Citation Nr: 18131252
Decision Date: 08/31/18	Archive Date: 08/31/18

DOCKET NO. 15-40 457
DATE:	August 31, 2018
ORDER
Entitlement to service connection for cardiomyopathy as secondary to service-connected premature ventricular contractions (PVCs) with arrhythmia is granted.
FINDING OF FACT
Resolving reasonable doubt in the Appellant’s favor, the Veteran’s cardiomyopathy was proximately due to his service-connected PVCs with arrhythmia.  
CONCLUSION OF LAW
The criteria for secondary service connection for cardiomyopathy are met.  38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 
REASONS AND BASES FOR FINDING AND CONCLUSION
The Veteran served on active duty from September 1971 to December 1975.  Unfortunately, the Veteran died in October 2016, during the pendency of the appeal.  In October 2016, the Appellant filed a VA Form 21-534EZ, Application for DIC, Death Pension, and/or Accrued Benefits.  In December 2016, the Board dismissed the Veteran’s appeal due to lack of jurisdiction after his death, and referred the Appellant’s claim for substitution.  The Appellant was recognized as the Veteran’s surviving spouse and the substitute claimant for the Veteran in this matter in February 2017.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).  The Veteran and the Appellant testified before the undersigned Veterans Law Judge (VLJ) at a hearing in July 2016.  A transcript of that hearing is of record.  
1. Entitlement to service connection for cardiomyopathy as secondary to service-connected premature ventricular contractions (PVCs) with arrhythmia
The Appellant contends that the Veteran’s cardiomyopathy was at least as likely as not proximately due to his service-connected PVCs with arrhythmia.
Neither the Appellant nor the Veteran has argued, and the record does not reflect, that the cardiomyopathy was incurred in service or caused by an in-service event other than the service-connected PVCs.  Therefore, the Board finds that service connection for cardiomyopathy on a direct-incurrence basis is not warranted, and will focus on service connection as secondary to the service-connected PVCs with arrhythmia.  
A disability may be service connected on a secondary basis if it is proximately due to or the result of a service-connected disease or injury; or, if it is aggravated beyond its natural progress by a service-connected disease or injury.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310(a), (b).
A September 2010 VA examination found that the Veteran’s cardiomyopathy was unrelated to service associated multiple VPBs (ventricular premature beats), which appears to be a reference to PVCs.  The rationale was that the VPBs were diagnosed and treated in service, and the cardiomyopathy was not diagnosed or treated in service and hence are not service connected.  The examiner alluded generally to his medical education and personal knowledge from clinical practice, as well as current medical literature.  This rationale does not explain why the service-connected VPBs or PVCs with arrhythmia that persisted after the Veteran left service did not cause or aggravate the Veteran’s cardiomyopathy.  A June 2015 VA supplemental medical opinion provided a negative opinion stating that the Veteran’s cardiomyopathy was less likely than not caused by service.  The rationale consisted of three conclusory statements that the VPCs, which appear to be a reference to the service-connected PVCs with arrhythmia, did not cause structural or functional heart disease, the nonischemic cardiomyopathy was not caused by the VPCs, and the ischemic cardiomyopathy was not caused by the VPCs.  The examiner also included a brief summary of the Veteran’s medical history.  The examiner’s conclusory statements are inadequate rationale because they do not include a reasoned medical explanation connecting the examiner’s clear conclusions with supporting data.  See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).  Moreover, the June 2015 opinion was a direct-incurrence opinion, not the secondary service connection opinion that is required, and none of the VA examinations of record provide an opinion as to whether the PVCs aggravated the Veteran’s cardiomyopathy, address the medical articles supplied by the Veteran discussing the connection between PVCs and cardiomyopathy, or address the Veteran’s own hearing testimony as a cardiologist that he believes his cardiomyopathy is at least as likely as not caused by the PVCs.  Therefore, the negative VA medical opinions are inadequate.
In the Veteran’s July 2016 hearing, he testified that he was a cardiologist, briefly outlined his medical training, and explained that it was his medical opinion that his cardiomyopathy was at least as likely as not proximately due to his service-connected PVCs with arrhythmia.  He pointed to several articles that he had submitted discussing the relationship between PVCs and cardiomyopathy as supporting his opinion, and asserted that he believed that the Journal of the American College of Cardiology, which published one of the articles that he had submitted, was one of the most reputable journals in the cardiology field.  Although the Veteran conceded that his nonservice-connected hypertension and diabetes mellitus could not be excluded as potential causes of his cardiomyopathy, he asserted that his hypertension was well-controlled and, based upon the correlation between PVCs and the subsequent development of cardiomyopathy set forth in the research, he believed that it was at least as likely as not that his cardiomyopathy was proximately due to the service-connected PVCs.  As the record reflects that the Veteran was a cardiologist, he had specialized medical training and was thus competent to provide an opinion on the medically complex issue of the etiology of his cardiomyopathy.  
The Board notes that a July 2016 VA treatment record notes that the Veteran is known to have non-ischemic cardiomyopathy that is thought to be secondary to frequent PVCs, and states in the assessment that the Veteran’s cardiomyopathy is of mixed etiology (ischemic and PVC related).  Although this treatment note does not include a rationale, and is somewhat unclear regarding whether the Veteran’s cardiomyopathy was ischemic or non-ischemic, the Board recognizes that the Veteran’s VA treating physician appears to have agreed with the Veteran’s assessment regarding the etiology of his cardiomyopathy.  The Board concludes that the Veteran’s competent medical opinion as discussed in his hearing testimony, which referenced several specific medical articles, and was recognized by his treating physician, is of at least equal probative value as the conclusory and inadequate VA medical opinions of record.  
As the most probative evidence of record is in favor of finding that the Veteran’s cardiomyopathy was proximately due to his service-connected PVCs with arrhythmia, the Board finds in favor of the Appellant and grants the claim of entitlement to service connection for cardiomyopathy as secondary to service-connected PVCs with arrhythmia.  

 
U. R. POWELL
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Budd, Counsel 

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