13-19 060, 13-19 060

Veteran served on active duty Dec 1950–Nov 1952 and filed a fully developed VA claim in Dec 2011 for a heart condition and increased rating for post‑operative tuberculosis residuals.
Service‑connected disability: tuberculosis, post‑op with removal of left 3rd and 4th ribs and wedge resection of left upper lobe; RO previously granted a 10% rating for restrictive lung disease/chondritis and a 20% rating under DC 5297 for rib removal.
VA completed multiple examinations (2012–2017) and obtained medical opinions addressing nexus between the rib/chest‑wall surgery and the Veteran’s heart condition.
Veteran and several lay/medical correspondents argued the chest‑wall defect from rib removal causes or aggravates mitral valve prolapse/mitral regurgitation (heart murmur).
Board found VA examinations and opinions persuasive, rejected speculative lay/professional statements lacking clinical rationale, and concluded the preponderance of evidence is against secondary service connection and against a rating above 20% (only two ribs removed).

Issue	Plaintiff's Argument	Defendant's Argument	Held
Service connection for heart condition as secondary to service‑connected TB/chest‑wall surgery	Chest‑wall deformity from rib removal causes pressure/altered mechanics that produced or aggravated heart murmur (MVP/MR)	Medical evidence shows no causal/biomechanical link; TB/ rib resection not a risk factor for MVP/MR; VA exams find less likely than not nexus	Denied — preponderance of evidence against secondary service connection
Increased rating for TB/post‑op rib removal (DC 5297) above 20%	Disability is more severe; Veteran had 4th rib removed and persistent pain — argues 30% rating applies	Rating criteria require removal of three ribs for 30% or greater; records confirm removal of two ribs only and limited, intermittent pain without functional loss	Denied — 20% remains appropriate (two ribs removed)

Gilbert v. Derwinski, 1 Vet. App. 49 (1990) (preponderance/benefit‑of‑the‑doubt standard explained)
Wallin v. West, 11 Vet. App. 509 (1998) (elements for secondary service connection)
Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004) (nexus requirement summarized)
Stegall v. West, 11 Vet. App. 268 (1998) (remand compliance requirement)
Dyment v. West, 13 Vet. App. 141 (1999) (standard for substantial compliance with remand)
Colvin v. Derwinski, 1 Vet. App. 171 (1991) (Board may not substitute its own medical judgment)
Bloom v. West, 12 Vet. App. 185 (1999) (medical opinions based on mere speculation are inadequate)