ATRIAL FIBRILLATION OR ATRIAL FLUTTER

Summary

The veteran, who served in the Air Force from June 1979 to September 1979, appeals the denial of service connection for a heart disability, specifically atrial fibrillation. The veteran contends that the atrial fibrillation is a progression of an in-service heart murmur. Service treatment records from 1979 noted a functional heart murmur and shortness of breath when running, but the veteran was released to full duty and reported feeling well regarding heart trouble at separation. Private treatment records indicate the atrial fibrillation diagnosis was made in 2007, approximately 28 years after service. The Board found that the evidence did not support chronic or continuous symptoms of atrial fibrillation since service, nor did it establish a nexus between the in-service murmur and the later-diagnosed atrial fibrillation. The Board gave significant weight to VA medical opinions from October 2016 and March 2025. The March 2025 opinion, in particular, concluded that the functional heart murmur was unrelated to the atrial fibrillation and that the veteran's risk factors (age, hypertension, sleep apnea) made the condition less likely than not related to or aggravated by service. The Board found the VA opinions probative and well-supported, noting that the veteran, as a layperson, was not competent to make the medical association between the murmur and atrial fibrillation. Consequently, service connection for atrial fibrillation was denied.

Rationale

No chronic or continuous symptoms of atrial fibrillation during or after service.; In-service heart murmur was functional and unrelated to atrial fibrillation.; VA opinions found atrial fibrillation less likely than not related to service due to risk factors and time lapse.

Full Decision Text

Citation Nr: 25008550
Decision Date: 06/27/25	Archive Date: 06/27/25

DOCKET NO. 17-66 273
DATE: June 27, 2025

ORDER

Service connection for a heart disability, to include atrial fibrillation, is denied.

FINDINGS OF FACT

1.  The evidence shows a current disability of atrial fibrillation.

2.  Symptoms of atrial fibrillation were not chronic during service, were not continuous since service separation, and did not manifest to a compensable degree within one year of service separation.

3.  The atrial fibrillation is not etiologically related to service. 

CONCLUSION OF LAW

The criteria for service connection for a heart disability are not met.  38 U.S.C. 

§§ 1112, 1131, 5103, 5103A; 38 C.F.R. §§ 3.159, 3.303, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran, who is the appellant, served on active duty from June 1979 to September 1979.  

This matter came before the Board of Veterans' Appeals (Board) on appeal from a January 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which is the Agency of Original Jurisdiction (AOJ).

In April 2022, the Veteran testified at a virtual hearing before the undersigned Acting Veterans Law Judge, and the transcript of that hearing is of record.  After the hearing, the Veteran was afforded two periods of time to submit evidence in support of the claim.  No evidence was received.  

In February 2023, the Board remanded this matter for additional development.  Specifically, the Board directed the AOJ to obtain service treatment and military personnel records, particularly those pertaining to the Veteran's Air Force Reserve service that began in September 1981 and from which the Veteran asserts he received a medical discharge.  Unfortunately, as described in a July 2023 "final attempt" letter to the Veteran and in the October 2023 Supplemental Statement of the Case (SSOC), despite thorough searches, the records requested were not located because, for example, the Veteran was not found in Air Force research databases.  See, e.g., March 2023 DD Form 2963, Service Treatment Record (STR) Certification.  The Board determined in its February 2025 decision that the AOJ had made reasonable efforts to obtain such records and had satisfied its duty to notify the Veteran of its inability to obtain such records in accordance with 

38 C.F.R. § 3.159(e).

In the February 2025 decision, the Board also remanded the matter for an addendum medical opinion regarding the claim for service connection for a heart disorder.  The Board directed VA to obtain addendum medical opinions regarding (1) all currently diagnosed heart disabilities, to include atrial fibrillation and (2) for each diagnosed heart disability, whether it is at least as likely as not that the diagnosed disability is related to (including was incurred in or was caused or aggravated by) service.  The additional development has been completed by VA and this matter has now returned to the Board for appellate consideration. 

Service Connection Legal Authority

Service connection can be granted for a disability resulting from a disease or injury incurred in or aggravated by active service.  38 U.S.C. § 1131; 38 C.F.R. 

§ 3.303(a).  Service connection may 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).  Service connection generally requires competent 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 current disability.

The Veteran is currently diagnosed with atrial fibrillation, which is a "chronic disease" for purposes of 38 C.F.R. § 3.309(a) as a "cardiovascular-renal disease"; accordingly, the presumptive service connection provisions under 38 C.F.R. 

§ 3.303(b) for service connection based on "chronic" symptoms in service and "continuous" symptoms since service are applicable.  See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Under 38 C.F.R. § 3.303(b), service connection will be presumed where there are either chronic symptoms shown in service or continuity of symptomatology since service for diseases identified as chronic in 38 C.F.R
 a "chronic disease" for purposes of 38 C.F.R. § 3.309(a) as a "cardiovascular-renal disease"; accordingly, the presumptive service connection provisions under 38 C.F.R. 

§ 3.303(b) for service connection based on "chronic" symptoms in service and "continuous" symptoms since service are applicable.  See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Under 38 C.F.R. § 3.303(b), service connection will be presumed where there are either chronic symptoms shown in service or continuity of symptomatology since service for diseases identified as chronic in 38 C.F.R. § 3.309(a); Walker, 703 F.3d at 1338-40 (holding that continuity of symptomatology is an evidentiary tool to aid in the evaluation of whether a chronic disease existed in service or an applicable presumptive period).  With a chronic disease shown as such in-service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes.  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.  If a condition noted during service is not shown to be chronic, then generally a showing of continuity of symptoms after service is required for service connection.  38 C.F.R. § 3.303(b).

Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service.  While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time.  38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309(a).

Service connection for a heart disability, to include atrial fibrillation, is denied.

The Veteran appeals for service connection for a heart disability, to include atrial fibrillation.  He contends that the atrial fibrillation is a progression of a heart murmur that manifested while on active duty.  See May 2025 Written Brief Presentation.  Service treatment records indicate the presence of a functional heart murmur while in service in 1979.  Preliminarily, the Board notes that the Veteran does not have a current heart murmur diagnosis.        

The evidence shows a current diagnosis of atrial fibrillation.  See March 2025 VA Medical Opinion.  Private treatment records reflect that the diagnosis was made in 2007.  See December 2007 Private Treatment Records.  An October 2015 private medical doctor noted that the atrial fibrillation was generally asymptomatic with no rapid ventricular rates on routine blood pressure checks.  Id.  Nevertheless, the present disability requirement is met.

The persuasive weight of the evidence is against a finding of "chronic" symptoms of atrial fibrillation during service.  While service treatment records reflect that a functional heart murmur was identified in 1979 and that the Veteran reported shortness of breath when running great distances, notes from September 1979 also show that the Veteran was permitted to return to full duty after the physical.  Additional notes state that an internal medical consult was needed; however, in the September 1979 Report of Medical History, the Veteran also reported that he felt good and checked "no" for heart trouble.  As will be discussed more fully with respect to direct service connection, there is no medical opinion of record that supports the contention that the later-diagnosed atrial fibrillation was indeed a progression of the in-service heart murmur; thus, the two diagnoses are unrelated.  As a result, the record does not reflect any known symptoms of atrial fibrillation during service.        

The weight of the evidence also shows that symptoms of atrial fibrillation were not continuous after service, including not to a compensable degree within one year of service.  In July 1982, less than 3 years after active duty, service treatment records reflect that the Veteran was deemed physically qualified for 15 days of active duty for training.  During the April 2022 hearing, the Veteran testified that post-service, he received treatment for his heart murmur beginning in 1983 or 1984.  See April 2022 Hearing Transcript at 3.  The Veteran stated that he would obtain these
 are unrelated.  As a result, the record does not reflect any known symptoms of atrial fibrillation during service.        

The weight of the evidence also shows that symptoms of atrial fibrillation were not continuous after service, including not to a compensable degree within one year of service.  In July 1982, less than 3 years after active duty, service treatment records reflect that the Veteran was deemed physically qualified for 15 days of active duty for training.  During the April 2022 hearing, the Veteran testified that post-service, he received treatment for his heart murmur beginning in 1983 or 1984.  See April 2022 Hearing Transcript at 3.  The Veteran stated that he would obtain these treatment records and was provided an opportunity to do so, but no additional evidence was submitted.  The earliest record evidence of treatment for the Veteran's heart are from December 2007 when he was diagnosed with atrial fibrillation.  A continuing heart murmur was not reflected in the private treatment records from December 2007 forward.  Indeed, in April 2008, private treatment records state that no murmur, gallop, or rub was heard.  There are additional notations regarding the lack of any identified heart murmur in private records from March 2009, March 2011, March 2012, July 2013, and October 2015.  See generally Private Treatment Records.  

The approximately 28-year period between service and the onset of atrial fibrillation is one factor that weighs against a finding of service incurrence, including by continuous symptoms since service from which service incurrence would be presumed.  See Buchanan v. Nicholson, 451 F.3d 1336 (Fed. Cir. 2006) (the lack of contemporaneous medical records is one fact the Board can consider and weigh against the other evidence, although the lack of such medical records does not, in and of itself, render the lay evidence not credible); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (the passage of many years between discharge from active service and the medical complaint of a claimed disability is one factor to consider as evidence against a claim of service connection).  Additional factors weighing against continuous symptomatology since service include the Veteran's lack of an identified heart murmur in private treatment records following service separation, and the lay and medical evidence of record.  For these reasons, the Board finds that, while a heart murmur was identified during service, symptoms of atrial fibrillation were not continuous since service separation and did not manifest to a compensable degree within one year of service separation.  

Next, the Board finds that the atrial fibrillation did not have its onset in service and is not otherwise etiologically related to service.  

A VA examination was conducted in October 2016 that noted the Veteran's diagnosis of atrial fibrillation.  It also noted that the Veteran reported a diagnosis of a functional heart murmur, but the VA examiner determined there was no objective evidence of a cardiac murmur during the examination.  The VA examiner noted the history of the Veteran's atrial fibrillation diagnosis 7-to-8 years prior, and that continuous medication was required to control the condition.  The VA examiner declined to render an opinion regarding service connection because there was no objective evidence of paroxysmal atrial fibrillation during active duty.

Thereafter, in a December 2016 medical opinion, a VA examiner noted that functional murmurs are heart sounds that are found on routine examinations and have no pathological origin.  The VA examiner stated, "they are most often found in young active healthy people who have supple cardiac muscles with excellent contractility resulting in higher blood flow thru the heart valves thus causing these adventitious and benign sounds.  They are not a forerunner of a cardiac condition or [arrhythmia] such as atrial fibrillation."  The October 2016 VA examiner concluded that it is less likely than not that the atrial fibrillation was due to military service duties and activities from many years ago.

In a February 2025 decision, the Board remanded the matter for an addendum medical opinion regarding the claim for service connection for a heart disorder.  The Board noted that the prior VA examiners did not consider the Veteran's report of shortness of breath or dyspnea indicated in November 2007 private treatment records.  The Board directed VA to provide addendum medical opinions regarding (1) all currently diagnosed heart disabilities, to include atrial fibrillation and (2) for each diagnosed heart disability, whether it is at least as likely as not that the diagnosed disability is related to (including was incurred in or was caused or aggravated by) service.       

VA provided an addendum opinion in March 2025
 many years ago.

In a February 2025 decision, the Board remanded the matter for an addendum medical opinion regarding the claim for service connection for a heart disorder.  The Board noted that the prior VA examiners did not consider the Veteran's report of shortness of breath or dyspnea indicated in November 2007 private treatment records.  The Board directed VA to provide addendum medical opinions regarding (1) all currently diagnosed heart disabilities, to include atrial fibrillation and (2) for each diagnosed heart disability, whether it is at least as likely as not that the diagnosed disability is related to (including was incurred in or was caused or aggravated by) service.       

VA provided an addendum opinion in March 2025 in compliance with the Board's remand order.  

The VA medical examiner noted the Veteran's diagnosis of atrial fibrillation.  No other current diagnoses were made in the addendum opinion.  The VA medical examiner reviewed the evidence of record and noted that no service clinic visits were found for issues, complaints, evaluation, diagnosis or treatment of a heart related complaint other than the internal medicine consult at the time of separation in September 1979.  Moreover, although the Veteran documented shortness of breath when running any great distances, no chest pain or cardiac complaints were documented.  Normal lung examination findings and normal chest x-rays were noted at separation.  In addition, while medical records documented a heart murmur, it was evaluated as being a "functional murmur" and the Veteran was released to return to full duty.  The VA examiner further stated that dyspnea, or shortness of breath, which was noted in the November 2007 private treatment records, can be due to many causes.     

The March 2025 VA examiner opined that the heart murmur is unrelated to the atrial fibrillation.  Functional or "innocent" heart murmurs are harmless sounds made by the blood circulating normally through the heart's chambers and valves or through blood vessels near the heart.  The VA examiner stated that "these heart murmurs are also called 'normal' or 'physiological' murmurs."  They typically diminish in intensity during certain movements like standing and sitting up.  Functional heart murmurs often disappear by adulthood.  Atrial fibrillation is the most common sustained cardiac arrythmia in clinical practice.  The prevalence of atrial fibrillation is increased in those with increasing age, males, and geography, namely North America.  The Veteran's risk factors were noted to be increasing age, hypertension, and obstructive sleep apnea.  The March 2025 VA examiner concluded that the diagnosis of atrial fibrillation was less likely than not incurred in or caused by the heart murmur during service.  The VA examiner cited to medical information from the American Heart Association and medical journals in support of the opinion.

Finally, the March 2025 VA examiner determined that the atrial fibrillation was not related to or aggravated by service.  The VA examiner noted that a baseline level of severity could not be determined.  However, the onset of the atrial fibrillation more than 28 years after service weighs against aggravation.  Moreover, the VA examiner noted again that the Veteran's risk factors for atrial fibrillation included increasing age, hypertension, and obstructive sleep apnea; thus, it was less likely than not that the diagnosed atrial fibrillation was related to or aggravated by service.    

The Board finds the VA examination and medical opinions to be probative.  The March 2025 VA examination, in particular, was based on a thorough review of the Veteran's claims file, was well reasoned, and was adequately supported.  Significantly, the private treatment records also support the March 2025 VA examiner's opinion.  A March 2009 note states, "due to his morbid obesity and sleep apnea, I feel that he is at risk for continued paroxysmal atrial fibrillation."  While the Veteran believes that his atrial fibrillation is a progression of his heart murmur, as a lay person, he is not competent to make that association.  The issue is medically complex, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing.  Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).  Consequently, the Board gives more probative weight to the competent medical evidence, to include the December 2016 and March 2025 VA medical opinions.  There are no medical opinions in the record that support a contrary conclusion.  

Based on the foregoing, the persuasive weight of the evidence is against service connection for atrial fibrillation and thus, the claim must be denied.  See 38 U.S.C. § 5107; 38 C.F.R.
, as it requires specialized medical education and the ability to interpret complicated diagnostic medical testing.  Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).  Consequently, the Board gives more probative weight to the competent medical evidence, to include the December 2016 and March 2025 VA medical opinions.  There are no medical opinions in the record that support a contrary conclusion.  

Based on the foregoing, the persuasive weight of the evidence is against service connection for atrial fibrillation and thus, the claim must be denied.  See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776, 781-82 (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). 

 

E. Blowers

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Prairie, N. R.

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.