Citation Nr: 0005440 Decision Date: 02/29/00 Archive Date: 03/07/00 DOCKET NO. 98-14 788 ) DATE ) ) On appeal from the Department of Veterans Affairs Medical and Regional Office Center in Wichita, Kansas THE ISSUE Entitlement to service connection for mitral valve disability. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD J. W. Loeb, Counsel INTRODUCTION The veteran served on active duty from October 1965 to October 1967, from January 1974 to February 1975, and from July 1978 to March 1991. This matter is before the Board of Veterans' Appeals (Board) on appeal from an October 1997 rating decision by the Department of Veterans Affairs (VA) Medical and Regional Office Center (M&ROC) in Wichita, Kansas. Since the veteran indicated in his September 1998 substantive appeal that the only issue that he wished to appeal was the denial of entitlement to service connection for mitral valve disability, the Board has limited its decision accordingly. FINDINGS OF FACT 1. All available evidence necessary for an equitable disposition of the appeal has been obtained. 2. Chronic mitral valve disability was present in service; it was not found on entrance examination and it did not clearly and unmistakably exist prior to service. CONCLUSION OF LAW Mitral valve disability was incurred in active duty. 38 U.S.C.A. §§ 1110, 1111, 1131, 1137, 5107(a) (West 1991); 38 C.F.R. § § 3.303, 3.304 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board has found the veteran's claim to be well grounded and is satisfied that all available evidence necessary for an equitable disposition of the appeal has been obtained. Service connection is granted for disability resulting from disease or injury incurred in or aggravated by active duty. 38 U.S.C.A. § § 1110, 1131 (West 1991); 38 C.F.R. § 3.303 (1999). Every veteran shall be taken to have been in sound condition when examined, accepted and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C.A. §§ 1111, 1137 (West 1991); 38 C.F.R. § 3.304 (1999). The veteran's service medical records reveal complaints of chest pain in April 1978, and examination revealed a mid systolic murmur, grade III/VI, with no previous history of murmur. An electrocardiogram (EKG) was normal in November 1978. Probable mitral valve regurgitation was the examiner's impression in February 1985. Subsequent service medical records continued to note a systolic murmur. An EKG in February 1988 was described as probably normal, with large precordial QRS voltages noticed. An EKG was considered borderline in July 1990. The veteran reported on his final discharge medical history report in January 1991 shortness of breath, chest pain, and heart trouble; mitral valve regurgitation was noted in the physician's summary section on the back of the form. According to the examination report in January 1991, the veteran's heart was normal; a Chest X-ray and an EKG were also considered normal. Emergency Clinic records for May and June 1997 reveal that the veteran was seen for chest pain in June 1997; an EKG showed sinus bradycardia with sinus arrhythmia. According to June 1997 records from St. Francis Hospital, a Doppler echocardiogram showed mitral valve prolapse with probable severe mitral insufficiency. It was thought that the veteran would need mitral valve surgery. On VA general medical examination in September 1997, it was noted that the veteran had a blowing holosystolic murmur with radiation to the neck vessels. The diagnoses included mitral prolapse, scheduled for surgery. A September 1997 EKG was considered borderline. July to December 1997 medical records from James W. Dammon, Jr., M.D., reveal that the veteran had severe mitral regurgitation of unknown etiology in July 1997. The veteran underwent mitral valve replacement in November 1997. Dr. Dammon stated in December 1997 that he doubted that the veteran's military service either caused or aggravated the veteran's mitral valve disease and that a history from the veteran's referring cardiologist and the veteran himself indicated that the veteran had mitral regurgitation since at least 1984. According to a July 1998 medical report from Gary B. Wood, M.D., a medical consultant who reviewed the veteran's claims file, the veteran's mitral valve prolapse was an inborn abnormality that slowly produced mitral valve deterioration unrelated to any other health factors. Dr. Woods concluded that military service neither caused nor accelerated the veteran's mitral valve disease. Dr. Wood also noted that the awareness of various examiners that the veteran's variable cardiac murmur between 1978 and 1991 could be due to mitral valve prolapse was not positively proven until signs and symptoms required further diagnostic testing in 1997. The foregoing evidence demonstrates that the veteran manifested mitral valve disease during service. This disease was not found on service entrance examination. Although the record contains medical evidence indicating that the disease existed prior to service, Dr. Woods did not express an opinion that the disorder clearly and unmistakably existed prior to service and no other medical opinion to this effect is of record. Moreover, the service medical records for the veteran's first two periods of active duty are negative for mitral valve disease. Therefore, the Board has concluded that the presumption of soundness has not been rebutted and the veteran is entitled to service connection for this disability on the basis of service incurrence. ORDER Service connection for mitral valve disability is granted. SHANE A. DURKIN Member, Board of Veterans' Appeals