BVA9500649 DOCKET NO. 93-15 661 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUE Entitlement to service connection for the cause of the veteran's death. REPRESENTATION Appellant represented by: AMVETS WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J. A. McDonald, Associate Counsel CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that service connection for the cause of the veteran's death is warranted as the veteran's heart disease and hypertension were first shown in service. It is also contended that the veteran's medications for ancillary disorders masked the symptoms of hypertension. DECISION OF THE BOARD The Board of Veterans' Appeals (hereinafter Board), in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the evidence supports the claim of entitlement to service connection for the cause of the veteran's death. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the Department of Veterans Affairs Regional Office in Columbia, South Carolina (hereinafter RO). 2. The veteran died in July 1991 of acute and remote myocardial infarction, due to hypertensive arteriosclerotic cardiovascular disease. Other significant conditions contributing to death, but not resulting in the underlying cause were chronic obstructive pulmonary disorder, diabetes, and cigarette smoking. An autopsy was not performed. 3. The veteran served on active duty from February 1951 to May 1971. At the time of his death, he was service-connected for post-operative residuals hiatal hernioplasty with vagotomy, gastrostomy, and pyloroplasty, rated as 10 percent disabling; residuals of a hemorrhoidectomy, assigned a noncompensable evaluation; and insomnia, assigned a noncompensable evaluation. 4. While in service, the veteran had intermittent high blood pressure readings indicative of hypertension, abnormal or questionable electrocardiograms, and chest pains. 5. The veteran's fatal myocardial infarction was caused by or the result of the veteran's arteriosclerotic heart disease, the origin of which can be traced to his active military service. 6. A disability of service origin contributed substantially or materially to the veteran's death. CONCLUSIONS OF LAW 1. Arteriosclerotic heart disease was incurred in active military service. 38 U.S.C.A. §§ 1110, 1131, 5107 (West 1991). 2. The veteran's death was caused or contributed to by a disability incurred in or aggravated by active service. 38 U.S.C.A. §§ 1310, 5107 (West 1991); 38 C.F.R. § 3.312 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION Upon review of the record, the Board concludes that the appellant's claim is well-grounded within the meaning of the statute and judicial construction. Murphy v. Derwinski, 1 Vet.App. 78, 81 (1990); 38 U.S.C.A. § 5107(a). The Department of Veterans Affairs (hereinafter VA) therefore has a duty to assist the appellant in the development of facts pertinent to her claim. In this regard, we note that the veteran's service medical records, post-service private clinical data, and VA outpatient, hospitalization, and examination reports have been included in his file. Upon review of the entire record, the Board concludes that the data currently of record provide a sufficient basis upon which to address the merits of the appellant's claim and that she has been adequately assisted in the development of her case. The law provides that service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110; 38 C.F.R. 3.303. In addition, service connection may be granted for any disease diagnosed after discharge, 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 veteran's service medical records show elevated blood pressure readings on service entrance in February 1951 of 140/90 sitting and 150/100 standing. A reading of 130/85 was shown when the veteran was recumbent. However, there were no findings of cardiovascular disease or hypertension. The veteran complained of pain in the cardiac region, with vertigo on exertion in February 1951 noted to have existed prior to service. However, the records in March 1951, indicate no previous history of heart disease or other disease which might have caused cardiac damage. The physical examination revealed moderate tachycardia, with the first sound accentuated. Exopthalmos or thyroid enlargement were not found. There were no murmurs or arrhythmia. No findings or diagnosis of a heart disorder were made. Blood pressure readings were 122/80, 124/88, and 130/90, in March 1954, November 1954, and January 1955, respectively. Blood pressure readings in 1956 and 1958, were 120/80. A blood pressure reading in July 1963 was 140/98. Blood pressure readings in 1964 were 120/80, 130/80, and 130/70. In January 1966, the veteran's blood pressure reading was 130/90. An electrocardiogram was performed in June 1966. The findings were questionable and the electrocardiogram was repeated. On retest, a positive deflection without negative deflection was found. This was noted as "probably a normal variant." The impression was "probably a normal EKG." On physical examination in June 1966, a blood pressure reading was 130/80. In September 1966, the veteran presented with chest pains and chills. His blood pressure reading was 164/120. Later that month the veteran was treated for an upper respiratory infection. His blood pressure reading was 136/94. In 1967, a blood pressure reading was 120/84. A medical record in August 1970, noted that the veteran had been seen on several occasions on an outpatient basis complaining of chest pain, which, at the time, had been attributed to costal chondritis. It was noted that the veteran's electrocardiograms had shown abnormal ventricular depolarization compatible with and incomplete right bundle branch pattern. The veteran's retirement examination did not find cardiovascular disease or note hypertension. The blood pressure reading was 128/86. Medical records subsequent to service, from September 1971 to March 1975, are absent for complaints or findings of high blood pressure or a heart disorder. Thereafter, an electrocardiogram in April 1975, noted a counterclockwise precordial rotation and a residual inferior wall myocardial infarction. Medical reports from May to September 1975, reported the veteran was on high blood pressure medicine but continued to have elevated blood pressure readings. In a letter to the VA in 1976, the appellant stated that the veteran had heart disease. Medical records beginning in 1978, report arteriosclerotic heart disease and hypertension. The records indicate the veteran continued to have intermittent high blood pressure readings. An electrocardiogram in December 1982, found normal sinus rhythm with a horizontal heart and an old inferior wall myocardial infarction. Elevated blood pressure readings of 156/96, 146/94, 150/98, and 152/96 were seen in 1989. High blood pressure readings were also reported in 1990 and 1991. The veteran died in July 1991, of acute and remote myocardial infarction due to hypertensive arteriosclerotic cardiovascular disease. Other significant conditions contributing to death but not resulting in the underlying cause, were chronic obstructive pulmonary disorder, diabetes, and cigarette smoking. An autopsy was not performed. The appellant testified at a personal hearing before the RO in November 1992. The appellant stated that the veteran first had high blood pressure when he returned from a tour of duty in Vietnam in 1969. She stated that the veteran's digestive disorders interfered with his treatment for his cardiovascular disease, diabetes, and respiratory disorders. She reported that the veteran had a severe heart attack in approximately 1979. The appellant additionally testified before the Board in September 1993. At that time, she testified that while he was in service, the veteran had been told he had hypertension. It is the defined and consistently applied policy of the VA to administer the law under a broad interpretation; consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, such doubt will be resolved in favor of the appellant. 38 U.S.C.A. § 5107(b). In the instant case, on service entrance, elevated blood pressure readings were recorded, however no findings of cardiovascular disease or hypertension were found. Within a month of service entrance, the veteran complained of dizziness and chest pain on exertion. It was noted that this existed prior to service entrance; however, no previous history of heart disease or other disease which might have caused cardiac damage was indicated. A physical examination at that time revealed moderate tachycardia. Blood pressure readings indicative of hypertension were shown in January 1955, July 1963, January 1966, and September 1966, with borderline readings throughout the veteran's military service. Furthermore, the veteran complained of chest pains on numerous occasions, and electrocardiograms conducted while in service were either questionable or abnormal. Treatment records after service show no complaints or recorded findings of hypertension or heart disease until 1975, at which time a residual inferior wall myocardial infarction was demonstrated and the veteran was noted to be on high blood pressure medication. The evidence of record first documents arteriosclerotic heart disease and hypertension in 1978; arteriosclerotic heart disease and hypertension have consistently been shown in the medical records subsequent to that time. Here, the record indicates the veteran was hypertensive entering service, and occasionally during service exhibited elevated blood pressure. However, the readings in service were not inconsistent with the level of hypertension entering service, and cannot be deemed indicative of aggravation. However, there were findings in service, which can be viewed in light of the entire record, as the initial manifestations of arteriosclerotic heart disease. He complained of chest pain on occasion and electrocardiograms conducted in service on several occasions were either questionable or abnormal. By 1975 electrocardiograms were being read as indicative of a residual inferior wall myocardial infarction, and those tracings were similar to those made in service. The evidence can reasonably be read as showing that the initial manifestations of arteriosclerotic heart disease which led to myocardial infarctions and eventually the veteran's death began during his extended period of active service. Consequently, service connection for cause of the veteran's death is warranted. ORDER Service connection for the cause of the veteran's death is granted. E. W. SEERY Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.