Citation Nr: 18147477
Decision Date: 11/06/18	Archive Date: 11/05/18

DOCKET NO. 17-53 790
DATE:	November 6, 2018
REMANDED
Entitlement to service connection for a heart condition, to include ischemic heart disease as due to herbicide exposure is remanded.
REASONS FOR REMAND
The Veteran served on active duty from June 1968 to June 1988, to include in the Republic of Vietnam, in the United States Army.
Entitlement to service connection for a heart condition, to include ischemic heart disease, to include as due to herbicide exposure is remanded.
The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a heart condition because no VA examiner has adequately opined on the nature of any heart condition, whether any heart condition is etiologically related to active duty service, and whether the Veteran’s documented coronary artery calcifications are evidence of ischemic heart disease.
The Veteran’s VA examinations to date are conflicted as to whether he has a current heart condition.  The first examination, conducted in  November 2016 diagnosed valvular heart disease, but no etiological opinion was offered.  The second examination, conducted in Septemer 2017 found that the Veteran has no diagnsed heart condition.  As for the Veteran’s documented coronary artery calcifications, the September 2017 VA examiner opined that the condtion did not meet the qualifications for the generally accepted medical definition of ischemic heart disease.  However, the examiner did not explain this conclusion.  Finally, while the Veteran has characterized his claim as etiologically due to conceded exposure to herbicide, this does not preclude establishing entitlement to service connection on a direct basis.
The matter is REMANDED for the following action:
1.  Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran has a heart condition is at least as likely as not related to active duty service, to include conceded exposure to herbicides.
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The examiner must identify all diagnosed heart conditions and in doing so must address the inconsistency in diagnosis between the November 2016 and September 2017 VA examinations.  For any diagnoseable heart condition the examiner must offer the opinion requested above.  The examiner is informed that rationale that any diagnosed heart condition is not a presumptive disease associated with exposure to herbicide is not sufficient for a negative opinion.

The examiner must also directly address the documented evidence of calcified coronary arteries and opine whether this is evidence of ischemic heart disease.  If not, the examiner must explain why.
 
M.E. Larkin
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	P.S. McLeod