Back to BVA DecisionsGRANTEDSpecial Benefit NO SPECIAL BENEFIT Docket No. 210420-154519
CARDIOMYOPATHY
M. SORISIO · 2026 · Case ID: A26037692
Summary
The Veteran, a veteran who served from June 1989 to June 1993, appeals the denial of service connection for a heart condition, claiming it is secondary to his service-connected PTSD or caused by toxic exposure risk activities (TERA). The Board found that the Veteran has a current heart condition, including cardiomyopathy and congestive heart failure (CHF), for which he underwent a heart transplant in 2012. Service connection for PTSD was previously established in June 2007. The key issue was whether the PTSD caused or aggravated the heart condition. A private medical opinion from Dr. M.S. in March 2025 concluded that the Veteran's PTSD caused his coronary artery disease (CAD), which in turn caused his CHF. Dr. M.S. supported this opinion with medical literature indicating that anxiety and PTSD increase the risk of CAD and are associated with cardiac mortality. While a VA treatment record noted a maternal grandfather with premature CAD, Dr. M.S.'s opinion was deemed persuasive by the Board due to its rationale and supporting literature, despite this minor discrepancy. The Board found the evidence weighed in favor of secondary service connection, granting the claim.
Rationale
Current disability established (cardiomyopathy, CHF, heart transplant); Service-connected PTSD established; Private medical opinion from Dr. M.S. found PTSD caused CAD, which caused CHF; Opinion supported by medical literature linking anxiety/PTSD to CAD risk; Board found opinion persuasive despite minor discrepancy in family history
Full Decision Text
Citation Nr: A26037692 Decision Date: 04/22/26 Archive Date: 04/22/26 DOCKET NO. 210420-154519 DATE: April 22, 2026 ORDER Service connection for a heart condition is granted. FINDING OF FACT The evidence is in approximate balance with respect to whether the Veteran's heart condition is secondary to his service-connected posttraumatic stress disorder (PTSD). CONCLUSION OF LAW The criteria for service connection for a heart condition have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1989 to June 1993. In the April 20, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on February 25, 2025. Therefore, the Board may only consider the evidence of record at the time of the November 2020 Agency of Original Jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his attorney at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. The Veteran filed a claim seeking service connection for cardiomyopathy. As the record reflects additional diagnoses, including congestive heart failure (CHF), coronary artery disease (CAD), and heart transplant, the Board has recharacterized the issue to ensure all heart conditions are considered. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Lastly, in the November 2020 rating decision on appeal, the AOJ found new and relevant evidence had been submitted to warrant readjudication of the claim. The Board is bound by this favorable finding and will not further address the matter of whether new and relevant evidence has been submitted. See 38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c). Service connection for a heart condition is granted. The Veteran contends that he is entitled to service connection for a heart condition. Specifically, he alleges that his heart condition is secondary to his service-connected PTSD or, alternatively, is caused by toxic exposure risk activities (TERA). As service connection is being awarded on a secondary causation basis, the Board will not further discuss other theories of entitlement. Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists, (2) that there is an already service-connected disability, and (3) that there is "but for" causation or aggravation of the disability for which service connection is sought by a service-connected disability. See Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and holding "but for" causation or aggravation is enough to show entitlement to secondary service connection). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the claimant prevailing in either event, or whether the weight of the evidence is persuasively against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). When there is an approximate balance of positive and negative evidence regarding any issue 3 (Fed. Cir. 2023) (invalidating the requirement of "proximate cause" and holding "but for" causation or aggravation is enough to show entitlement to secondary service connection). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the claimant prevailing in either event, or whether the weight of the evidence is persuasively against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. In the November 2020 rating decision on appeal, the AOJ favorably found the Veteran has a current disability, as VA treatment records show he has been diagnosed with cardiomyopathy and CHF, and that he underwent a heart transplant in January 2012. The Board is bound by this favorable finding. See 38 U.S.C. § 5104A; 38 C.F.R. § 3.104(c). In addition, the record reflects that the Veteran was hospitalized in 2006 for CAD. Thus, the first element of secondary service connection has been established. Regarding the second element, the record reflects that the Veteran was awarded service connection for PTSD in a June 2007 rating decision. Therefore, the second element of secondary service connection has also been established. The remaining issue is whether the service-connected PTSD caused or aggravated the Veteran's heart condition. An April 2019 VA treatment record includes a note that the Veteran's nonischemic cardiomyopathy was diagnosed in 2006 and "thought to be due to viral etiology." However, it was also noted that the exact cause was unclear. In March 2025, the Veteran submitted a private opinion from Dr. M.S. In the opinion, Dr. M.S. opined that the Veteran's PTSD caused his CAD, which caused his CHF. Dr. M.S. noted that he had conducted an interview with the Veteran and had reviewed his medical records and lay statements, which show the Veteran has a negative family history for CAD and a negative smoking history, that he was diagnosed with CHF in 2006 and underwent a heart transplant in 2012, that he reported experiencing symptoms of PTSD for a significant period of time prior to his diagnosis, and that his medical history is negative for any other conditions that can cause CAD and CHF. Dr. M.S. then indicated that PTSD can cause CAD, and that it is well-settled medical principle that CAD is a major cause of CHF. He referenced medical literature in support of this opinion, including an article in which researchers found anxiety and PTSD increases the risk of the incidence of CAD and is associated with cardiac mortality; an article in the American Heart Journal which reports that the risk attributable to anxiety disorders, PTSD, and depression is similar in magnitude to other major established risk factors for CAD such as diabetes and smoking; and an article in the Journal of American College of Cardiology which found anxiety disorders, including PTSD, are predictive of CAD events later in life and that early-onset anxiety is a risk factor for CAD in men. After review, the Board concludes that the evidence weighs in favor of finding that the Veteran's heart condition is secondary to his service-connected PTSD. The Board finds the medical opinion provided by Dr. M.S. persuasive and places great probative weight on it as it is supported by medical literature. Although Dr. M.S. indicated that the Veteran does not have a family history of CAD, while an October 2019 VA treatment record shows he reported that his maternal grandfather had premature CAD, the opinion and supporting medical literature adequately explain how the Veteran's PTSD caused his heart condition. Thus, while the opinion is not flawless, the opinion has a clear conclusion and rationale and serves to link the claimed heart condition to the service-connected PTSD. As the only medical opinion of record with significant probative value indicates that the Veteran's heart condition is secondary to his service-connected PTSD, the Board finds service connection is warranted. Accordingly, the claim is granted. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.J. 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. with significant probative value indicates that the Veteran's heart condition is secondary to his service-connected PTSD, the Board finds service connection is warranted. Accordingly, the claim is granted. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.J. 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.