SUPRAVENTRICULAR ARRHYTHMIAS

C. J. MCENTEE · 2022 · Case ID: A22010485

MIXED

Summary

The Veteran, who served from July 1949 to November 1952 and August 1954 to May 1955, appeals the denial of service connection for heart conditions and the denial of special monthly compensation (SMC) based on aid and attendance. The Veteran also appeals the denial of service connection for vision impairment. The Board found that new and relevant evidence, specifically a March 1999 VA physician's opinion and a March 2022 private cardiologist's opinion, warranted readjudication of the heart condition claims. The VA physician noted the Veteran was diagnosed with Wolf-Parkinson-White syndrome during service, questioning the prior denial. The private cardiologist opined that the Veteran's heart conditions were at least as likely as not due to active duty, citing the onset of irregular heart rhythms during service and subsequent development of permanent atrial fibrillation. The Board found these opinions probative and granted service connection for tachycardia and angina with Wolf-Parkinson-White syndrome and tachyarrhythmia. For the vision impairment claim, the Board found a pre-decisional duty to assist error, remanding the issue for an addendum opinion to determine the etiology of the Veteran's vision loss, considering his service treatment records which showed normal vision at induction but later defective vision and prescribed glasses. The SMC claim was also remanded due to its interrelation with the vision impairment issue.

Rationale

New and relevant evidence (March 1999 VA opinion, March 2022 private cardiologist opinion) warranted readjudication.; VA physician noted Wolf-Parkinson-White syndrome diagnosis during service.; Private cardiologist opined condition at least as likely as not due to active duty.; Board found opinions probative and supported service connection.

Special Benefit

SMC - AID & ATTENDANCE

Docket No.

220503-240126

Full Decision Text

Citation Nr: A22010485
Decision Date: 06/06/22 Archive Date: 06/06/22

DOCKET NO. 220503-240126
DATE: June 6, 2022

ORDER

Readjudication of the claim for service connection for tachycardia (claimed as heart condition) is granted.

Readjudication of the claim for service connection for angina with Wolf-Parkinson-White syndrome and tachyarrhythmia (claimed as heart condition) is granted.

Service connection for tachycardia is granted.

Service connection for angina with Wolf-Parkinson-White syndrome and tachyarrhythmia is granted.

REMANDED

The claim of entitlement to service connection for cataract with phthisis (claimed as vision impairment) is remanded.

The claim of entitlement to special monthly compensation (SMC) based on the need for aid and attendance is remanded.

FINDINGS OF FACT

1. New and relevant evidence was received after an unappealed January 1985 Board of Veterans' Appeals (Board) decision denying service connection for heart disorders.

2. The evidence of record supports the finding that the Veteran's heart disorders are related to service.

CONCLUSIONS OF LAW

1. The criteria for readjudication of the claim for service connection for tachycardia based on new and relevant evidence have been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(d).

2. The criteria for readjudication of the claim for service connection for angina with Wolf-Parkinson-White syndrome and tachyarrhythmia based on new and relevant evidence have been met. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(d).

3. The criteria for service connection for tachycardia have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for angina with Wolf-Parkinson-White syndrome and tachyarrhythmia have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active duty from July 1949 to November 1952 and August 1954 to May 1955.

The issues are on appeal from October 2021 and March 2022 rating decisions.

Briefly addressing the procedural history, the Veteran's claim of service connection was denied by the Board in January 1985 because it found that the Veteran had a pre-existing heart disorder which was not aggravated by active duty. The Veteran did not appeal the decision.

In October 2021, he filed a supplemental claim to reopen the service connection claim for a heart condition. The Agency of Original Jurisdiction (AOJ) found that new and relevant evidence had not been received and denied the request to reopen in an October 2021 rating decision.

In a March 2022 rating decision, the AOJ denied the claims for special monthly compensation (SMC) based on aid and attendance/housebound status and service connection for vision impairment.

The Veteran filed a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) in May 2022, appealing the findings of the October 2021 and March 2022 rating decisions. He selected the Direct Review lane. As explained in the VA Form 10182, direct review" means that the Board's decision must be based upon the evidence of record at the time of the prior decision, with no evidence submission or hearing request. Direct review means the Board's review is limited to that evidence already of record at the time of the October 2021 and March 2022 rating decisions.

In November 2021, the Veteran indicated an interest in seeking special monthly pension. The Board refers the issue to the AOJ for appropriate consideration.

New and Relevant Evidence

VA will readjudicate a claim under the AMA framework if new and relevant evidence is presented or secured. 38 C.F.R. § 3.156(d). "Relevant evidence" is evidence that tends to prove or disprove a matter in issue. 38 C.F.R. § 3.2501(a)(1).

Thus, the initial questions for the Board are whether new evidence was added to the claims file after the prior final (unappealed) January 1985 denial of his claims for service connection for heart condition, and,
2021, the Veteran indicated an interest in seeking special monthly pension. The Board refers the issue to the AOJ for appropriate consideration.

New and Relevant Evidence

Thus, the initial questions for the Board are whether new evidence was added to the claims file after the prior final (unappealed) January 1985 denial of his claims for service connection for heart condition, and, if so, whether that evidence is relevant to his claims.

Initially, going forth, the claims for tachycardia and angina with Wolf-Parkinson-White syndrome and tachyarrhythmia will be collectively referred to as "heart conditions."

New evidence added to the Veteran's claims file since the January 1985 Board decision include a March 1999 opinion by a VA physician stating that the Veteran was diagnosed with Wolf-Parkinson-White syndrome during service and a March 2022 opinion by a private cardiologist stating that the Veteran's heart conditions began during active duty, eventually leading to the development of permanent atrial fibrillation. The Board finds this new and relevant evidence after the prior final Board decision, evidence that was not already of record and may prove or disprove the nexus element of the claims for service connection for heart conditions. Readjudication of the claims are thus warranted and will be addressed in the next section below. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(d).

Service Connection

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).

Turning to the evidence, the Veteran's service treatment records include a July 1949 induction report of medical examination with no heart issues reported or noted. In May 1952, the Veteran complained of sudden dizziness and that his heart began to skip or pound while performing training exercises. A consult note reveals that the Veteran said his first attack of a rapid heartrate began a few years ago but he had no definite history of shortness of breath or other symptoms, and the May 1952 attack was the worst one that he had experienced. He was admitted to the hospital and diagnosed with tachycardia and paroxysmal due to Wolf-Parkinson-White syndrome.

Post-separation, the Veteran continued to seek treatment for his heart conditions. In March 1999, the Veteran's treating VA physician wrote that he had Wolf-Parkinson-White syndrome which was complicated by tachyarrhythmias and was diagnosed with Wolf-Parkinson-White syndrome during active duty. The physician expressed confusion as to why the Veteran was not service-connected for heart conditions as he was clearly diagnosed during active duty and the diagnosis was complicating his medical condition.

In March 2022, a private cardiologist examined the Veteran and reviewed his claims file. He noted the Veteran's relevant medical history regarding his heart conditions. The private cardiologist opined that it was at least as likely as not that the Veteran's heart conditions were due to his active duty based on the onset of irregular heart rhythms at the end of his initial term of active duty and the subsequent development of permanent atrial fibrillation resulting in an eventual stroke, visual loss, progressive dementia, and development of high blood pressure and kidney disease.

The Board finds that the evidence of record supports a finding that the Veteran's heart conditions began during active duty. Further, the Board assigns the March 1999 and March 2022 opinions significant probative weight as they were based on relevant evidence of record and provided supporting explanations.

Accordingly, service connection for tachycardia and for angina with Wolf-Parkinson-White syndrome and tachyarrhythmia is granted.

REASONS FOR REMAND

Remands are limited under the AMA to correct an error by an AOJ to satisfy its duty to assist the Veteran under 38 U.S.C. § 5103A, if the
, progressive dementia, and development of high blood pressure and kidney disease.

Accordingly, service connection for tachycardia and for angina with Wolf-Parkinson-White syndrome and tachyarrhythmia is granted.

REASONS FOR REMAND

Remands are limited under the AMA to correct an error by an AOJ to satisfy its duty to assist the Veteran under 38 U.S.C. § 5103A, if the error occurred prior to the AOJ decision on appeal, or to correct any other AOJ error "in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating" the claim. 38 C.F.R. § 20.802(a).

In August 2021, the Veteran filed a claim for vision impairment, stating that his vision changed during active duty and he was prescribed glasses.

The Veteran's service treatment records demonstrate normal eyes and 20/20 vision on his July 1949 enlistment report of medical examination. On his June 1954 enlistment report of medical examination, he was found to have defective vision and defective color perception. After a vision evaluation, his right eye had 20/70 and his left eye had 20/20 results. The physician ordered two pairs of glasses for the Veteran in August 1954. His April 1955 separation evaluation revealed normal eyes and field of vision.

The Veteran was afforded a VA examination in October 2021. He was diagnosed with cataract in the left eye and phthisis in the right eye. The examiner opined that the vision impairments were unrelated to active duty as the loss of vision in the right eye was due to a stroke in 2017 and loss of vision in the left eye was due to a cataract, which was the primary cause and disease.

An addendum opinion should be issued because the October 2021 VA examination report did not address any of the findings in the Veteran's service treatment records regarding his vision.

Accordingly, the Board finds that a pre-decisional duty to assist error was committed, and that this issue must be remanded for an addendum opinion as to the etiology of the Veteran's vision impairment, after review of the Veteran's full medical history has been considered.

The claim for SMC is intertwined with this remand and with the claims granted above so it must be remanded as well.

The matters are REMANDED for the following action:

Obtain an addendum medical opinion to determine the nature and etiology of the Veteran's vision loss.

The examiner's attention is directed to the Veteran's service treatment records. His initial July 1949 induction examination demonstrated perfect vision. The Veteran then was found to have defective vision and defective color perception on his June 1954 induction examination and prescribed glasses in August 1954.

The examiner must provide an opinion as to whether there is an approximate balance of positive and negative evidence that an eye or vision disorder was incurred in or aggravated by active duty.

C. J. McEntee

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J. Lee

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.

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