The appellant sought service connection for a heart disorder diagnosed in service as a ventricular septal defect. The Board treated the condition as congenital and concluded that it preexisted service and was not aggravated. The Court explained that congenital diseases may be service connected, while congenital defects are not diseases or injuries for compensation purposes, and that the Board had not adequately supported its conclusion that the condition preexisted service.

The Court held that the Board failed to identify clear and unmistakable evidence sufficient to rebut the presumption of soundness. It also held that because the condition increased in severity during service, the presumption of aggravation applied, and the Board pointed to no clear and unmistakable evidence to rebut that presumption either. The Court vacated and remanded for readjudication with an adequate statement of reasons or bases and proper consideration of the governing General Counsel precedent on congenital conditions.

A veteran is presumed sound on entry unless VA produces clear and unmistakable evidence that a condition both preexisted service and was not aggravated by service; when a preexisting condition increases in severity during wartime service, aggravation is presumed unless rebutted by clear and unmistakable evidence.

VA must do more than characterize a disability as congenital. If it is treated as a disease rather than a defect, the agency must confront both soundness and aggravation presumptions with evidence, not assumptions, and explain the reasoning clearly.

Monroe is an early and important decision on congenital conditions, presumption of soundness, and presumption of aggravation. It remains useful for challenging denials where VA relies on congenital origin or in-service findings without meeting its evidentiary burden.

Assuming a condition preexisted service because it is congenital, without identifying clear and unmistakable evidence and without properly addressing aggravation.

A veteran is found to have a heart murmur during service, and VA denies service connection by calling it congenital. Under Monroe, counsel can argue that VA must still rebut the presumption of soundness and, if there was in-service worsening, the presumption of aggravation.

Use Monroe to argue that VA may not substitute a congenital label for the required legal analysis. It is especially helpful where the record lacks an entrance exam or where VA relies on inference rather than medical evidence to find preexistence or no aggravation.

VA Gen. Couns. Prec. 82-90, Gilbert v. Derwinski, Colvin v. Derwinski