BVA9501610 DOCKET NO. 93-06 752 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in New Orleans, Louisiana THE ISSUE Entitlement to service connection for cause of death. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Nancy R. Kegerreis, Associate Counsel INTRODUCTION The veteran served on active duty from June 1944 to February 1946. He died on August [redacted] 1992. This matter comes before the Board of Veterans' Appeals (Board) from a November 1992 rating decision by the Department of Veterans' Affairs (VA) Regional Office (RO) in New Orleans, Louisiana, which denied service connection for the cause of the veteran's death. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends, in essence, that the RO was incorrect in its determination that the veteran's death was not service connected. She maintains that since the veteran had been service connected for tachycardia for many years and died of atherosclerotic heart disease, these diseases are either one and the same or one is secondary to the other. Therefore, she requests a favorable determination. 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 the preponderance of the evidence is against the claim for service connection for the cause of the veteran's death. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appeal has been obtained. 2. The veteran died in August 1992 at the age of 66 due to atherosclerotic heart disease. 3. During the veteran's lifetime, service connection had been established for sinus tachycardia at a noncompensable evaluation and for residuals of traumatic hematoma of the left ankle at a noncompensable evaluation. 4. Atherosclerosis was not clinically manifested or diagnosed during service or within one year of the veteran's separation from service. 5. The veteran's atherosclerosis was not causally or etiologically related to a service-connected disability. 6. The veteran's death was not produced or hastened by a disability of service origin. CONCLUSION OF LAW The veteran's death was not caused, or substantially or materially contributed to, by a service-connected disability. 38 U.S.C.A. §§ 1310, 5107 (West 1991); 38 C.F.R. § 3.312 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSION As a preliminary matter, the Board notes that the appellant's claim is well grounded within the meaning of 38 U.S.C.A. § 5107 (West 1991). That is, the Board finds that she has presented a claim which is plausible. The Board is also satisfied that all relevant and available facts have been properly developed. No further assistance to the appellant is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107. I. Background The appellant's claim is based upon a diagnosis of sinus tachycardia in service. In March 1946, the RO granted the veteran service connection at 10 percent for sinus tachycardia, effective from February 1946. This rating was amended in October 1947 with an effective date of April 1946. Because a March 1949 VA special cardiovascular examination found no evidence whatsoever of a heart disorder, the RO in April 1949 reduced the veteran's evaluation to a noncompensable rating, effective from June 1949. The veteran did not appeal. In January 1968, the Board denied a compensable evaluation for sinus tachycardia. The appellant filed her Application for Dependency and Indemnity Compensation or Death Pension in October 1992. The RO denied the appellant's claim for dependency and indemnity compensation in November 1992, but granted her nonservice-connected death pension benefits. The Board's review of the record discloses that the veteran's February 1946 separation examination revealed that his cardiovascular system, including a chest x-ray, was normal, although he was noted to have had sinus tachycardia. His blood pressure was within normal limits, his pulse was 100 three minutes after exercise and regular. It was noted that the veteran was physically qualified for discharge from the Navy and required neither treatment nor hospitalization. No further information relating to this disorder is found in the service medical records. A VA special cardiovascular examination in March 1949 noted no cardiovascular complaints, i.e., no dizziness, headaches, syncope, dyspnea, orthopnea, chest pains, edema, or palpitation. Blood pressure was 124/78 and the pulse rate was 62. Examination showed no heart enlargement, no heart murmurs, and no abnormal heart sounds. There was no liver enlargement and no edema. The examiner was unable to provide a diagnosis, stating that he found no evidence of cardiovascular disease. Medical Reports, dated in June 1958 and in June 1959, by W. J. Briley, M.D., a private physician, noted sinus tachycardia only by history and reported that the physical examination was negative for the disorder at the time of these examinations. Thus, subsequent to discharge through June 1959, there were no reported complaints of sinus tachycardia and no objective evidence of any cardiac abnormality. Beginning in mid-1960, the veteran began complaining of indigestion, shortness of breath, and a very rapid heart beat. Although physical examinations at that time revealed no objective abnormalities, he received diagnoses from both VA and private physicians of either paroxysmal tachycardia or sinus tachycardia. In August 1974, the veteran was admitted to a VA hospital with a history of sinus tachycardia and many episodes of hyperventilation and tight chest. He had also been treated by a private physician with a variety of "nerve pills" because of episodes of anxiety and possible depression. Several weeks before this admission, the veteran had developed a severe, substernal tightness with shortness of breath and diaphoresis while working under very hot conditions. Examination showed point of maximal impulse (PMI) was not palpable and that the first and second heart sounds were normal. There were no murmurs, gallops, rubs, or heaves. An electrocardiogram showed left ventricular hypertrophy with strain and left atrial overload, and a chest x-ray showed borderline enlargement of the heart. The veteran was asymptomatic while in the hospital, with the exception of frequent "hot" episodes without chest pain, but with tightness in the throat and hyperventilation. Blood pressure was 150/90, and with medication he had a good reduction in blood pressure. Work up was not completed because of early discharge. It was believed, however, that the veteran had angina pectoris on the basis of history and hypertension with anxiety and depression. The relevant diagnosis was hypertensive and arteriosclerotic cardiovascular disease with angina pectoris. This is the veteran's first diagnosis of a serious heart disorder. A letter from a private physician, D. L. Bienvenu, M.D., dated in September 1974, noted that the veteran had had a recent myocardial infarction and would be disabled for at least six months. In March 1977, the veteran was admitted to a VA medical facility for evaluation. Examination showed a supine blood pressure of 166/110, with a pulse of 64, and a standing blood pressure of 176/126 and a pulse of 80. The heart showed a regular rhythm, with a Grade I/VI systolic murmur at the left lower sternal border, with no rubs or gallops. He had a probable fourth heart sound (S4). A chest x-ray revealed a normal cardiac shadow, with a markedly ectatic aortic arch. An electrocardiogram (EKG) revealed normal sinus rhythm, left axis deviation, marked left ventricular hypertrophy with strain, and possible biventricular hypertrophy. There had been no change in his previous EKG's since June 1976. Diagnoses were hypertension, atherosclerotic cardiovascular disease, and history of sinus tachycardia and atrial fibrillation. A March 1990 letter from Dr. Bienvenu noted that the veteran was completely and totally disabled because of congestive myocardiopathy due to coronary artery disease, as well as poorly controlled hypertension, diabetes mellitus, and chronic obstructive lung disease. In May 1990 Dr. Bienvenu reported that the veteran had recently been admitted to a private hospital for congestive heart failure due to a cardiomyopathy related to coronary artery disease. The veteran was considered to be completely and totally disabled, and the prognosis was extremely poor. The veteran died enroute to a private hospital on August [redacted] 1992. The immediate cause of death was listed as atherosclerotic heart disease, which was stated to have existed for "years." No secondary causes or underlying causes were noted. An autopsy was not performed. II. Analysis Pursuant to 38 C.F.R. § 3.312 (1993), the death of a veteran will be considered as having been due to a service-connected disability when the evidence establishes that such disability was either the principal or a contributory cause of death. The service-connected disability will be considered as the principal cause of death when such disability, singly or jointly with some other condition, was the immediate or underlying cause of death or was etiologically related thereto. A contributory cause of death is inherently one not related to the principal cause. In determining whether the service-connected disability contributed to death, it must be shown that it contributed substantially or materially; that it combined to cause death; that it aided or lent assistance to the production of death. It is not sufficient to show that it casually shared in producing death, but rather it must be shown that there was a causal connection. The issue involved will be determined by exercise of sound judgment, without recourse to speculation, after a careful analysis has been made of all the facts and circumstances surrounding the death of the veteran, including, particularly, autopsy reports. The Board's review of the record discloses that, although the veteran had been reported to have sinus tachycardia during service, no evidence of cardiovascular disease, including hypertension, was manifested or diagnosed during service or for many years following the veteran's separation from service. It was not until the early 1960's that the veteran voiced specific complaints of shortness of breath and tachycardia, but during that time, objective evidence of tachycardia or of cardiac abnormalities were not found during physical examination. In a May 1970 employment statement, the veteran stated that he had been continually ill for the past year due to hypertension, emphysema, and "bronchial," but made no mention of heart disease. Since there was no evidence of atherosclerotic heart disease during service or during the one-year presumptive period after service or for many years thereafter, the Board may not speculate that the veteran's sinus tachycardia, or rapid heart rate, in service was caused by atherosclerosis and not by one of the many noncardiac causes of this type of disorder. Therefore, the Board finds that there is no objective evidence to show that the veteran's service-connected sinus tachycardia was the principal cause of death or a contributory cause of death. The appellant's contention that sinus tachycardia and atherosclerosis are the same or that one disorder caused the other is completely unsubstantiated. The appellant is not capable of providing competent evidence as to a diagnosis or the cause of death. See Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992). Given this record, the Board finds that the veteran's service- connected sinus tachycardia did not cause, contribute substantially or materially to cause the veteran's death, or aid or lend assistance to the production of the veteran's death. Therefore, service connection for the cause of the veteran's death is not warranted. ORDER Service connection for the cause of the veteran's death is denied. WARREN W. RICE, JR. 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.