Citation Nr: 18131202
Decision Date: 08/31/18	Archive Date: 08/31/18

DOCKET NO. 16-07 233
DATE:	August 31, 2018
ORDER
1. Entitlement to service connection for a breathing disability is denied.
2. Entitlement to service connection for residuals of a pacemaker, to include an abnormal heartbeat, is denied.
3. Entitlement to service connection for anxiety disorder is denied.
FINDINGS OF FACT
1. The preponderance of the evidence of record is against a finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of a breathing disability.
2. The preponderance of the evidence is against a finding that the Veteran’s for residuals of a pacemaker, to include an abnormal heartbeat, was incurred in or otherwise related to service.
3. The preponderance of the evidence is against a finding that the Veteran’s anxiety disorder was incurred in or otherwise related to service.
CONCLUSIONS OF LAW
1. The criteria for service connection for a breathing disability are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a).
2. The criteria for service connection for residuals of a pacemaker, to include an abnormal heartbeat, are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a).
3. The criteria for service connection for anxiety disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran served on active duty in the United States Navy from February 1964 to February 1966 and the United States Coast Guard from September 1969 to March 1970. 
In the May 2013 VA Form 9, the Veteran requested a Board hearing. The Board scheduled the Veteran for a hearing in August 2016, however the Veteran failed to appear for this hearing. The Veteran has not supplied good cause or any explanation for his failure to appear for the hearing, therefore the request for a Board hearing is deemed withdrawn. 38 C.F.R. § 20.702.
Service Connection
Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service.  See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.  Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).
When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.
1. Entitlement to service connection for a breathing disability.
The question for the Board in this case is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease or is caused or aggravated by a service-connected disability.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. In order for service connection to be established, there needs to be competent evidence of a current disability.
The Board concludes that the Veteran does not have a current diagnosis of a breathing disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim.  38 U.S.C. §§ 1110, 1131, 5107(b), 38 C.F.R. § 3.303(a), (d).
Despite consistent treatment from February 2006 to October 2015, private treatment records do not contain a diagnosis of a breathing disability. The Board notes that the Veteran has experience symptoms of shortness of breath, however the Veteran and his examiners have attributed this symptom to his anxiety disorder and panic attacks. For example, in a January 2009 private medical record, at Anchor Hospital, the Veteran indicated that his shortness of breath is associated with panic attacks. Accordingly, the Veteran’s symptoms related to his shortness of breath do not constitute a diagnosis of a breathing disability, as this symptom has been attributed to another disability. 
The Board also notes an October 2015 private medical record submitted by the Veteran indicates preliminary impressions of emphysematous cystic changes in the right lung and a nodule of the right upper lobe favored to represent a post inflammatory nodule or granuloma. The record indicates that further evaluation is recommended. The Board finds that this record does not indicate a final diagnosis for any lung condition, as the section is labeled “impression” and recommends additional follow up. Accordingly, this document does not constitute evidence of a diagnosis of a breathing disability. 
While the Veteran believes he has a current diagnosis of a breathing disability, he is not competent to provide a diagnosis in this case.  The issue is medically complex, as it requires specialized medical education.  Consequently, the Board gives more probative weight to the competent medical evidence.
In sum, without competent evidence of a current disability, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for a breathing disability, and the claim is denied.
2. Entitlement to service connection for residuals of a pacemaker, to include an abnormal heartbeat.
The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for residuals of a pacemaker. The reasons follow.
The Veteran received a pacemaker via surgery in 2009, and thus there is evidence of a current disability. The Veteran contends that an abnormal heart rate resulted from service, which necessitated the use of a pacemaker. Alternatively, the Veteran contends that an abnormal heart rate resulted from a service incurred breathing disability or from a service incurred anxiety disorder.
However, as to service incurrence, the Veteran’s claim fails on both the in-service disease or injury and the nexus to service. The service treatment records (STRs) show that the Veteran was found to have clinically normal assessments of his heart, including rhythm and sounds, in November 1963, February 1964, February 1966, August 1969, and February 1970. Furthermore, although not directly related, the Veteran also denied a history of pounding heart or palpitations in November 1963, February 1964, and August 1969. The Veteran’s clinically normal assessments of his heart throughout service is evidence against a finding that he had an abnormal heartbeat in service.
As to a nexus to service, private medical records indicate that the Veteran’s pacemaker was surgically installed in 2009, which is approximately 29 years following service discharge, and tends to establish that an abnormal heartbeat did not have its onset in service. 
To the extent that the Veteran had implied that an abnormal heartbeat had its onset in service, his service treatment records refute such a finding. The Board accords high probative value to these reports by the Veteran, as he completed these forms contemporaneously with service. 
The Veteran is not medically trained and is therefore not qualified to competently opine about medical etiology. Although the Veteran claims that his pacemaker residuals are related his service, it is well established that a layperson without medical training is not qualified to render medical opinions regarding the etiology of certain disorders and disabilities. 38 C.F.R. § 3.159(a)(1). In certain instances, lay testimony may be competent to establish medical etiology or nexus. However, abnormal heartbeats require specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. The origin or cause of the Veteran’s abnormal heartbeat is not a simple question that can be determined based on mere personal observation by a lay person, the Veteran’s lay assertion is not competent to establish a nexus.
The Board notes that the Veteran is not service connected for a breathing disability or for an anxiety disorder, and thus is not entitled to secondary service connection on the basis of these disabilities.
In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for residuals of a pacemaker, to include an abnormal heartbeat. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence.
3. Entitlement to service connection for anxiety disorder.
The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for anxiety disorder. The reasons follow.
The STRs show that the Veteran was found to have clinically normal psychiatric assessments in November 1963, February 1964, February 1966, August 1969, and February 1970. Furthermore, the Veteran also denied a history of “depression or excessive worry” and “nervous trouble of any sort” in November 1963, February 1964, and August 1969. The Veteran’s clinically normal psychiatric assessments, and denial of symptoms related to depression, excessive worry, and nervous trouble of any sort throughout service is evidence against a finding that he had an anxiety disorder in service.
As to a nexus to service, in a January 2013 private treatment record at the Anchor Hospital, the Veteran stated that his anxiety was due to an increased workload at his employment. This evidence establishes that anxiety disorder did not have its onset in service. 
The Veteran’s contention that his anxiety disorder was incurred in service is outweighed by the probative value of Veteran’s medical records. Here, the record from January 2013 establishes, based on the Veteran’s own report, that his anxiety was due to his post-service employment, and outweigh the Veteran’s contention that he incurred anxiety disorder due to service. Additionally, despite the fact that the private treatment record took place approximately four years after the Veteran’s application for benefits, he does not mention to his treatment provider his contention that his anxiety disorder is due to service.
The Veteran’s statement to his treating clinician is also more reliable as motivated by a desire for accurate medical treatment. It is sufficient for the Board to conclude that the credibility of the Veteran’s contention of in-service incurrence of anxiety disorder is substantially impeached by his contradicting statement and by medical findings of record.
To the extent that the Veteran had implied that anxiety disorder had its onset in service, his service treatment records refute such a finding. To the extent that the Veteran has implied that anxiety disorder is otherwise related to service, his allegation is outweighed by the January 2013 private treatment record, in which the Veteran states that he incurred anxiety disorder after service.
The Veteran is not medically trained and is therefore not qualified to competently opine about medical etiology. Although the Veteran claims that his anxiety disorder is related his service, it is well established that a layperson without medical training is not qualified to render medical opinions regarding the etiology of certain disorders and disabilities. 38 C.F.R. § 3.159(a)(1). In certain instances, lay testimony may be competent to establish medical etiology or nexus. However, anxiety disorders require specialized training for determinations as to diagnosis and causation, and is therefore, not susceptible to lay opinions on etiology. The origin or cause of the Veteran’s anxiety disorder is not a simple question that can be determined based on mere personal observation by a lay person, the Veteran’s lay assertion is not competent to establish a nexus.
In sum, the Board concludes that the preponderance of the evidence of record is against the Veteran’s claim for service connection for anxiety disorder. The benefit-of-the-doubt doctrine enunciated in 38 U.S.C. § 5107(b) is not applicable, as there is no approximate balance of evidence.
 
 
A. P. SIMPSON
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	R. Husain, Associate Counsel 

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

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