Citation Nr: 18143415 Decision Date: 10/19/18 Archive Date: 10/18/18 DOCKET NO. 16-24 631A DATE: October 19, 2018 ORDER Service connection for ischemic heart disease, to include as a result of exposure to herbicide agents, is denied. REMANDED Service connection for hypertension, to include as a result of exposure to herbicide agents, is remanded. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran has, or has had at any time during the appeal, a current diagnosis of ischemic heart disease as defined by VA regulations. CONCLUSION OF LAW The criteria for service connection for ischemic heart disease are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from August 1969 to June 1971, which included service in the Republic of Vietnam. He is seeking service connection for ischemic heart disease and hypertension, which he asserts were caused by his in-service herbicide agent exposure. Service Connection for Ischemic Heart Disease Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). A veteran who served in Vietnam during the Vietnam Era is presumed to have been exposed to Agent Orange. 38 U.S.C. § 1116; 38 C.F.R. § 3.307. Certain enumerated chronic diseases associated with exposure to herbicide agents (Agent Orange) may be service connected on a presumptive basis as due to exposure to herbicides. 38 C.F.R. § 3.309 (e). Of note, ischemic heart disease (IHD) is a disease that VA regulations include on the presumptive list. No other heart disease or condition is on the list. The VA regulations further explain that “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. 38 C.F.R. § 3.309 (e). The Veteran, having served in the Republic of Vietnam during the Vietnam Era, is presumed to have had exposure to herbicide agents. Because the Veteran is presumed to have herbicide agent exposure, service connection could be presumed if he was diagnosed with one of the enumerated chronic diseases associated with exposure to herbicide agents. Here, however, despite the Veteran claiming service connection for IHD, he has not actually been diagnosed with such a condition. Post-service medical records provide no indication that the Veteran has ever been treated for or diagnosed with myocardial infarction, atherosclerotic cardiovascular disease, or any type of angina; nor has he ever undergone coronary bypass surgery since he separated from active service, despite him having alluded to having IHD in filing this claim. The Veteran was also afforded a VA examination in June 2013, where the examiner confirmed that the Veteran did not have IHD at the time of the examination or at any previous time. The examiner also specifically ruled out the Veteran having any history of percutaneous coronary intervention; myocardial infarction; coronary bypass surgery; heart transplant; implanted cardiac pacemaker; implanted automatic implantable cardioverter defibrillator; or congestive heart failure. Further, the examiner reviewed diagnostic testing and stated there was no evidence of cardiac hypertrophy or dilation. Despite the Veteran claiming he has IHD as a result of exposure to Agent Orange in Vietnam, he lacks the medical training and expertise to provide a complex medical opinion, such as diagnosing IHD. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Here, the probative value of the Veteran’s statements about his current condition are outweighed by the complete lack of medical treatment or diagnosis of any IHD condition. For a disability to be service-connected, it must be present at the time a claim for VA disability compensation is filed or during the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319 (2007). Congress has specifically limited entitlement to service-connected benefits to cases where there is a current disability. In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992). In this case, there is no medical evidence that the Veteran has had any condition sufficient to meet the VA regulations definition of IHD during the pendency of this claim. Accordingly, as the Veteran has not been shown to have ischemic heart disease as defined by VA regulations, service connection for IHD is denied. REASONS FOR REMAND VA treatment records show that the Veteran is currently diagnosed with hypertension, and he takes medication to control his high blood pressure. Prior to entering active service, on the Veteran’s pre-induction medical examination in October 1968, he checked a box indicating he had a history of “high or low blood pressure,” but he further explained this response by disclosing that he had been diagnosed with an irregular heartbeat. He was clinically evaluated as “normal” by medical examination that same day with respect to both his heart and vascular system. The Veteran was afforded a VA hypertension examination in June 2013. For reasons which are not completely clear, the VA examiner was directed to consider this as a condition which clearly and unmistakably preexisted the Veteran’s active service, and was only asked to opine as to whether it was aggravated by the Veteran’s active service. The VA examiner noted that the Veteran reported on examination that his hypertension was onset in 1975, over three years after he separated from service. As there is no medical evidence or indication in the Veteran’s service treatment records that this condition preexisted the Veteran’s active service, an opinion is also needed as to whether this condition was actually a preexisting condition. If it cannot be considered as having clearly and unmistakably preexisted the Veteran’s active service, an opinion should also be rendered as to whether a direct service connection is warranted for the Veteran’s hypertension. Furthermore, the National Academy of Sciences (NAS) Institute of Medicine’s “Veterans and Agent Orange: Update 2010” concluded that there is limited or suggestive evidence of an association between exposure to Agent Orange and hypertension. However, no medical opinion currently associated with the claims file has addressed the possibility that the Veteran’s hypertension was caused by his presumed herbicide agent exposure. As such, an opinion on this matter is also necessary to adjudicate this claim. The matter is REMANDED for the following action: 1. Obtain a medical opinion regarding the etiology of the Veteran’s hypertension (if an opinion cannot be provided without an examination, one should be scheduled). The examiner should answer the following questions: (a.) Did the Veteran’s hypertension clearly and unmistakably pre-exist his active service? Why or why not? (b.) If the answer to the above question is “yes,” was the condition clearly and unmistakably not aggravated by the Veteran’s active service (meaning that hypertension was not permanently aggravated beyond the natural progression of the condition during service), to include as a result of his presumed exposure to herbicide agents? Why or why not? (c.) If the answer to either of the above questions is “no,” is it at least as likely as not (50 percent or greater) that hypertension either began during or was otherwise caused the Veteran’s military service, to include as a result of his presumed exposure to herbicide agents? Why or why not? In answering these question, the examiner should discuss the relevance, if any, of the findings by the Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides 2012 report “Veterans and Agent Orange: Update 2012” that continued to categorize hypertension as having limited or suggestive evidence of association with herbicide agent exposure (meaning that epidemiologic evidence suggests an association between exposure to herbicide agents and the outcome, but a firm conclusion is limited because chance, bias, and confounding could not be ruled out with confidence). MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Davidoski, Associate Counsel