BRADYCARDIA WITH IMPLANTED CARDIAC PACEMAKER

Summary

The Veteran, an Army veteran who served from August 2004 to January 2008, appeals the denial of service connection for a cardiac condition, specifically bradycardia with an implanted cardiac pacemaker. The Veteran claimed this condition was caused by toxic exposures, including burn pits, and his job as a light wheel mechanic. The Regional Office (RO) conceded participation in toxic exposure risk activity and acknowledged the Veteran's diagnosis of bradycardia with a pacemaker. However, the Veteran's service treatment records (STRs) were silent regarding any cardiac issues during service. The condition first appeared in post-service records in 2024, approximately 16 years after separation, with a pacemaker implanted in September 2024. The VA examiner diagnosed bradycardia and a pacemaker, noting the Veteran's significant smoking history and chronic alcohol use as alternative risk factors. The examiner opined that the condition was less likely than not caused by toxic exposure, citing a lack of direct scientific evidence linking the exposures to bradycardia and the presence of alternative risk factors. The Veteran submitted a lay statement and an article on PAHs and cardiovascular disease, but the Board found the article had little probative value as it did not address the Veteran's specific case or alternative causes. The Board found the VA examiner's opinion highly competent and probative, concluding that the evidence did not support a causal relationship between service exposures and the cardiac condition. Therefore, service connection was denied.

Rationale

Service treatment records silent regarding cardiac conditions during service.; Condition first appeared post-service, approximately 16 years after separation.; VA examiner opined condition was less likely than not caused by toxic exposure, citing lack of direct scientific evidence and presence of alternative risk factors (smoking, alcohol).

Full Decision Text

Citation Nr: A26037557
Decision Date: 04/22/26	Archive Date: 04/22/26

DOCKET NO. 250811-572950
DATE: April 22, 2026

ORDER

Entitlement to service connection for a cardiac condition, claimed as bradycardia with implanted cardiac pacemaker, is denied. 

FINDING OF FACT

The evidence of record persuasively weighs against finding that the Veteran had a cardiac condition that began during active duty service, manifested within one year of separation, or was otherwise etiologically related to an in-service injury or event, to include due to toxic exposure.   

CONCLUSION OF LAW

The criteria for service connection for a cardiac condition have not been met.  38 U.S.C. §§ 1110, 1131, 5107(b); 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 in the United States Army from August 2004 to January 2008. 

This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2025 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).  

In the September 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 April 2025 rating decision on appeal.  38 C.F.R. § 20.301.  Any evidence submitted after the RO 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 claim[s], considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision. 

Context in this case is important:  The Board notes that the Veteran has been in receipt of a 90 percent total disability rating since October 2022.   

Service Connection

Generally, to prevail on a claim of service connection on the merits, there must be competent evidence of (1) a current disability, (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury, and (3) medical evidence or other competent evidence of a nexus between the claimed in-service disease or injury and the present disease or injury.  See Hickson v. West, 12 Vet. App. 247 (1999); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

The absence of any one element will result in the denial of service connection.  Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006).

Moreover, service connection may also be granted on the basis of a post-service initial diagnosis of a disease when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).

The Board notes the enactment of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022, also known as the Honoring our PACT Act of 2022 (hereinafter referred to as the PACT Act), which expands VA health care and benefits for Veterans exposed to burn pits or other toxic substances during military service.  As it pertains to this case, the PACT Act lists several diseases or illnesses that can be considered presumptively service-connected if a veteran was exposed to burn pits or other toxic substances during the Vietnam, Gulf War, and post 9/11 eras.  Veterans who were exposed to burn pits or toxic substances specifically during the Gulf War and post 9/11 eras are eligible for presumptive service connection if they have a current disability diagnosed as brain cancer, glioblastoma, respiratory cancer of any type, gastrointestinal cancer of any type, head cancer of any type, lymphoma of any type, lymphatic cancer of any type, neck cancer, pancreatic cancer, reproductive cancer of any type, kidney cancer, melanoma, asthma (diagnosed after service), chronic rhinitis, chronic sinusitis, constrict
 be considered presumptively service-connected if a veteran was exposed to burn pits or other toxic substances during the Vietnam, Gulf War, and post 9/11 eras.  Veterans who were exposed to burn pits or toxic substances specifically during the Gulf War and post 9/11 eras are eligible for presumptive service connection if they have a current disability diagnosed as brain cancer, glioblastoma, respiratory cancer of any type, gastrointestinal cancer of any type, head cancer of any type, lymphoma of any type, lymphatic cancer of any type, neck cancer, pancreatic cancer, reproductive cancer of any type, kidney cancer, melanoma, asthma (diagnosed after service), chronic rhinitis, chronic sinusitis, constrictive bronchiolitis or obliterative bronchiolitis, emphysema, granulomatous disease, interstitial lung disease (ILD), pleuritis, pulmonary fibrosis, sarcoidosis, chronic bronchitis, and chronic obstructive pulmonary disease (COPD).  See PACT Act, Pub. L. No. 117-168 § 3373, 136 Stat. 1759 (2022).

In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence.  Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007).  Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so.  Bryan v. West, 13 Vet. App. 482, 488-89 (2000).  In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so.  Owens v. Brown, 7 Vet. App. 429, 433 (1995).

Importantly, the Veteran bears the burden of presenting and supporting his claim for benefits.  See 38 U.S.C. § 5107(a).  In its evaluation, the Board considers all information and lay and medical evidence of record. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board gives the benefit of the doubt to the claimant. Id.; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Service connection for a cardiac condition 

The Veteran contends his cardiac condition, claimed as bradycardia with implanted cardiac pacemaker, is a result of his active service including toxic exposures due to burn pits and his job as a light wheel mechanic.  See December 2024 VA 21-526EZ, Fully Developed Claim (Compensation); December 2024 VA 21-4138 Statement In Support of Claim; September 2025 VA Form 10182 - Notice of Disagreement.  

Under the AMA, the Board is bound by favorable findings by the RO in the absence of evidence of clear and unmistakable error.  38 C.F.R. § 3.104 (c).  In the April 2025 rating decision, the RO made the following favorable findings:  (1) the Veteran has been diagnosed with a disability; the January 2025 VA examination confirmed a diagnosis of bradycardia with implanted cardiac pacemaker; and (2) participation in a toxic exposure risk activity is conceded. 

The Board notes that the Veteran's service treatment records (STRs) are silent as to any complaints, diagnoses, or treatment for any cardiac conditions.  

Notably, the Veteran's cardiac condition initially appears in the record in 2024, approximately 16 years after leaving service.  The post-service records show that the Veteran reported experiencing frequent lightheadedness and episodes of syncope.  A thorough evaluation revealed bradycardia as the underlying cause.  To address this, a transarterial pacemaker was implanted in September 2024.  See CAPRI Records.  

Additionally, the VA treatment records indicate that the Veteran is a current smoker and has been smoking for more than 15 years, but less than 30 years.  See August 2024 CAPRI Record.  

The Veteran underwent a VA examination for his condition in January 2025.  The examiner diagnosed bradycardia and implanted cardiac pacemaker and indicated that the Veteran reported feeling well with no recurrence of symptoms since his procedure in September 2024.  

The examiner opined that the Veteran's condition was
 of syncope.  A thorough evaluation revealed bradycardia as the underlying cause.  To address this, a transarterial pacemaker was implanted in September 2024.  See CAPRI Records.  

Additionally, the VA treatment records indicate that the Veteran is a current smoker and has been smoking for more than 15 years, but less than 30 years.  See August 2024 CAPRI Record.  

The Veteran underwent a VA examination for his condition in January 2025.  The examiner diagnosed bradycardia and implanted cardiac pacemaker and indicated that the Veteran reported feeling well with no recurrence of symptoms since his procedure in September 2024.  

The examiner opined that the Veteran's condition was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.  The examiner reasoned that the Veteran's enlistment exam and separation exam showed no findings related to the claimed condition; there is a lack of direct scientific evidence linking the specified military toxic exposures to bradycardia; there is a presence of alternative risk factors (heavy smoking and chronic alcohol use) that are well-documented contributors to autonomic and conduction abnormalities; and recent diagnostic testing showed an absence of structural or ischemic cardiac abnormalities.  Ultimately, the examiner found that while toxic exposures during military service cannot be entirely ruled out, the available evidence does not support a strong or direct causal relationship between these exposures and the development of bradycardia in this case.

In his statement in support of claim, the Veteran stated that he believes his cardiac condition was caused by exposure to PAHs and PCBs in the diesel fuels and other gases while working as a light wheel mechanic.  See December 2024 VA 21-4138 Statement In Support of Claim.  In support of his claim, the Veteran submitted an article titled "Heart Failure and PAHs, OHPAHs, and Trace Elements Levels in Human Serum: Results from a Preliminary Pilot Study in Greek Population and the Possible Impact of Air Pollution".  While this information has been considered, the Board finds it has little probative value.  The article speaks generally about cardiovascular diseases being associated with environmental pollutants but does not specifically address the Veteran's case and fails to address other causes, namely smoking and alcohol use.    

The Board finds the medical opinion from the January 2025 VA examination highly competent and probative.  The Veteran's history of smoking is clear.   

The Board also acknowledges the Veteran's lay statements and his belief that his cardiac condition was caused by his exposure during service.  While the Veteran is competent to report his symptoms, he is not a medical expert and is not competent to diagnose a cardiac condition or opine on its etiology.  Here, the best medical evidence does not support that his cardiac condition was caused by his in-service exposure, and this evidence cannot be ignored.   

Accordingly, the competent and probative evidence of record is not in approximate balance with regard to an in-service condition or nexus between his current cardiac condition and his service.  As such, the benefit of the doubt doctrine does not apply, and the Board concludes that service connection for a cardiac condition is not warranted.  See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

 

 

John J. Crowley

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. Murphy

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.