BVA9500916 DOCKET NO. 93-06 483 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in San Francisco, California THE ISSUE Entitlement to service connection for heart disease. REPRESENTATION Appellant represented by: California Department of Veterans Affairs WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD C.A. Skow, Associate Counsel INTRODUCTION The appellant served on active duty from October 1940 to November 1945 from January 1946 to January 1961. This matter came before the Board of Veterans' Appeals (the Board) on appeal from a May 1991 rating decision of the San Francisco, California, Department of Veterans Affairs Regional Office (VARO). CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that he sustained early manifestations of heart disease during service in 1955, although his condition was misdiagnosed as a gastrointestinal disorder because of unqualified medical personnel and inadequate testing procedures. DECISION OF THE BOARD The 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 entitlement to service connection for heart disease is not warranted. FINDINGS OF FACT 1. The appellant served on active duty from October 1940 to November 1945 and from January 1946 to January 1961. 2. Service medical records are negative for clinical findings or manifestation of organic heart disease although chest pain attributable to a gastrointestinal disorder was noted. 3. Post-service medical records reflect that the appellant was first diagnosed with heart disease in 1979, eighteen years after discharge; these records further reflect continued epigastric distress unrelated to the appellant's cardiac disorder. 4. There is no objective medical evidence of record to establish the presence of a chronic organic heart disease related to the appellant's period of service. CONCLUSION OF LAW Chronic heart disease is not shown to have been incurred in or aggravated by service. 38 U.S.C.A §§ 1101, 1110, 1112, 1113, 1131, 5107(a) (West 1991); 38 C.F.R. §§ 3.303, 3.307, 3.309 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board finds that the appellant has submitted evidence which is sufficient to justify a belief that his claim is well grounded. 38 U.S.C.A. § 5107(a) (West 1991) and Murphy v Derwinski, 1 Vet.App. 78 (1990). Furthermore, the undersigned believes that this case has been adequately developed for appellate purposes by VARO and that a disposition on the merits is in order. Background Service medical records are negative for complaints, findings, or manifestations of heart disease. Although these records reflect numerous complaints of chest pain, described by the appellant as a burning sensation which was relieved by drinking milk and occasionally belching, the appellant's condition was diagnosed as a gastrointestinal disorder, and a low fat, bland diet, was recommended. During the appellant's period of service, numerous chest x-ray and electrocardiographic studies were conducted. These studies revealed no abnormalities of the heart, and, on cardiovascular examinations, there were no murmurs or trills. However, in January 1958, an electrocardiographic study revealed paroxysmal tachycardia, an increased heart rate, clinically attributed to a mild anxiety disorder produced by new job stress. No abnormalities were shown on subsequent electrocardiographic studies performed in March and November 1960. Blood pressures recorded in service were below 150/90. Service medical records, including retirement physical examination in November 1960, reflect no evidence of a chronic organic heart disease. Post-discharge medical records dated 1977 to 1992 reflect treatment by the Army Medical Center for complaints of epigastric pain and arteriosclerotic heart disease. In December 1977 and again in November 1978, the appellant reported complaints for epigastric pain. The appellant was assessed with a hiatal hernia although it was not confirmed. In February 1979, when the appellant was examined again for complaints of epigastric pain, a 2-3 year history of indigestion was noted. At this time a treadmill stress test was performed. The appellant reported chest pain, and occasional premature ventricular contractions in the recovery period were noted. An Army inpatient treatment report dated March 1979 reflects that the appellant complained of nocturnal chest pain, but no symptoms of congestive heart failure or myocardial infarction were noted. By history, the appellant reported tobacco use during past 20 years, a positive heart disease risk factor; however, he indicated that he had stopped smoking one year prior. Clinical findings were negative for cardiomegaly, congestive heart failure, and abnormal sinus rhythm. A chest x-ray and electrocardiogram revealed no abnormalities. The appellant was diagnosed with arteriosclerotic heart disease with anginal syndrome and a triple coronary bypass was performed. Post- operatively the appellant did well with no chest pains, congestive heart failure, or palpitations, and normal heart size and sinus rhythm were noted. On subsequent Army outpatient treatment notes dated September and December 1979 and January 1980, the appellant was reported to experience indigestion which was relieved with a bland diet and Mylanta; this condition was noted to be unrelated to the recent triple bypass surgery. Additionally, in an Army outpatient treatment report dated January 1980, it was indicated that a relationship between the appellant's epigastric pain and his heart conditions was unlikely, noting that the appellant experienced "gas" related to specific foods, such as spicy and fried foods. Army inpatient treatment record dated November 1990 reflects that the appellant sought treatment for epigastric pain. The appellant was noted to have a history of coronary artery disease dating back to 1979 with unstable angina. At this time, he was diagnosed again with coronary arteriosclerosis, and underwent a second coronary bypass in December 1990. In June 1992, a personal hearing was conducted at VARO. The appellant testified that he was first treated for chest pain in 1955, during service, which was diagnosed as gastritis. He reported that his chest pain continued throughout service and had required hospitalization. The appellant argued that his chest pain in service represents the onset of his heart disorder because the type of pain he experienced during service was the same as that experienced in 1987 and 1990 when he was diagnosed with a heart disorder. The appellant further argued that his symptoms were misconstrued as a gastrointestinal disorder because of inadequate diagnostic procedures in existence or available during his period of service. The appellant indicated that he had not received treatment between 1961 and 1979 although he had continued to experience chest pain. He acknowledge that he was first diagnosed with heart disease in 1979. Analysis The appellant seeks service connection for heart disease. Service-connection may be granted for a disability resulting from disease or injury incurred in or aggravated while on active duty. 38 U.S.C.A. §§ 1110, 1131 (West 1991). Furthermore, in the case of any disease diagnosed after discharge, service-connection may be granted when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (1993). Service-connection is presumed if a veteran manifests a chronic disease, such as organic heart disease, to a degree of at least 10 percent within one year after separation from service. 38 U.S.C.A. § 1112 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1993). In weighing the evidence of record, the Board finds that the objective evidence of record does not establish a relationship between the presence of heart disease first noted many years after discharge from service, and the episodes of epigastric and chest pains noted in service. While numerous service medical records reflect that the appellant was treated for chest pains, described on one occasion as a burning sensation which was relieved by drinking milk and occasionally belching, there are no clinical findings relating the appellant's heart disease first found in March 1979 to the episodes of epigastric pain in service. The Board acknowledges the appellant's contentions with respect to the relationship between the presence of heart disease post service and the episodes of chest pain in service. Cartright v. Derwinski, 2 Vet.App. 24 (1991). However, the Board may not accept unsupported lay speculation with regard to medical issues. See Espiritu v. Derwinski, 2 Vet.App. 482 (1992). Furthermore, in light of service medical records which show that appropriate studies were conducted to determine the nature of the appellant's epigastric distress, including cardiovascular studies such as electrocardiograms, blood pressure reading, and chest x-rays, the Board finds that the appellant was adequately examined during service and that the weight of evidence does not suggest he was improperly diagnosed. In view of the above, the Board concludes that the evidence of record does not establish a relationship between the presence of heart disease after discharge and the episodes of epigastric pain in service. As such, a chronic cardiac disability has not been shown to have been present in service. ORDER Service connection for heart disease is denied. C.P. RUSSELL 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.