Back to BVA DecisionsDENIEDSpecial Benefit NO SPECIAL BENEFIT Docket No. 250202-514103
MYOCARDIAL INFARCTION
L. CHU · 2026 · Case ID: A26004699
Summary
The veteran, who served from December 1988 to January 1998, appeals the denial of secondary service connection for myocardial infarction, coronary artery disease, and peripheral artery disease. The veteran contended these conditions were caused or aggravated by his service-connected hypertension. The Board found no direct service connection, noting the absence of in-service symptoms and the significant time lapse between service and diagnosis. Regarding secondary service connection, the Board reviewed the veteran's lay statements and a December 2024 VA medical opinion. The VA examiner opined that the peripheral artery disease, coronary artery disease, and myocardial infarction were less likely than not caused by service and less likely than not related to the veteran's service-connected hypertension. The examiner cited risk factors such as age, hyperlipidemia, diabetes, and smoking as the causes, and noted that medical literature did not support a direct link between hypertension and peripheral artery disease. While hypertension can contribute to coronary artery disease and myocardial infarction if uncontrolled, the veteran's hypertension was well-managed with medication. The examiner found no evidence of aggravation by hypertension. The Board found the VA opinion more probative than the veteran's lay statements, as laypersons are not competent to determine the cause of medical conditions. Consequently, the Board denied secondary service connection for all three conditions.
Rationale
Service treatment records silent for myocardial infarction.; Diagnosed post-service in February 2016.; VA examiner opined less likely than not caused by service.; VA examiner opined less likely than not related to service-connected hypertension.; Examiner attributed condition to risk factors (age, hyperlipidemia, diabetes, smoking).; Veteran's hypertension was controlled with medication.; No evidence of aggravation by hypertension.; Veteran's lay statements not competent to determine medical causation.
Full Decision Text
Citation Nr: A26004699 Decision Date: 01/20/26 Archive Date: 01/20/26 DOCKET NO. 250202-514103 DATE: January 20, 2026 ORDER Entitlement to secondary service connection for myocardial infarction is denied. Entitlement to secondary service connection for coronary artery disease is denied. Entitlement to secondary service connection for peripheral artery disease is denied. FINDINGS OF FACT 1. The Veteran's myocardial infarction is not etiologically related to service, nor was it caused or aggravated by his controlled service-connected hypertension. 2. The Veteran's coronary artery disease is not etiologically related to service, nor was it caused or aggravated by his controlled service-connected hypertension. 3. The Veteran's peripheral artery disease is not etiologically related to service, nor was it caused or aggravated by his controlled service-connected hypertension. CONCLUSIONS OF LAW 1. The criteria for entitlement to secondary service connection for myocardial infarction have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for entitlement to secondary service connection for coronary artery disease have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for entitlement to secondary service connection for peripheral artery disease have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from December 1988 to January 1998. The rating decision on appeal was issued in January 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the February 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the January 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included in this decision. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Establishing service connection generally requires (1) evidence of 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. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also 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). When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, reasonable doubt will be resolved in each such issue in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. An appellant needs to only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. To deny a claim on its merits, the preponderance of the evidence must be against the claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 1. Entitlement to secondary service connection for myocardial infarction 3.303(d). When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, reasonable doubt will be resolved in each such issue in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. An appellant needs to only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. To deny a claim on its merits, the preponderance of the evidence must be against the claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 1. Entitlement to secondary service connection for myocardial infarction 2. Entitlement to secondary service connection for coronary artery disease 3. Entitlement to secondary service connection for peripheral artery disease The Veteran contends that his peripheral artery disease, coronary artery disease, and myocardial infarction were caused or aggravated by his service-connected hypertension. Service treatment records are silent for complaints, symptoms, or treatment for peripheral artery disease, coronary artery disease, and myocardial infarction. Post-service the Veteran was diagnosed with peripheral artery disease in July 2021 and coronary artery disease and myocardial infarction in February 2016. The Veteran underwent emergency intervention in October 2022 and January 2023 regarding the Veteran's peripheral artery disease. The Veteran's hypertension was controlled with medication. In a December 2024 VA opinion for peripheral artery disease, the examiner opined that the Veteran's peripheral artery disease was less likely than not caused by service. The examiner noted that the Veteran's service treatment records were silent for peripheral artery disease, and the Veteran was diagnosed post service in July 2021. The examiner further opined that the Veteran's peripheral artery disease was less likely than not related to his service-connected hypertension. Based on medical literature, the examiner stated that peripheral artery disease occurs when blood vessels narrow, reducing blood flow to the extremities. Risk factors included smoking, high cholesterol, age, and diabetes. The examiner stated that the Veteran was over the age of 50, with hyperlipidemia, diabetes, and used tobacco products. The examiner stated that the Veteran's risk factors caused his peripheral artery disease. The examiner noted that medical literature did not support a direct etiology establishing a relationship between hypertension and peripheral artery disease. The Veteran's hypertension was controlled by medication. Regarding aggravation, the examiner noted that the Veteran underwent emergency intervention for the left lower blood vessels and right lower blood vessels, which treatment records attributed to his chronic smoking. The Veteran's treatment records were silent for any aggravation by his hypertension. In a December 2024 VA opinion for coronary artery disease and myocardial infarction, the examiner opined that the Veteran's coronary artery disease and myocardial infarction were less likely than not caused by service. The examiner noted that the Veteran's service treatment records were silent for coronary artery disease or myocardial infarction, and the Veteran was diagnosed post service in February 2016. The examiner also opined that the Veteran's coronary artery disease and myocardial infarction were less likely than not related to his service-connected hypertension. Based on medical literature, risk factors associated with coronary artery disease and myocardial infarction include age, high cholesterol, diabetes, and smoking tobacco; the Veteran had all of the risk factors. The examiner noted that smoking increases the risk by damaging blood vessels, which can lead to atherosclerosis and plaque buildup in the coronary arteries. Thus, the examiner attributed the Veteran's coronary artery disease and myocardial infarction to being over 50 years old, hyperlipidemia, diabetes, and use of tobacco products. Regarding aggravation, the examiner noted that hypertension can be a contributor to both coronary artery disease and myocardial infarction if uncontrolled. However, the Veteran's hypertension was controlled with medication. After reviewing the records, the examiner noted that the Veteran's cardiology and vascular specialists did not identify evidence of deterioration nor worsening of his coronary artery disease. The examiner opined that the Veteran's coronary artery disease was not aggravated by his service-connected hypertension. At the outset, the Board finds that service connection is not warranted on a direct basis. The Veteran does not claim, nor does the record reflect, that he had any symptoms related to myocardial infarction, coronary artery disease, or peripheral artery disease during, or on an ongoing basis, since service. The Board notes that, although not a dispositive factor, the passage of time between the Veteran's discharge and an initial diagnosis for the claimed disorder is one factor that weighs against the Veteran's claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Turning to the issue of secondary service, the Board is persuaded against the service-connected hypertension. At the outset, the Board finds that service connection is not warranted on a direct basis. The Veteran does not claim, nor does the record reflect, that he had any symptoms related to myocardial infarction, coronary artery disease, or peripheral artery disease during, or on an ongoing basis, since service. The Board notes that, although not a dispositive factor, the passage of time between the Veteran's discharge and an initial diagnosis for the claimed disorder is one factor that weighs against the Veteran's claim. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Turning to the issue of secondary service, the Board is persuaded against the Veteran's claim of service connection for myocardial infarction, coronary artery disease, or peripheral artery disease as secondary to his service-connected hypertension. Initially, the Board finds that the Veteran has diagnoses of myocardial infarction, coronary artery disease, and peripheral artery disease along with service connection for hypertension. Therefore, the remaining issue before the Board is whether the Veteran's myocardial infarction, coronary artery disease, or peripheral artery disease was caused or aggravated by his service-connected hypertension. The Board acknowledges the Veteran's lay statements that his myocardial infarction, coronary artery disease, or peripheral artery disease was caused or aggravated by his service-connected hypertension. However, the only positive evidence of record suggesting a connection between the two disabilities is that of the Veteran's lay statements. As a layperson, the Veteran is competent to report observable symptoms; however, the Veteran, in this case, is not competent to determine the cause of his symptoms because it would involve medical inquiry into biological processes, anatomical relationships, and physiological functioning. Such internal physical processes are not readily observable and are not within the competence of the Veteran in this case, who has not been shown by the evidence of record to have medical training or skills. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). The Board finds the December 2024 opinion to be of greater probative weight than the Veteran's lay assertions. An opinion linking current diagnoses of myocardial infarction, coronary artery disease, or peripheral artery disease to hypertension requires medical knowledge not capable of lay observation. Meanwhile, the December examiner fully reviewed the claims file, the Veteran's service-connected hypertension, and his cardiac disabilities. Additionally, the examiner provided opinions for both causation and aggravation supported by the Veteran's treatment records and medical literature. The examiner's conclusions, supported by sound rationale, is the most probative evidence. As the Board is persuaded against the Veteran's claim, there is no reasonable doubt to be resolved. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Therefore, the Board finds that service connection for myocardial infarction, coronary artery disease, and peripheral artery disease on either a direct or secondary basis is not warranted. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Clevenger, Gordanna A. 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.