Citation Nr: 18144696 Decision Date: 10/25/18 Archive Date: 10/24/18 DOCKET NO. 17-00 334 DATE: October 25, 2018 ORDER Entitlement to service connection for diabetes mellitus (diabetes) is granted. Entitlement to service connection for ischemic heart disease is denied. REFERRED The issue of service connection for hypertension with nephropathy was raised in a February 2017 appellate brief. That issue is not included in the scope of the instant claim, because hypertension and ischemic heart disease are commonly understood to be two different medical conditions. The Veteran’s statements throughout the appeal have been limited to ischemic heart disease, and the representative’s appellate brief shows that this is understood to be a distance issue. As such, the issue is referred to the Agency of Original Jurisdiction (AOJ) for further action.   FINDINGS OF FACT 1. Resolving all doubt in the Veteran’s favor, his job duties placed him in close proximity to the demilitarized zone (DMZ) in Korea during the Vietnam Era. The Veteran’s diabetes mellitus can be presumed to be connected to exposure to herbicides. 2. The record fails to demonstrate that the Veteran has a current diagnosis of ischemic heart disease. CONCLUSIONS OF LAW 1. The criteria for service connection to diabetes mellitus have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for ischemic heart disease have not been met. 38 U.S.C. §§ 1110, 1116, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 1970 to January 1972 with service in the Republic of Korea. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. Service Connection Veteran contends that he has current diagnoses of diabetes mellitus and ischemic heart disease. He believes that these diseases are linked to herbicide exposure that he experienced in Korea. 1. Service connection for diabetes The Veteran has a current diagnosis with diabetes. A 2004 Veterans Affairs Medical Center (VAMC) reported that his diabetes was controlled by his diet. In September 2018, the Veteran reported that he will soon need to be on dialysis for his diabetes. The Veteran contends that he was exposed to herbicide agents, specifically Agent Orange, during his military service. Agent Orange, classified as an “herbicide agent,” was used along the southern boundary of the DMZ in Korea. Department of Defense has also identified specific military units that were assigned or rotated to areas along the DMZ where Agent Orange was used. If a Veteran was exposed to an “herbicide agent,” such as Agent Orange, used in support of the United States and allied military operations in the Republic of Vietnam from January 9, 1962, to May 7, 1975, or in a unit identified by the DOD that operated in or near the Korean DMZ between April 1, 1969 and August 31, 1971, then, absent affirmative evidence to the contrary, certain diseases, including diabetes mellitus, will be presumptively service connected even if there is no record of the disease in service. 38 U.S.C. §§ 1110, 1116; 38 C.F.R. §§ 3.307 (a)(6), (d), 3.309(e). Exposure is presumed for “[a] veteran who, during active military, naval, or air service served between April 1, 1968 and August 31, 1971, in a unit that, as determined by the Department of Defense, operated in or near the Korean DMZ in an area in which herbicides are known to have been applied.” 38 U.S.C. §3.307(a)(6)(iii). The Department of Defense identified the 2nd Engineer Battalion, 2nd Infantry Division as a unit that operated in or near the Korean DMZ. The Veteran was assigned to Korea in November 1970. The Veteran’s Records of Assignments show that he was assigned to be a Combat Construction Specialist with the 2nd Engineer Battalion, 2nd Infantry Division. This is one of the units identified by DoD as operating in the Korean DMZ during the qualifying time period. See VBA Manual M21-1, IV.ii.1.H.4.b., Units or Other Military Entities Identified by DoD as Operating in the Korean DMZ During the Qualifying Time Period, Major Command Assignment, Other. His Service Treatment Records confirm that he was in Korea. First, the Veteran was at Camp Stanley in February 1971, then at Camp Edwards in April 1971, and finally, Camp Howze in October 1971. Additionally, the Veteran asserts that he spent time at Camp Red Cloud. Further, the Veteran received Hostile Fire Pay for 6 trips from November 1 through November 30, 1971 with the 2nd Engineer Battalion, 2nd Infantry Division. After considering the evidence of record, the Board resolves reasonable doubt in favor of the Veteran and finds that the Veteran was likely exposed to herbicide agents during service in Korea along the DMZ. The service records confirm that he was in one of the units identified by the DOD to have participated in the DMZ within the presumptive period. Because he developed diabetes, in the absence of any evidence to the contrary, it is presumed to be associated with his exposure to herbicide agents in service. As such, service connection is granted. 2. Service connection for ischemic heart disease. The Veteran contends that he is entitled to service connection for ischemic heart disease as a result of herbicide agent exposure in the Republic of Korea. As explained herein above, this claim is limited to consideration of ischemic heart disease. To the extent the Veteran has hypertension, which he feels is secondary to diabetes, that issue has never been considered by the RO. Therefore, the Veteran would be prejudiced should the Board adjudicate it in the first instance without having been developed and adjudicated by the RO. See 38 U.S.C. § 7104(a); Bernard v. Brown, 4 Vet. App. 384, 394 (1993). Generally, service connection will be granted for a disability resulting from an injury or disease caused or aggravated by service. 38 U.S.C. §§ 1110 (2012). A grant of service connection for a disability requires: (1) a present disability or persistent or recurrent symptoms of a disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (“nexus”) between the present disability and the in-service event, injury, or disease. 38 C.F.R. § 3.303 (2017); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). If a veteran was exposed to a herbicide agent (to include Agent Orange) during active service, the following diseases shall be service-connected if the requirements of 38 C.F.R. § 3.307 (a)(6) are met, even though there is no record of such disease during service, provided that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied: AL amyloidosis, chloracne or other acneform diseases consistent with chloracne, type II diabetes, Hodgkin’s disease, ischemic heart disease (including, but 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), all chronic B-cell leukemias, multiple myeloma, non-Hodgkin’s lymphoma, Parkinson’s disease, early-onset peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea) and soft-tissue sarcomas (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma). The term ischemic heart disease does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke, or any other condition that does not qualify within the generally accepted medical definition of ischemic heart disease. 38 C.F.R. § 3.309(e). Medical evidence of record does not reflect that he has been diagnosed with any of the conditions classified as ischemic heart disease under § 3.309(e), including a myocardial infarction, atherosclerotic cardiovascular disease, or stable, unstable, or Prinzmetal’s angina. In September 2016, a VA medical opinion was obtained regarding the nature of the Veteran’s heart disability on appeal. The examiner noted the Veteran’s medical history. After a thorough review of the medical evidence of record, the examiner determined that the Veteran does not have ischemic heart disease. In fact, VAMC records from July 2014 indicate that the Veteran’s heart was negative for ischemia. The Veteran was hospitalized in March 2016 at VA for chest pain and near syncope, but all testing was all negative for ischemia. Finally, these findings are supported by the Veteran’s treatment records. The Veteran’s May 2013 questionnaire did not list a diagnosis of ischemic heart disease, or a related condition that would be presumptively caused by herbicide agent exposure. VAMC treatment records and the VA medical opinion of record constitute probative evidence that the Veteran does not have a present diagnosis of ischemic heart disease, as they represent the informed conclusions of medical professionals based on objective testing and clinical assessment of the Veteran. Apart from hypertension (which is not within the scope of this claim), the VAMC treatment records show multiple complaints of heart pain and diagnoses of a heart murmur. However, these conditions, as indicated by the VA examiner, are not classified as ischemic heart disease. Nor is there any indication that they may be due to Agent Orange exposure or otherwise related to service or a service-connected disability. The Board recognizes that the Veteran believes he has a diagnosis of ischemic heart disease caused by exposure to herbicide agents in Korea. While the Veteran is competent to provide testimony to establish the occurrence of medical symptoms, he is not medically qualified to prove a matter requiring medical expertise. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). The etiologies and classifications of heart disabilities are complex medical determinations outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The probative medical evidence of record has consistently determined that the Veteran’s heart conditions are non-ischemic in nature. Thus, although the Board has carefully considered the lay contentions of record suggesting that the Veteran’s heart disabilities were caused by herbicide agent exposure, the Board ultimately affords the objective medical evidence of record greater probative weight than the lay opinions. See Gilbert v. Derwinski, 1 Vet. App. 49, 54 (1990). In the February 2017 appellate brief, the Veteran’s representative argued that he has heart disease secondary to diabetes. Lacking a current diagnosis, however, the threshold element of service connection has not been met. Therefore, service connection for ischemic heart disease cannot be established on a direct, presumptive, or secondary basis. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, service connection for ischemic heart disease is denied. C. BOSELY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Gillespie, Law Clerk