HYPERTENSION

Summary

The Veteran, a veteran who served from August 1980 to February 1991, appeals the denial of service connection for a heart condition, specifically chest pain. The Veteran's in-service medical records noted chest pain attributed to GERD and muscle strain, not a cardiac issue. Despite multiple prior remands and appeals, the core issue remained service connection for a heart condition. The Board reviewed the most recent VA examination from April 2025, which concluded it was less likely than not that the claimed condition was related to service, citing negative in-service cardiac workups and lack of service records indicating a heart condition. The Board found this opinion persuasive, noting it was competent, credible, and consistent with the record, particularly the Veteran's own statements attributing chest pain to GERD or muscle strain. The Board distinguished this case from Buchanan v. Nicholson, finding the VA opinion adequate despite the absence of contemporaneous medical evidence for a heart condition, as the Veteran never claimed the in-service chest pain was cardiac-related. The Board also noted the Veteran is already service-connected for GERD, musculoskeletal chest pain, and hypertension. Ultimately, the Board found the evidence weighed against service connection for a heart condition, denying the claim.

Rationale

In-service cardiac workup was negative.; Service records do not indicate a heart condition.; VA opinion found less likely than not related to service.

Full Decision Text

Citation Nr: 25009428
Decision Date: 07/21/25	Archive Date: 07/21/25

DOCKET NO. 14-38 310
DATE: July 21, 2025

ORDER

Entitlement to service connection for a heart condition is denied.

FINDING OF FACT

The evidence of record persuasively weighs against finding that the Veteran's heart condition began during active service or is otherwise related to an in-service injury or disease or was manifest within one year of discharge.

CONCLUSION OF LAW

The criteria for service connection for a heart condition are not 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 served on active duty from August 1980 to February 1991.

This matter is before the Board on appeal from a June 2011 rating decision.  After seven previous decisions by the Board, six of which were remands, the issue of service connection for a heart condition has returned to the Board from an April 2025 Supplemental Statement of the Case.

The most recent Board remand in this appeal requested updated treatment records and an addendum medical opinion.  The Agency of Original Jurisdiction has performed those actions.  Therefore, the previous Board remand directives have been substantially complied with.  Stegall v. West, 11 Vet. App. 268, 271 (1998).  After seven journeys back and forth, this appeal at last finds it final repose.

Entitlement to service connection for a heart condition

The Veteran seeks service connection for chest pain.

The Veteran suffered chest pain noted to be probably due to GERD and muscle strain during active service.  See November 2014 STR - Medical.  The Veteran has submitted two claims for "chest pain."  See February 1991 VA Form 21-526 and March 2010 VA Form 21-0820.  The current claim involves chest pain that the Veteran experienced in October 1990.  Id.  For reasons not explained, the VA processed these claims as a claim for "cardiac disease (claimed as chest pain)" and denied them both because the service treatment records and VA exam were "negative for evidence or diagnosis of underlying cardiac disease..."  See October 1991 Rating Decision. 

Following a denial of the second claim for "cardiac disease (claimed as chest pain)," the Veteran wrote a letter to the VA.  "[T]his was the second time that this was mistakenly thought that I was claiming chest pain as a cardiac arrest," he wrote.  "The pain that I was referring to was heartburn or acid reflux.  Because the pain is from my chest, I called it chest pain."  See November 2011 Correspondence."

Following an October 2018 Board decision, the Veteran appealed the issue of "cardiac disease (claimed as chest pain)" to the Court of Appeals for Veterans Claims (CAVC).  In September 2019, the Secretary and the Veteran filed a Joint Motion for Partial Remand (JMPR), which was granted by the CAVC in an October 2019 Order.

The parties to the JMPR determined that the Board failed to assist the Veteran in developing the record.  The evidence indicated that the Veteran was granted Social Security Administration (SSA) disability benefits in 1998 based, in part, on "musculoskeletal chest pain," but the Board failed to obtain these records or proffer an explanation as to why that could not be accomplished.  Golz v. Shinseki, 590 F.3d 1317, 1323 (Fed. Cir. 2010); 38 C.F.R. § 3.159(c)(2).  The case was remanded for the Board to ensure that VA obtains these records, if possible, and to afford the Veteran a VA Examination.  

Following the first Board remand in March 2020, the VA examination was completed and a negative response from the SSA has been received.  See May 2025 Medical Treatment Records - Furnished by SSA.  As a result of the examination, the VA granted the Veteran's claim, awarding entitlement to service connection for gastrointestinal reflux disease (GERD) and musculoskeletal chest pain.  See August 2020 Rating Decision.  It appeared that the Veteran had received what he asked for.  On the same day, the VA issued a Supplemental Statement of the Case, returning to the Board the issue of entitlement to service connection for "cardiac disease, also claimed as chest pain."  See August 2020 SSOC.  Five more Board remands followed, all with instructions to obtain an adequate
 completed and a negative response from the SSA has been received.  See May 2025 Medical Treatment Records - Furnished by SSA.  As a result of the examination, the VA granted the Veteran's claim, awarding entitlement to service connection for gastrointestinal reflux disease (GERD) and musculoskeletal chest pain.  See August 2020 Rating Decision.  It appeared that the Veteran had received what he asked for.  On the same day, the VA issued a Supplemental Statement of the Case, returning to the Board the issue of entitlement to service connection for "cardiac disease, also claimed as chest pain."  See August 2020 SSOC.  Five more Board remands followed, all with instructions to obtain an adequate medical opinion regarding a heart condition.  See October 2020, April 2022, January and December 2023, and April 2025 BVA Decisions.

Pursuant to the April 2025 Board remand, an opinion was obtained based on records reviewed.  The practitioner concluded that it was less likely than not that the claimed condition was related to service.  As rationale, the practitioner noted that the Veteran's in-service cardiac workup was negative, and that the service records did not indicate a heart condition having its onset during service.  See April 2025 C&P Exam.

Generally, service connection may also be established if the evidence demonstrates that a current disability resulted from a disease or injury incurred in or aggravated by active-duty service.  38 C.F.R. § 3.303.  To that end, service connection may be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to the period of service, establishes the disease was incurred during active-duty service.  38 C.F.R. § 3.303(d).

In order to prove service connection, there must be competent and credible evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus or link between the current disability and the in- service disease or injury.  See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

For Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service.  38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309.

In providing their opinion, the April 2025 practitioner recognized a key fact: that the Veteran's in-service cardiac workup was negative.  It was determined that the Veteran's chest pain was musculoskeletal and GERD.  This is entirely consistent with the Veteran's lay statements of record.  Further, the VA practitioner recognized that there are no service records that indicate a cardiac condition.  

Although brief, the Board finds that the April 2025 VA opinion to be persuasive.  In light of the fact that the Veteran never expressed an intent to seek benefits for a cardiac condition, a persuasive opinion need not be lengthy.  See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (holding that a medical examination does not require that it "explicitly lay out the examiner's journey from the facts to a conclusion").  The VA practitioner is simply stating that the chest pain in service was not related to a cardiac condition.

The Board finds that the April 2025 VA examination to be competent because the examiner has specialized medical training and experience.  It is credible because it is internally consistent and consistent with the record.  Therefore, the Board affords the April 2025 report significant probative weight.

The Board recognizes that the Federal Circuit has held that the "Board cannot weight the absence of contemporaneous medical evidence against the lay evidence of record."  Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006).  In Buchanan, the Veteran submitted statements from himself and others that his symptoms began during active service.  The Board denied the claim because the lay evidence was not corroborated by his service treatment records.  Id, at 1333-1334.  The Federal Circuit rules that credibility of lay evidence cannot be rebutted by a lack of contemporaneous service records.  Id.

However, this case is distinguishable from Buchanan in two ways.  First, there is contemporaneous in-service medical evidence in this case.  The service records confirm that the Veteran had chest pain in service and attributed his chest pain to conditions other than a heart condition.
.3d 1331, 1337 (Fed. Cir. 2006).  In Buchanan, the Veteran submitted statements from himself and others that his symptoms began during active service.  The Board denied the claim because the lay evidence was not corroborated by his service treatment records.  Id, at 1333-1334.  The Federal Circuit rules that credibility of lay evidence cannot be rebutted by a lack of contemporaneous service records.  Id.

However, this case is distinguishable from Buchanan in two ways.  First, there is contemporaneous in-service medical evidence in this case.  The service records confirm that the Veteran had chest pain in service and attributed his chest pain to conditions other than a heart condition.  Second, the Board has not, and will not, determine that the lay evidence lacks credibility in this case.  In fact, the examiner has considered the Veteran's own statements of chest pains, and the Veteran has never stated that his in-service chest pain was due to a heart condition.  Thus, the VA examiner's reference to service records that are "silent" for a diagnosis of a heart condition, does not render the opinion inadequate under Buchanan.

The Board is cognizant that the Veteran's representative continues to advocate for service connection for "heart condition / chest pain."  See June 2025 Appellate Brief.  However, the Veteran's representative has not pointed to evidence of record to support any heart condition.  Rather, they simply advocate that a "lack of a diagnosis during service must not preclude entitlement to service connection."  Id.  However, this assertion fails to recognize that there are conditions for which chest pains are attributed as symptoms during service.

The Board finds that the Veteran has not suffered a heart condition that is related to active service.  This finding is based on the following: 1) the Veteran's cardiac workup in service did not reveal a heart condition; 2) the Veteran experienced chest pain in service due to GERD and/or a muscle strain; 3) the Veteran is currently service-connected for musculoskeletal chest pain, GERD, and hypertension, effective as of the date of this claim, March 2, 2010; 4) the Veteran has never submitted lay evidence that he suffered from a heart condition during service; 5) the Veteran considered it a mistake that his claim for chest pain was processed a claim for a heart condition; 6) the April 2025 VA opinion that confirmed that the Veteran's in service cardiac workup was normal; and 7) the lack of a medical opinion supporting a service-related cardiac condition.

Because there is no conflicting evidence in this case, the benefit of the doubt doctrine does not apply.  The evidence is against a claim for entitlement to service connection for a heart condition, and entitlement to service connection for a heart condition is not warranted.  

 

 

J. JACK

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Chris Bumgarner, Associate 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.