Citation Nr: A26041014 Decision Date: 04/30/26 Archive Date: 04/30/26 DOCKET NO. 250828-584339 DATE: April 30, 2026 ORDER Service connection for a cardiac disability to include arteriosclerotic heart disease (ASHD)/coronary artery disease (CAD) is denied. FINDING OF FACT The evidence of record persuasively weighs against finding that the Veteran's cardiac disability began during active service or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for a cardiac disability have not been 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 had active military service from September 1990 to February 1993. This matter comes before the Board of Veterans' Appeals (Board or BVA) on appeal from an April 2025 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The modernized review system, also known as the Appeals Modernization Act (AMA), automatically applies to all claims for which VA issues notice of an initial decision on or after February 19, 2019. See 38 C.F.R. § 3.2400(a)(1). As the rating decision on appeal was issued in April 2025, it constitutes an initial decision; therefore, the AMA applies. In August 2025, the Veteran submitted his VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), and elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the April 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. The Veteran contends that his heart condition was caused by Toxic Exposure Risk Activity (TERA). Service connection may be granted 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. The three-element test for 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 in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The question for the Board is whether the Veteran's cardiac disability began during service or is at least as likely as not related to an in-service injury, event, or disease. VA treatment records indicate that the Veteran has a current diagnosis of ASHD/CAD. In addition, a September 2024 TERA Memorandum confirms that the Veteran participated in a TERA. The Veteran underwent VA examination in September 2024 at which time he was diagnosed as having had a myocardial infarction and ASHD (CAD) with percutaneous coronary intervention (PCI) in 2016. The examiner noted that the etiology of the Veteran's cardiac disability was unknown. The examiner opined, The claimed condition was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran." The examiner stated, CAD is due to the formation of plaques in the lumen of coronary arteries, which impede blood flow to the coronary arteries and results in a demand-supply mismatch of oxygen, with decreased oxygen delivery to the myocardium (heart muscle). The most prevalent risk factor is dietary intake of fast foods and unhealthy meals as well as male gender tobacco use, obesity, hyperlipidemia and increase in age, regardless of gender. The Board concludes that although the Veteran has a current diagnosis of ASHD/CAD, and evidence shows that he participated in a TERA, the evidence of record persuasively weighs against finding that the Veteran's diagnosis of ASHD/CAD began during service or is otherwise related to an in-service injury, event, or disease. In this case, the only etiology opinion of record for the Veteran's ASHD/CAD was provided by the September 2024 VA examiner who opined that the Veteran's ASHC/CAD was not at least as likely as not related to an in-service injury, event, or disease, including participation in a TERA. 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). Although the Veteran believes that his ASHD/CAD is related to an in-service injury, event, or disease, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex and requires medical knowledge. 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, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the September 2024 VA examiner's medical opinion. (Continued on the next page) ? For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether service connection is warranted for ASHD/CAD. Rather, the evidence persuasively weighs against the claim. The benefit of the doubt doctrine, see 38?U.S.C. §?5107(b), is therefore not for application as to this claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application). John R. Doolittle, II Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Olson, Patricia 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.