Entitlement to service connection for a heart disability (claimed as coronary artery disease (CAD)), to include as secondary to a service-connected disability, is denied.
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Citation Nr: 19121950 Decision Date: 03/25/19 Archive Date: 03/23/19 DOCKET NO. 11-20 271 DATE: March 25, 2019 ORDER Entitlement to service connection for a heart disability (claimed as coronary artery disease (CAD)), to include as secondary to a service-connected disability, is denied. FINDING OF FACT The Veteran has no current heart disability. CONCLUSION OF LAW The criteria for service connection for a heart disability, to include as secondary to a service-connected disability, have not been met. 38 U.S.C. §§ 1110, 5107 (2014); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from August 1978 to July 1991, which includes four years at the Naval Academy. In April 2011, the Veteran testified before a Decision Review Officer (DRO) at a RO hearing. A transcript of the hearing is of record. In July 2015, August 2016 and August 2017, the Board remanded the issue of service connection for a heart disability for additional development. The case now returns to the Board after satisfactory completion of the ordered development. Thus, there has been compliance with the Board’s prior remand directives. See Stegall v. West, 11 Vet. App. 268 (1998); D’Aries v. Peake, 22 Vet. App. 97 (2008). In August 2017, the Board also denied service connection for hypertension. The Veteran appealed the decision to the Court of Appeals for Veterans Claims (CAVC). The Court affirmed the Board’s August 2017 decision in a July 2018 Memorandum Decision. The issues of entitlement to an initial disability rating in excess of 30 percent for PTSD with anxiety disorder and an initial disability rating in excess of 20 percent for diabetes mellitus have been perfected, but not yet certified to the Board. The Board’s review of the record reveals that the Agency of Original Jurisdiction (AOJ) is still taking action on the issues. As such, the Board will not accept jurisdiction over them at this time. 1. Entitlement to service connection for a heart disability Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009). Service connection may also be granted for a disease first 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). In addition, a disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310 (a). Secondary service connection includes the concept of aggravation of a nonservice-connected disability by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). A necessary element for establishing service connection is the existence of a current disability. Degmetich v. Brown, 104 F. 3d 1328 (1997). The presence of a disability at the time of filing of a claim or during its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board’s adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319 (2007). Review of the extensive treatment records associated with the claims file reveals no evidence of a heart disability at any time during the appeal period. The December 2015 VA examiner, with October 2016 and February 2018 addendum opinions, determined that the Veteran does not have a heart disability. He acknowledged that the Veteran was evaluated for chest pain by Dr. Triffon, a board-certified cardiologist, but noted that ischemic heart disease, coronary artery disease, and coronary atherosclerosis were not found. He also noted that the Veteran has metabolic syndrome, which increases her risk for atherosclerosis, and was prescribed a drug to prevent coronary artery disease. The examiner also acknowledged that the Veteran has a mild, non-rheumatic aortic valve insufficiency. He explained that this condition is not a disability, but a finding of “slight regurgitant jet of blood seen on ultrasound” that required no further workup or treatment. There is no structural problem with the valve. There is no evidence of any functional impairment due to this condition. The Board acknowledges Dr. Triffon’s August 2010 correspondence. As the December 2015 VA examiner correctly notes, Dr. Triffon does not diagnose the Veteran with coronary artery disease or any other heart condition. Rather, he discusses the Veteran’s various risk factors for developing cardiovascular disease. The Board also acknowledges Dr. Bash’s June 2010 correspondence, which states that an October 19, 2006 private treatment record contains a diagnosis of coronary artery disease. This is incorrect. The record Dr. Bash refers to indicates that the Veteran has carotid artery disease and not coronary artery disease or any disease of the heart. Thus, Dr. Bash’s opinion that the Veteran’s coronary artery disease is due to her service-connected PTSD and/or her nonservice-connected hypertension is given no probative value. If the Veteran wishes to file a claim for service connection for carotid artery disease, she is free to do so. To the extent the Veteran alleges that she has a heart disability, it appears to be based on self-diagnosis and not on any statement from qualified medical professionals. The Veteran is a layperson, lacking any specialized medical knowledge or training, and is not competent to render a diagnosis. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). (Continued on the next page) Congress has specifically limited entitlement to service-connected benefits to cases where there is a current disability. “In the absence of proof of a present disability, there can be no valid claim.” Brammer v. Derwinski, 3 Vet. App. 223 (1992). There is no objective indication of a heart disability. Therefore, given the lack of a current disability, service connection cannot be awarded. ROBERT C. SCHARNBERGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R.N. Poulson, Counsel