CORONARY ARTERY DISEASE (CAD)

Summary

The Veteran served from August 1987 to August 1991. The Veteran appeals the denial of service connection for costochondritis, coronary artery disease (CAD), supraventricular arrhythmia (SVA), and atypical chest pain, claiming they are secondary to his service-connected panic disorder. The Board reviewed medical evidence, including a November 2024 heart conditions examination which diagnosed CAD, SVT, and atypical chest pain, with the examiner finding risk factors like smoking and alcohol abuse outweighed service exposure. A February 2025 VA examiner opined that the claimed conditions were less likely than not caused by service. However, addendum medical opinions from November 2025 found it at least as likely as not that the Veteran's service-connected panic disorder aggravates costochondritis, CAD, SVT, and atypical chest pain, citing how panic attacks can worsen cardiac workload and chest discomfort. Based on this, the Board granted service connection for these conditions as secondary to panic disorder. The case also involves a remand for chronic obstructive pulmonary disorder (COPD), claimed as shortness of breath. The Board found the November 2023 VA secondary service connection opinions inadequate because the examiner failed to apply the required "but-for" analysis from Spicer v. McDonough. A remand is ordered for a new examination to determine if COPD is at least as likely as not due to or aggravated by the service-connected panic disorder, using the "but-for" standard.

Rationale

Addendum medical opinions from November 2025 found it at least as likely as not that panic disorder aggravates the conditions.; Examiner reasoned recurrent panic attacks can increase chest wall tension, perceived pain sensitivity, and trigger arrhythmia episodes or chest discomfort.; Board found competent and probative evidence demonstrates aggravation by service-connected panic disorder.

Full Decision Text

Citation Nr: 26001951
Decision Date: 02/11/26	Archive Date: 02/11/26

DOCKET NO. 17-10 557
DATE: February 11, 2026

ORDER

Service connection for costochondritis, coronary artery disease (CAD), supraventricular arrhythmia (SVA), and atypical chest pain, each as secondary to service-connected panic disorder, is granted.

REMANDED

Service connection for chronic obstructive pulmonary disorder (COPD), claimed as shortness of breath is remanded.

FINDING OF FACT

The competent and probative evidence demonstrates that service connected panic disorder aggravates costochondritis, coronary artery disease (CAD), supraventricular arrhythmia (SVA), and atypical chest pain.

CONCLUSION OF LAW

The criteria for service connection for costochondritis, coronary artery disease (CAD), supraventricular arrhythmia (SVA), and atypical chest pain, each as secondary to service-connected panic disorder, have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active duty service from August 1987 to August 1991.

These matters come to the Board of Veterans' Appeals (Board) on appeal from a June 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran testified before the Board in April 2023.  A copy of the hearing transcript is associated with the claims file.

The matters were previously before the Board and remanded for additional development in July 2023, April 2024, and February 2025.

This case has been advanced on the docket pursuant to 38 C.F.R. § 20.902(c).

SERVICE CONNECTION

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 military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).

As a general matter, establishing service connection requires competent evidence of (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the in-service disease or injury and the present disability.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303.

Service connection may be established on a secondary basis for a disability resulting from a service-connected disease or injury.  38 U.S.C. §§ 1110, 1131.  The Federal Circuit held that secondary service connection is warranted where a nonservice-connected disability would have been less severe but-for a service-connected disability, either because there is an etiological link between the two (to include worsening of functionality of the nonservice-connected disability), or because the service-connected disability resulted in the inability to treat the nonservice-connected disability.  Spicer v. McDonough, 61 F.4th 1360, 1364 (Fed. Cir. 2023).

The Veteran is competent to report symptoms and experiences he can observe. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159 (a). The VA must give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009).

The standard of proof to be applied in decisions on claims for veteran's benefits is set forth in 38 U.S.C. § 5107.  Under § 5107(b) and Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001), a claimant is to receive the benefit of the doubt when there is an "approximate balance" of positive and negative evidence, which Ortiz interpreted as "nearly equal" evidence.  Lynch v. McDonough, 21 F.4th 776, 780-81 (Fed. Cir. 2021) (en banc).

1. Service connection for costochondritis, coronary artery disease (CAD), supraventricular arrhythmia (SVA), and atypical chest pain

The Veteran contends that costochondritis, coronary artery disease (CAD), supraventricular arrhythmia
 and Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001), a claimant is to receive the benefit of the doubt when there is an "approximate balance" of positive and negative evidence, which Ortiz interpreted as "nearly equal" evidence.  Lynch v. McDonough, 21 F.4th 776, 780-81 (Fed. Cir. 2021) (en banc).

1. Service connection for costochondritis, coronary artery disease (CAD), supraventricular arrhythmia (SVA), and atypical chest pain

The Veteran contends that costochondritis, coronary artery disease (CAD), supraventricular arrhythmia (SVA), and atypical chest pain are related to his period of active service.

After reviewing the evidence of record, the Board finds that service connection for costochondritis, coronary artery disease (CAD), supraventricular arrhythmia (SVA), and atypical chest pain is warranted.

During a November 2024 heart conditions examination, the examiner diagnosed CAD, SVT, and atypical chest pain.  The examiner rendered a negative toxic exposure risk activity opinion.  The examiner reasoned that the Veteran's risk factor of smoking and alcohol abuse far outweigh his exposure to fuel/fume products and CARC paint during service.

In February 2025, a VA examiner found that the claimed conditions of costochondritis, coronary artery disease (CAD), supraventricular arrhythmia (SVA), and atypical chest pain are less likely than not incurred in or caused by the claimed in-service injury, event, or illness.  The examiner reasoned that there was not enough evidence to substantiate the claims.

Addendum medical opinions were obtained in November 2025.  The November 2025 examiner opined that it is at least as likely as not that the Veteran's service-connected panic disorder aggravates his costochondritis, CAD, SVT, and atypical chest pain.  The examiner reasoned that recurrent panic attacks can increase chest wall muscle tension and perceived pain sensitivity and can exacerbate cardiac workload and trigger arrhythmia episodes or chest discomfort.  The examiner later opined as to the baseline severity of costochondritis, CAD, SVT, and atypical chest pain prior to the worsening.

In light of the foregoing, the Board finds that the competent and probative evidence demonstrates that service-connected panic disorder aggravates costochondritis, CAD, SVT, and atypical chest pain.  Accordingly, service connection for costochondritis, CAD, SVT, and atypical chest pain, each as secondary to service-connected panic disorder, is granted.  38 C.F.R. § 3.102.  38 U.S.C. § 5107.

REASONS FOR REMAND

1. Service connection for chronic obstructive pulmonary disorder (COPD), claimed as shortness of breath is remanded.

The Board is not able to make a fully informed decision regarding the issue of service connection for chronic obstructive pulmonary disorder (COPD), claimed as shortness of breath.

A November 2023 respiratory conditions examination revealed a diagnosis of chronic obstructive pulmonary disease (COPD).  In negative secondary service connection opinions, the examiner found that COPD is less likely than not proximately due to or the result of the Veteran's service-connected panic disorder.  The examiner noted that the Veteran gives a history of anxiety and panic disorders which can cause him to hyperventilate and have chest pain that will resolve as soon as he slows his breathing down.  The examiner opined that panic attacks will not make COPD worse.  The examiner further opined that COPD is less likely than not aggravated beyond its natural progression by the Veteran' service-connected panic disorder and reasoned that there is no correlation between COPD and the service-connected panic disorder.

The Board finds that the November 2023 secondary service connection opinions are inadequate because examiner did not apply the required "but-for" analysis in discussing secondary service connection.  Under Spicer, secondary service connection is warranted where a nonservice-connected disability would have been less severe "but-for" a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability.  See Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023).  As such, remand is required to obtain an adequate medical opinion.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion regarding the nature and etiology of COPD, claimed as shortness of breath.  The need for an in-person examination is left to the discretion of the examiner.  The examiner should review the claims file and
 less severe "but-for" a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability.  See Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023).  As such, remand is required to obtain an adequate medical opinion.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion regarding the nature and etiology of COPD, claimed as shortness of breath.  The need for an in-person examination is left to the discretion of the examiner.  The examiner should review the claims file and address the following:

2. Whether it is at least as likely as not (an approximate balance of positive and negative evidence, i.e., nearly equal) that COPD, claimed as shortness of breath is due to service-connected panic disorder (i.e., but for the service-connected panic disorder, the Veteran would not have COPD, claimed as shortness of breath).  

3. Whether it is at least as likely as not (an approximate balance of positive and negative evidence, i.e., nearly equal) that COPD, claimed as shortness of breath is aggravated by service-connected panic disorder (i.e., COPD, claimed as shortness of breath would be less severe and result in less functional impairment but for the Veteran's service-connected panic disorder) either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected panic disorder resulted in the inability to treat the non-service-connected COPD, claimed as shortness of breath.

If the examiner opines there is aggravation, the examiner should provide an opinion about the baseline severity of the COPD, claimed as shortness of breath before aggravation.

(Continued on the next page)

?

The examiner must provide a complete rationale for any opinion expressed based on their clinical and medical expertise, established medical principles, and references to the evidence of record, as appropriate.

 

 

K. Parakkal

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	B Jackson, M.

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.