VALVULAR HEART DISEASE (INCLUDING RHEUMATIC HEART DISEASE)

Summary

The veteran, a veteran who served from August 1979 to August 1982, appeals the denial of service connection for a heart disorder, specifically coronary artery disease (CAD) status post coronary artery bypass surgery (CABG) and valvular heart disease (VHD) status post heart valve replacement (HVR). The veteran contends his heart disorder is related to service, noting a minimal exposure to asbestos during service as a seaman, which the AOJ favorably found. However, the Board found that the evidence did not establish a nexus between the veteran's current heart condition and this in-service exposure. Two VA examiners opined that the veteran's heart disorder was less likely than not caused by the identified Toxic Exposure Risk Activity (TERA), noting that known risk factors like family history, lifestyle choices, diabetes, hypertension, hyperlipidemia, obesity, and age far outweighed any speculative link to asbestos exposure. The Board afforded great weight to the second VA examiner's opinion, finding it well-reasoned and supported by the evidence, and noted the absence of contrary medical opinions. The veteran's lay opinion regarding the etiology of his heart disorder was not considered competent due to the complexity of the medical issue. Furthermore, the evidence showed the heart condition did not manifest during service or within one year of separation, and there was no continuity of symptomatology. Consequently, service connection was denied.

Rationale

No nexus between heart disorder and TERA; VA examiner opined less likely than not caused by TERA; No medical literature links TERA to CAD or VHD; Known risk factors outweigh TERA; No continuity of symptomatology; Condition did not manifest within one year of separation

Full Decision Text

Citation Nr: A26036483
Decision Date: 04/20/26	Archive Date: 04/20/26

DOCKET NO. 250416-534649
DATE: April 20, 2026

ORDER

Service connection for a heart disorder is denied.

FINDING OF FACT

A heart disorder, diagnosed as coronary artery disease (CAD) status post coronary artery bypass surgery (CABG) and valvular heart disease (VHD) status post heart valve replacement (HVR), is not shown to be causally or etiologically related to any disease, injury, or incident during service, and did not manifest to a compensable degree within one year of separation from active duty.

CONCLUSION OF LAW

The criteria for service connection for a heart disorder have not been met. 38 U.S.C. §§ 1101, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from August 1979 to August 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in April 2025 by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act (AMA), which after conducting a higher level review of a December 2024 rating decision, continued the denial of service connection for a heart disorder. Later that month, the Veteran timely appealed such rating decision by submitting a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) and requested direct review of the evidence considered by the Agency of Original Jurisdiction (AOJ).  

Therefore, the Board may only consider the evidence of record at the time of the December 2024 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 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, he 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 claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Entitlement to service connection for a heart disorder.

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, to include cardiovascular-renal disease, to a degree of 10 percent within one year, from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303(b). 

The Veteran contends that his heart disorder is related to his military service; however, he reported the onset of such disorder decades after service; his service treatment records are
 in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.307, 3.309. Alternatively, when a disease at 38 C.F.R. § 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303(b). 

The Veteran contends that his heart disorder is related to his military service; however, he reported the onset of such disorder decades after service; his service treatment records are negative for any relevant complaints, treatment, or diagnoses; and the initial notation of heart-related findings were rendered after an October 2016 CT scan. Nonetheless, the Board notes that, in an April 2024 Toxic Exposure Risk Activity (TERA) Memorandum, the AOJ found that he participated in a TERA, identified as minimal exposure to asbestos coincident with his military occupational specialty as a seaman. In this regard, the AOJ favorably found that the Veteran had a current diagnosis of the aforementioned heart disorder and participated in the above noted TERA. The Board is bound by such favorable findings. 38 C.F.R. § 3.104(c). Therefore, the remaining inquiry is whether the Veteran's current heart disorder is related to such in-service TERA.

In this regard, an April 2024 VA examiner opined that the Veteran's heart disorder is less likely than not caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERAs of the Veteran. In support thereof, he noted that the factors that increase the risk of heart disease such as those found in the Veteran include: high LDL cholesterol, low HDL cholesterol, high blood pressure, family history, diabetes, smoking, being older than 45, and obesity. The examiner further found that there is no medical or scientific evidence that provides an indication of a relationship between the development of the Veteran's heart disease and the TERA.

Following the AOJ's determination that the aforementioned opinion did not adequately address the matter at hand, an addendum opinion from another VA examiner was obtained in September 2024. At such time, he opined that the Veteran's heart disorder is less likely than not caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERAs of the Veteran. In support thereof, the examiner stated that he could not find any medical literature that showed that the Veteran's TERA has a causative relationship with CAD or VHD. In this regard, he indicated that some research has shown that asbestos exposure can increase the risk of developing heart disease, but such articles note only speculative reasons as to how the two may be linked, and the meta-analysis was limited based on the amount and type of exposure. Here, the examiner found that the Veteran's in-service exposure to asbestos did not outweigh the known risk factors, which include genetics/family history, lifestyle choices, diabetes mellitus, hypertension, hyperlipidemia, obesity, age, etc. He explained that asbestos exposure is more typically associated with lung-related conditions such as mesothelioma and lung cancer, and further noted that his medical history is positive for smoking, alcohol use, hyperlipidemia, and family history of diabetes, which far outweigh any other risk factors for development of CAD and VHD.

The Board affords great probative weight to the September 2024 VA examiner's opinion as such considered all pertinent evidence of record, to include the Veteran's statements and his relevant medical history, and provided a complete rationale, relying and citing to the records reviewed. Moreover, the examiner offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Notably, there is no medical opinion to the contrary. 

The Board also considered the Veteran's assertion as to the etiology of his heart disorder; however, as a lay person, he does not have the requisite training and experience necessary to address such a complex medical matter. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 
 fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Notably, there is no medical opinion to the contrary. 

The Board also considered the Veteran's assertion as to the etiology of his heart disorder; however, as a lay person, he does not have the requisite training and experience necessary to address such a complex medical matter. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the etiology of such disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Accordingly, the Veteran's opinion as to the etiology of his heart disorder is not competent evidence and, consequently, is afforded no probative weight. 

Furthermore, the evidence fails to demonstrate that the Veteran's heart disorder manifested to a compensable degree within one year of his year of separation from active duty. In this regard, his heart was normal at his July 1982 separation examination, and the first indication of such disorder was noted in October 2016. Additionally, the Veteran has not alleged a continuity of symptomatology.

Therefore, the Veteran's heart disorder is not shown to be causally or etiologically related to any disease, injury, or incident during service, and did not manifest to a compensable degree within one year of separation from active duty. Thus, service connection for such disorder is not warranted. In reaching such decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claim for service connection for a heart disorder, such doctrine is not applicable in the instant appeal and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 

 

A. JAEGER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Deal, Katie

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.