (VA) Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision by a VA Agency of Original Jurisdiction (AOJ). In January 2020, January 2023, and, most recently, in February 2024, the Board remanded this issue to the AOJ for additional development; the claims file has been returned to the Board for adjudication. Entitlement to service connection for an aortic valve condition. Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1101, 1110; 38 C.F.R. § 3.303 (a). Service connection can be demonstrated for a disease diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to establish service connection, the evidence must generally show: (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 or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 506 (1995). Service connection may be granted for congenital diseases, but not congenital defects. Quirin v. Shinseki, 22 Vet. App. 390, 394 (2009) (discussing VAOPGCPREC 82-90); Monroe v. Brown, 4 Vet. App. 513, 515 (1993). When no pre-existing medical condition is noted upon entry into service, a Veteran is presumed to have been sound upon entry. 38 U.S.C. § 1111; Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991). The presumption of soundness applies if a veteran's congenital disease is not noted at entry. See Quirin, 22 Vet. App. at 396-97, Monroe, 4 Vet. App. at 515. "[A] defect differs from a disease in that the former is 'more or less stationary in nature' while the latter is 'capable of improving or deteriorating.'" Quirin, 22 Vet. App. at 394 (quoting VA Gen. Couns. Prec. 82-90 (July 18, 1990)). Therefore, "any worsening any change at all might demonstrate that the condition is a disease, in that VA considers defects to be 'more or less' static and immutable." Id. at 395 (quoting G.C. Prec. 82-90); see O'Bryan v. McDonald, 771 F.3d 1376, 1380 (Fed. Cir. 2014) ("[A] congenital or developmental condition that is progressive in nature that can worsen over time is a disease rather than a defect."). In July 2003, the Veteran underwent surgery for replacement of his bicuspid aortic valve due to aortic stenosis. In an April 2024 opinion, a VA examiner explained that a bicuspid aortic valve is congenital valve condition. The examiner stated that, "Young adults are generally asymptomatic and may not have any signs on physical examination as noted in entrance exam and on separation exam. However, with age, the bicuspid valve undergo accelerated calcification leading to aortic stenosis." The Board notes that the Veteran's aortic valve condition has been characterized as a congenital defect rather than a congenital disease. See June 2020 VA medical opinion. However, as explained above, for VA purposes a congenital or developmental condition that is progressive in nature that can worsen over time is a disease rather than a defect. The April 2024 examiner noted that with age the bicuspid valve undergoes accelerated calcification leading to aortic stenosis. Accordingly, because the Veteran's aortic valve condition was progressive in nature and led to aortic stenosis, for the purposes of this decision it will be characterized as a congenital disease. An aortic valve condition was not noted during the Veteran's October 1967 or September 1972 entrance examinations. Therefore, he is presumed sound. See 38 U.S.C. § 1111. During service in June 1975, the Veteran was noted to have a Grade II ejection murmur in the aortic area and sinus tachycardia. The assessment was probable aortic valve disease with ejection click and systolic murmur. After service, the Veteran underwent surgery for replacement of his bicuspid aortic valve. The evidence of record shows that the Veteran's need for aortic valve replacement (AVR) was due to his congenital bicuspid valve and aging which caused the calcification on the valve resulting in aortic stenosis. As such, the evidence of record shows that the Veteran's aortic valve disorder was diagnosed during service and progressed after service with calcification on the valve resulting in aortic stenosis, ultimately requiring surgery for aortic valve replacement in July 2003. Therefore, the Board finds that service connection for an aortic valve condition, status post an aortic valve replacement, is warranted. Accordingly, the Veteran's claim is granted. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Anderson, Megan 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.