Citation Nr: 18143446 Decision Date: 10/23/18 Archive Date: 10/19/18 DOCKET NO. 16-05 054 DATE: October 23, 2018 REMANDED Entitlement to service connection for heart disease, to include coronary artery disease (CAD) or ischemic heart disease (IHD). REASONS FOR REMAND The Veteran served on active duty from June 1965 to April 1969. This appeal arose from an October 2013 decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Boise, Idaho. Entitlement to service connection for CAD or IHD The Veteran contends that he is entitled to service connection for CAD or IHD. For the following reasons, the Board finds a remand necessary prior to adjudication. Veterans who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent. 38 C.F.R. § 3.307(a)(6)(iii). IHD, to include CAD, is listed among the conditions presumed to be service connected in veterans that have been exposed to certain herbicidal agents. 38 C.F.R. § 3.309(e). The Veteran’s DD-214 demonstrates that he served in Vietnam and, as such, is presumed to have been exposed to Agent Orange. The only question still in contention is whether or not the Veteran has a current diagnosis of IHD or CAD. At the Veteran’s September 2015 examination, a Compensation and Pension (C&P) examiner determined the Veteran had a diagnosis of IHD. At the Veteran’s December 2015 examination, however, a C&P examiner determined the Veteran did not have IHD and quoted extensively from the Veteran’s medical records to demonstrate that every instance in which the Veteran underwent stress tests or cardiac testing, it was determined that he did not have IHD. The Veteran’s VA medical records, however, list CAD as a current and ongoing problem. As such, a clarifying opinion is necessary. Moreover, even if the Veteran is found to suffer from heart problems other than CAD or IHD that are not presumed to be associated with herbicide exposure, a nexus opinion must be obtained in which the examiner determines if such is related to Agent Orange. Combee v. Brown, 34 F.3rd 1039, 1042 (Fed. Cir. 1994) (even when a veteran is not entitled to a regulatory presumption of service connection for a given disability, the claim must still be reviewed to determine whether service connection can be established on a direct basis). The matter is REMANDED for the following action: 1. Schedule the Veteran for an examination by an examiner (M.D.), with the appropriate expertise, who has not previously examined the Veteran to determine any current heart-related diagnoses and the nature and etiology thereof. The examiner is asked to review the claims file and provide the following information. (a) Identify all diagnosed heart disabilities, reconcile VA medical records listing CAD as a current and ongoing problem. (b) Opine whether it is it as least as likely as not (50 percent or greater probability) that any heart disability was incurred in or otherwise related to the Veteran’s service, to include his exposure to Agent Orange? (b) If it is determined that there is another likely etiology for a diagnosed heart disability, that should be stated. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Ryan, Associate Counsel