Citation Nr: 1104167 Decision Date: 02/02/11 Archive Date: 02/14/11 DOCKET NO. 07-29 136 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUE Entitlement to service connection for coronary artery disease (CAD), post-myocardial infarction, to include as secondary to service-connected asthma. REPRESENTATION Appellant represented by: Vietnam Veterans of America WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD A. Ishizawar, Associate Counsel INTRODUCTION The appellant is a Veteran who served on active duty from March 1971 to March 1974. This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2004 rating decision of the Chicago, Illinois Department of Veterans Affairs (VA) Regional Office (RO). In August 2009, a Travel Board hearing was held before the undersigned. A transcript of the hearing is associated with the Veteran's claims file. FINDINGS OF FACT 1. The Veteran served in the Republic of Vietnam during the Vietnam era; it is presumed he was exposed to certain herbicide agents therein. 2. The Veteran's CAD, post-myocardial infarction, is now a listed disease associated with exposure to certain herbicide agents in Vietnam. CONCLUSION OF LAW Service connection for CAD, post-myocardial infarction, is warranted. 38 U.S.C.A. §§ 1101, 1110, 1116, 5107 (West 2002 & Supp. 2010); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.313 (2010); 75 Fed. Reg. 53, 202 (Aug. 31, 2010). REASONS AND BASES FOR FINDINGS AND CONCLUSION A. Veterans Claims Assistance Act of 2000 (VCAA) The VCAA, in part, describes VA's duties to notify and assist claimants in substantiating a claim for VA benefits. See 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126; 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a). The VCAA applies to the instant claim. However, inasmuch as the benefit sought is being granted, there is no reason to belabor the impact of the VCAA on the matter; any notice defect or duty to assist failure is harmless. Accordingly, the Board will address the merits of the claim. B. Legal Criteria, Factual Background, and Analysis Service connection may be granted for disability due to disease or injury incurred in or aggravated by active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). In order to prevail on the issue of service connection, there must be medical evidence of a current disability; medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Hickson v. West, 12 Vet. App. 247 (1999). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303(a). For certain chronic diseases (including cardiovascular disease), service connection may be established on a presumptive basis if they are manifested to a compensable degree in a specified period of time postservice (one year for cardiovascular disease). 38 U.S.C.A. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. If a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam Era (from January 9, 1962 to May 7, 1975), and has one of the enumerated diseases associated with exposure to certain herbicide agents [to include Agent Orange], that disease shall be considered to have been incurred in or aggravated by such service, notwithstanding that there is no record of evidence of such disease during the period of such service. 38 U.S.C.A. § 1116;38 C.F.R. § 3.309(e). In August 2010, VA amended 38 C.F.R. § 3.309(e) to establish presumptive service connection based on herbicide exposure for chronic B-cell leukemias, Parkinson's disease, and ischemic heart disease. Ischemic heart disease includes, but is not limited to, "acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina." This amendment is applicable to claims received by VA on or after August 31, 2010, and to claims pending before VA on that date, as well as certain previously denied claims. See 75 Fed. Reg. 52,202 (Aug. 31, 2010). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. The Board notes that it has reviewed all of the evidence in the Veteran's claims file, with an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no need to discuss, in detail, every piece of evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (VA must review the entire record, but does not have to discuss each piece of evidence). Hence, the Board will summarize the relevant evidence as appropriate and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as to the claim. The Veteran's service personnel records show he served in the Republic of Vietnam from October 1971 to July 1972. His service treatment records (STRs) are silent for any complaints, findings, treatment, or diagnoses related to a heart disability. The Veteran's extensive postservice VA and private treatment records show that he has a long history of CAD and is status post a myocardial infarction in October 1994 and a coronary artery bypass surgery (CABG) in May 1998, with a redo CABG in September 1998. He also underwent a percutaneous transluminal coronary angioplasty (PTCA) in 2002. On January 2003 VA examination, it was noted that the Veteran had a past medical history of CAD, status post myocardial infarction in 1994; two CABGs in May and September 1998; status post PTCA in 2002; hypertension; hyperlipidemia; asthma; peptic ulcer disease; and peripheral vascular disease. It was also noted that until four years prior, he had smoked 1 pack cigarettes per day for 40 years. Four months prior, he had restarted smoking half a pack of cigarettes per day. His current complaint consisted of chest pains. Following an examination, the examiner noted that the Veteran had progressive worsening of typical cardiac chest pain, and therefore recommended he undergo an angiography and angioplasty. He further opined that the Veteran's cardiac condition was "not related to his army service," and advised him about smoking, exercise, and diet. On September 2003 VA examination, the Veteran was noted to have CAD, status post CABG, status post multiple stents in the right coronary artery, angina, and severe sternal xyphoid pain secondary to surgery. In a September 2003 addendum opinion, the examiner opined that the Veteran's CAD was not related to his service-connected asthma, and stated that the disease in his right coronary artery was due to the normal progression of the disease in the setting of active chronic smoking. In a January 2005 addendum opinion, the examiner reaffirmed his September 2003 opinion, and stated, "[The Veteran] had a restenosis of the stent in the [right coronary artery] and that by itself it is a well known fact that stents have a propensity to restenose, regardless of any other factors, including asthma. The restenosis is due to fibroplastic intimal degeneration, and [is] not influenced by [chronic obstructive pulmonary disorder] or asthma." In a March 2006 addendum opinion, the examiner further opined that the bronchodilator medications the Veteran used to treat his asthma did "not have any influence in aggravating or [changing] the natural history" of the Veteran's CAD. In a December 2004 letter by Dr. M.S., he states the Veteran presented to him solely for a second medical opinion as to whether there was any correlation between his CAD and service- connected asthma. The Veteran did not want to be examined or given any recommendations regarding his underlying cardiac problems; instead, he provided copies of his voluminous medical records and of Internet articles he had found for Dr. M.S.'s review. Based on the information provided, Dr. M.S. opined, "As I recall from the article and reading the literature there is a possibility of [CAD] affecting the right ventricle, and with regards to asthma affecting the right heart chambers, and also with regards to developing [CAD] specifically in the right coronary artery related to the pulmonary conditions. I believe there is correlation on that effect and several articles have been published in the past. This needs to be researched further with regards to this possibility." As noted, the evidence of record amply establishes that the Veteran has a diagnosis of CAD, is status post a myocardial infarction, and underwent CABG surgery twice in 1998. CAD, old myocardial infarctions, and coronary bypass surgery are included in the definition of 'ischemic heart disease' under the amended 38 C.F.R. § 3.309(e). As the record also shows that the Veteran served in the Republic of Vietnam during the Vietnam Era, service connection for CAD is warranted under the presumptive provisions of 38 U.S.C.A. § 1116. [The Board notes that the Veteran has asserted various alternate theories of entitlement to service connection for CAD, including one of secondary service connection. In light of the grant of service connection for CAD on a presumptive basis, discussion of other theories of entitlement is not necessary.] ORDER Service connection for CAD, post-myocardial infarction, is granted. ____________________________________________ George R. Senyk Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs