17-44 471
17-44 471
| Board of Vet. App. | Nov 30, 2017Background
- Veteran served on active duty in the U.S. Air Force from Jan 1957 to Jan 1961 and was treated for rheumatic fever in service (hospitalized ~6 months).
- Separation exam in Dec 1960 noted no complications or sequelae from the rheumatic fever.
- Veteran has a current diagnosis of coronary artery disease and asserts it is related to his in-service rheumatic fever.
- VA provided a May 2017 examination: examiner reviewed records, examined the Veteran, and opined it was less likely than not that the coronary artery disease was caused by in-service rheumatic fever, citing alternative etiologies (aging, congestive heart failure) and lack of evidence of rheumatic valvular disease on prior echos.
- Board found the May 2017 opinion well-reasoned and most probative, concluding the preponderance of evidence is against service connection for coronary artery disease; no reasonable doubt existed to resolve in the Veteran’s favor.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Entitlement to service connection for coronary artery disease | Veteran: CAD is etiologically related to in-service rheumatic fever | VA/RO: Medical evidence and VA examiner show no nexus; alternative causes (aging, CHF); no complications noted at separation | Denied — preponderance against nexus; May 2017 VA opinion is most probative |
Key Cases Cited
- Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009) (elements for establishing service connection)
- Hickson v. West, 12 Vet. App. 247 (Vet. App. 1999) (evidentiary framework for service-connection claims)
- Clemons v. Shinseki, 23 Vet. App. 1 (Vet. App. 2009) (limitations on lay competence to opine on medical etiology)
- Gilbert v. Derwinski, 1 Vet. App. 49 (Vet. App. 1990) (reasonable doubt rule and burdens when evidence is in approximate balance)