Back to BVA DecisionsDENIEDSpecial Benefit SMC - AID & ATTENDANCE; SMC - HOUSEBOUND Docket No. 220614-249992
MYOCARDIAL INFARCTION
G. A. WASIK · 2026 · Case ID: A26033259
Summary
The veteran, who served from April 1971 to April 1973, appeals the denial of service connection for coronary artery bypass graft s/p myocardial infarction, left leg amputation above the knee due to venous insufficiency, and a kidney disorder. The veteran also appeals the denial of special monthly compensation (SMC) based on aid and attendance/housebound status. Regarding the heart condition, service treatment records showed only a mild, basketball-related chest strain in service, with a normal cardiac exam at separation. A VA examiner provided a negative nexus opinion, stating the in-service chest pain was unrelated to the current heart condition. The Board found no competent opinion linking the current condition to service, and thus denied service connection. For the left leg amputation, the veteran claimed an in-service knee injury led to the amputation due to venous insufficiency. Service records noted a mild left knee tendonitis in service, with a normal musculoskeletal exam at separation. A VA examiner provided a negative nexus opinion, stating that knee injuries do not cause chronic venous insufficiency leading to amputation. The Board found the veteran competent to report symptoms but not to diagnose or relate the amputation to service, denying service connection. For the kidney condition, service records noted a referral for kidney complaints and flank pain, but the separation exam was normal. A recent VA examination found no renal dysfunction or kidney disorder, and the nexus opinion was negative due to the lack of a diagnosed condition. The Board found the weight of the evidence against a current kidney disorder, denying service connection. Finally, the Board denied SMC, as the veteran is not service-connected for any disability, making SMC based on service-connected conditions inapplicable.
Rationale
No heart symptoms noted in service treatment records.; Separation examination showed normal heart.; VA examiner provided negative nexus opinion.; No competent opinion relates current disorder to service.
Full Decision Text
Citation Nr: A26033259 Decision Date: 04/09/26 Archive Date: 04/09/26 DOCKET NO. 220614-249992 DATE: April 9, 2026 ORDER Service connection for coronary artery bypass graft s/p myocardial infarction is denied. Service connection for left leg amputation above the knee due to venous insufficiency is denied. Service connection for kidney disorder is denied. Entitlement to special monthly compensation (SMC) based on aid and attendance/housebound is denied. FINDINGS OF FACT 1. The Veteran's coronary artery bypass graft s/p myocardial infarction was not incurred during service and is not attributable to service. 2. The Veteran's left leg amputation above the knee due to venous insufficiency was not incurred during service and is not attributable to service. 3. The Veteran does not have a current kidney disorder. 4. The Veteran is not service-connected for any disability and does not require regular aid and attendance due to service-connected disabilities. CONCLUSIONS OF LAW 1. The criteria of service connection for coronary artery bypass graft s/p myocardial infarction are not met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 2. The criteria of service connection for left leg amputation above the knee due to venous insufficiency are not met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 3. The criteria for service connection for a kidney disorder are not met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 4. The criteria for special monthly compensation based on aid and attendance/housebound are not met. 38 U.S.C. §§ 1114(l); 38 C.F.R. §§ 3.350(b), 3.352. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1971 to April 1973. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of May 2022. The Veteran filed a Board appeal in June 2022 and selected the review option of hearing with a Veterans Law Judge (VLJ). The Veteran testified at a Board hearing on September 30, 2025. A transcript of the hearing is of record. Pursuant to the review option selected by the Veteran, the evidence to be considered by the Board is limited to the evidence of record at the time of the rating decision on appeal as well as any evidence submitted by the Veteran at the Board hearing or within 90 days following the hearing. 38 C.F.R. §§ 20.302, 20.303. Service Connection In general, service connection will be granted for a current disability that results 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). Establishing service connection generally requires a current disability, an in-service incurrence or aggravation of a disease or injury, and a nexus between the claimed in-service disease or injury and the present disability. See Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004). For certain chronic diseases shown as such in service (or within a presumptive period under 38 C.F.R. § 3.307), subsequent manifestations of the same chronic disease at a later date, however remote, are service connected. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.303 (b), 3.307, 3.309. The scope of a claim includes any disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Board may not make its own unsubstantiated medical conclusion. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Any favorable finding made by the agency of original jurisdiction (AOJ) is binding on the Board unless clearly and unmistakably erroneous. 38 C.F.R. § 3.104(c). 1. Service connection for coronary artery bypass graft s/p myocardial infarction. A rating decision of May 2022 denied service connection for coronary artery bypass graft s/p myocardial infarction ( and the other information of record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Board may not make its own unsubstantiated medical conclusion. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Any favorable finding made by the agency of original jurisdiction (AOJ) is binding on the Board unless clearly and unmistakably erroneous. 38 C.F.R. § 3.104(c). 1. Service connection for coronary artery bypass graft s/p myocardial infarction. A rating decision of May 2022 denied service connection for coronary artery bypass graft s/p myocardial infarction (claimed as chest pain/ heart condition). The favorable findings identified by the rating decision were that the service treatment records (STRs) show acute complaint of chest pain in September 1972, and that a VA examination report and outpatient treatment records diagnose coronary artery bypass grant s/p myocardial infarction. No heart symptoms are noted in the service treatment records. Chest pain following basketball playing was noted in September 1972. For the separation examination of January 1973, the Veteran's heart was found to be normal with respect to thrust, size, rhythm, and sounds. No heart symptoms were found or reported. The Veteran underwent a VA examination for heart conditions in April 2022. It was noted that the Veteran's left leg was amputated above the knee in November 2021 due to venous insufficiency. The Veteran testified before the Board that he began having tremors in his legs six months after separating from service, and that at a later, undefined date a doctor told him that poor circulation caused his left leg problem. The Veteran testified that his left leg and then, approximately two years later, his right leg were amputated due to poor circulation. The Veteran is not entitled to presumed service connection for coronary artery disease as a listed chronic disease, because his current disorder did not have its onset during service or within a year of service separation. 38 C.F.R. § 3.303(b), 3.309(a). Herbicide exposure is also not at issue, because the Veteran did not serve in the Republic of Vietnam or otherwise have herbicide exposure. The Veteran is competent to report his experienced symptoms and a contemporaneous medical diagnosis, but he is not competent to diagnose a heart disorder or to relate a current heart disorder to a disease or injury of service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Kahana v. Shinseki, 24 Vet. App. 428 (2011). The VA examiner offered a negative nexus opinion. The rationale was that the Veteran's chest pain noted during service in September 1972 involved a pulled chest muscle caused by playing basketball and did not cause the Veteran's current heart condition with chest pain. The VA nexus opinion is adequately supported. There is no competent opinion that dates the onset of the Veteran's coronary artery bypass grant s/p myocardial infarction to his service period or the year following service or otherwise relates the current disorder to service. Accordingly, service connection is not warranted. Because the positive and negative evidence is not approximately balanced, there is no reasonable doubt to be resolved in the Veteran's favor. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 2. Service connection for left knee condition. In November 2008, the Veteran filed a service-connection claim for a right knee injury. He asserted that he injured his right knee during active duty training, that he was unable to complete his training because of the injury, and that the injury never healed properly. A rating decision of July 2009 denied service connection for right knee condition. In March 2022, the Veteran filed a claim seeking service connection for the left knee. A rating decision of May 2022 denied service connection for a left knee condition. Although no favorable finding was identified as such, the rating decision acknowledged a current disability and the fact that the service treatment records reflect complaints, treatment, or a diagnosis similar to that claimed. A service treatment record of February 1972 notes an injury to the left leg two days prior to presenting, and the diagnosis was mild flexor tendonitis of the left knee. For the January 1973 separation examination, the Veteran was found to have a normal musculoskeletal system. He reported no left knee symptoms. In April 2022, the Veteran underwent a VA examination for the knees. A 1972 diagnosis of left knee strain was noted. The left knee could not currently be tested because the Veteran left knee condition. Although no favorable finding was identified as such, the rating decision acknowledged a current disability and the fact that the service treatment records reflect complaints, treatment, or a diagnosis similar to that claimed. A service treatment record of February 1972 notes an injury to the left leg two days prior to presenting, and the diagnosis was mild flexor tendonitis of the left knee. For the January 1973 separation examination, the Veteran was found to have a normal musculoskeletal system. He reported no left knee symptoms. In April 2022, the Veteran underwent a VA examination for the knees. A 1972 diagnosis of left knee strain was noted. The left knee could not currently be tested because the Veteran's left leg had been amputated above the knee in November 2021 due to venous insufficiency. The Veteran was noted to have had left knee pain stiffness and weakness in May 2008. A nexus opinion was obtained in May 2022. In the clinician's opinion, the Veteran's left leg amputation due to venous insufficiency was less likely than not the result of an in-service injury. The rationale was that the Veteran's left knee/leg injury in February of 1972 was, at the time, thought to be a possible lateral collateral knee injury with mild flexor tendonitis. The amputation of the Veteran's left leg in November 2021 was due to venous insufficiency, which occurs when the venous wall or the valves in the legs are not working effectively, making it difficult for blood to return to the heart from the legs and causing blood to pool. Chronic venous insufficiency can occur because of aging, extended sitting or standing, or a combination of aging and reduced mobility. The clinician explained that an injury to the knee does not cause of chronic venous insufficiency. The Veteran testified before the Board that his left leg was amputated due to poor circulation. He alleged having had problems with his left knee and receiving treatment during service. The Veteran also stated that he began having tremors in his legs six months after separating from service, and that on a later, unspecified date, a doctor told him that his leg problem was caused by poor blood circulation. He testified that his left leg and subsequently his right leg were amputated due to poor circulation. Service connection is not warranted. The Veteran is competent to report his experienced symptoms but not to attribute his leg amputation to a disease or injury of service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The negative VA nexus opinion is adequately supported. There is no competent opinion that relates the Veteran's left leg amputation above the knee to service. Because the positive and negative evidence is not approximately balanced, there is no reasonable doubt to be resolved in the Veteran's favor. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 3. Service connection for kidney condition. A rating decision of May 2022 denied service connection for kidney condition. The favorable finding identified in the rating decision was that the service treatment records show referral due to kidney complaints and bilateral flank pain in April 1972. An STR of April 1972 also notes an impression of R/O prostatitis. For the separation examination report of January 1973, the Veteran was found to have a normal genitourinary system. No kidney symptoms or flank pain was reported by the Veteran or found at separation. The Veteran testified before the Board in September 2025 that his private doctor had recently told him that something was wrong with his kidney. No disorder was specified. The Veteran stated that he began having kidney problems several months prior to the Board hearing. A VA treatment record of November 2021 notes the Veteran's negative response to a radiology survey question, "Do you have kidney disease?" When the Veteran was examined by VA for kidney conditions in April 2022, no renal disfunction or kidney disorder was found. Urinalysis was positive for blood, but the test results for blood urea nitrogen (BUN), creatinine, and complete blood count (CBC) were normal. The remarks of the examiner were that the Veteran was well- developed, well- nourished, in no acute distress, and showing no sign of malaise. For the claimed kidney condition, there was no diagnosis because there were no findings, signs, or symptoms to support a diagnosis. The nexus opinion was negative for the same reason, namely the lack of a currently diagnosed kidney condition. As a layperson, the Veteran is competent to report his experienced symptoms and a contemporaneous medical diagnosis. See Jandre no renal disfunction or kidney disorder was found. Urinalysis was positive for blood, but the test results for blood urea nitrogen (BUN), creatinine, and complete blood count (CBC) were normal. The remarks of the examiner were that the Veteran was well- developed, well- nourished, in no acute distress, and showing no sign of malaise. For the claimed kidney condition, there was no diagnosis because there were no findings, signs, or symptoms to support a diagnosis. The nexus opinion was negative for the same reason, namely the lack of a currently diagnosed kidney condition. As a layperson, the Veteran is competent to report his experienced symptoms and a contemporaneous medical diagnosis. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). He is not competent to diagnose a kidney disorder. See Kahana v. Shinseki, 24 Vet. App. 428 (2011). The requirement of a current disability is satisfied if a disorder is diagnosed at the time a claim is filed or at any time during the pendency of the appeal. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The clear weight of the evidence is against finding that the Veteran has a current kidney disorder. No kidney disorder was found upon VA examination or in the VA treatment records. The Veteran has not specified the kidney dysfunction allegedly identified by his private doctor. Even if the Veteran is considered credible in his competent report of having been told by his private doctor in 2025 that he has a kidney problem, no competent evidence relates a current kidney problem to a disease, injury, or event of service. Nor has the Veteran described symptoms that might qualify as a disability, despite the absence of a diagnosis, because of resulting impairment of earning capacity. See Saunders v. Wilkie, 886 F.3d 1356 (2018). Service connection requires a current disorder. See Degmetich v. Brown, 104 F.3d 1328, 1333 (1997). Service connection is not warranted in this case for lack of a current kidney disorder. The positive and negative evidence is not approximately balanced. Therefore, there is no reasonable doubt to be resolved in the Veteran's favor. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Special Monthly Compensation Special monthly compensation (SMC) is available when, as the result of service- connected disability, a veteran suffers additional hardships beyond those contemplated by VA's schedule for rating disabilities. 38 U.S.C. § 1114; 38 C.F.R. §§ 3.350, 3.352. SMC is payable in addition to the basic rate of compensation otherwise payable for the degree of disability. Special monthly compensation is payable under 38 U.S.C. § 1114 (l) if, as the result of a service-connected disability, a veteran is so helpless as to be in need of regular aid and attendance of another person or is permanently bedridden. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). Under 38 U.S.C. § 1114 (s), SMC at the housebound rate is payable if a veteran has a single service-connected disability rated at 100 percent and has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100- percent, service-connected disability and involving different anatomical segments or bodily systems. 4. Entitlement to special monthly compensation based on aid and attendance/housebound. (Continued on the next page) ? A rating decision of May 2022 denied entitlement to special monthly compensation based on aid and attendance/housebound. SMC entitlement may be granted for a special level of disability caused by service-connected disabilities. Because the Veteran currently is not service-connected for any disorder, any special level of disability that he may have is not based on a service-connected disability. The clear weight of the evidence is against finding entitlement to special monthly compensation based on a need for regular aid and attendance or statutory housebound status within the meaning of VA regulations. Because the positive and negative evidence is not approximately balanced, there is no reasonable doubt to be resolved in the Veteran's favor. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Najarian, Steven The Board's decision in this case is binding only with respect to the instant matter level of disability that he may have is not based on a service-connected disability. The clear weight of the evidence is against finding entitlement to special monthly compensation based on a need for regular aid and attendance or statutory housebound status within the meaning of VA regulations. Because the positive and negative evidence is not approximately balanced, there is no reasonable doubt to be resolved in the Veteran's favor. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Najarian, Steven 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.