Citation Nr: 18148203 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 14-16 883 DATE: November 7, 2018 ORDER Entitlement to service connection for ischemic heart disease, including as due to exposure to herbicide agents, is denied. FINDING OF FACT The Veteran does not currently have ischemic heart disease. CONCLUSION OF LAW The criteria for entitlement to service connection for ischemic heart disease have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had honorable active military service from March 1954 to July 1957 and October 1957 to September 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared and testified at a Board video-conference hearing held before the undersigned Veterans Law Judge in April 2017. In July 2017, the Board remanded the Veteran’s Appeal to the Agency of Original Jurisdiction (AOJ) for development of evidence. The Board also ordered an additional VA examination regarding the Veteran’s current heart disorder and requested an opinion on whether the condition constitutes ischemic heart disease as claimed. The Board ordered the AOJ to then readjudicate the claims, and if necessary, issue a Supplemental Statement of the Case and return the outstanding claim(s) to the Board. The Board finds that there has been substantial compliance with the directives of the July 2017 remand regarding the issues on appeal resolved by this Board decision. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The record indicates that the AOJ sent a letter to the Veteran in July 2017 in accordance with the remand directives requesting private medical records. The records were received in September 2017. In addition, a further VA examination was conducted in November 2017, and the AOJ issued a Supplemental Statement of the Case in September 2018. The Board notes that the AOJ also issued a new Rating Decision on September 4, 2018 granting the Veteran’s claim for entitlement to service connection for diabetes mellitus Type II. Therefore, that issue has been rendered moot, and no question of fact or law remains that requires the Board’s decision. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c) (2016). 38 U.S.C. § 7107(a)(2). Service Connection Establishing service connection generally requires medical or, in certain circumstances, lay evidence of: (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed.Cir.2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff’d per curiam, 78 F.3d 604 (Fed.Cir.1996) (table). Service connection may be awarded on a presumptive basis for certain chronic diseases listed in 38 C.F.R. § 3.309(a) that manifest to a degree of 10 percent within 1 year of service separation. 38 C.F.R. § 3.303(b); see Walker v. Shinseki, 708 F.3d 1331, 1337 (Fed.Cir.2013). Evidence of continuity of symptomatology may be sufficient to invoke this presumption if a claimant demonstrates (1) that a condition was “noted” during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Barr v. Nicholson, 21 Vet. App. 303, 307 (2007) (citing Savage v. Gober, 10 Vet. App. 488, 496–97(1997)); see 38 C.F.R. § 3.303(b). Certain diseases, such as ischemic heart disease, may be service connected on a presumptive basis if manifested in a Veteran who was exposed to herbicide agents during service, even if there is no record of such disease during service. 38 U.S.C. § 1116 (a)(1), (2); 38 C.F.R. §§ 3.307(a)(6), 3.309(e). A veteran who, during active naval service, served in the Republic of Vietnam during the Vietnam era (beginning in January 1962 and ending in May 1975) shall be presumed to have been exposed during such service to herbicide agents. 38 U.S.C. § 1116(f). 1. Entitlement to service connection for ischemic heart disease, to include as due to exposure to herbicide agents. Based on the evidence, the Board concludes that service connection is not warranted for ischemic heart disease. The Board notes at the outset that the preponderance of the evidence indicates that the Veteran’s heart disorder -- atherosclerosis -- was not manifest in service or to a degree of 10 percent within 1 year of service and is unrelated to service, nor does the Veteran claim as much. The Veteran’s Service Treatment Records (STRs) show normal heart condition throughout service, and no VA or private treatment records contain evidence of a heart condition until many years after service. The Veteran’s theory of entitlement is service connection due to exposure to herbicides, including Agent Orange, during service in Vietnam. As outlined in the Board’s previous remand order, the Veteran is presumed to have been exposed to Agent Orange. As herbicide exposure has been conceded based on service in Vietnam, the critical question in this claim is whether the evidence demonstrates current ischemic heart disease. The Veteran has been diagnosed with atherosclerosis, which is not a presumed condition for Agent Orange exposure. In November 2017, a VA examiner found the Veteran did not have ischemic heart disease because a myocardial scan and angiogram revealed no evidence of a significant blockage of the coronary arteries. This finding is consistent with private medical records, which show the Veteran was diagnosed in April 2015 with atherosclerosis and hypertension. In addition to the above diagnostic testing, The VA examiner reviewed the claims file and addressed the private treatment records in the rationale. In light of this analysis, and the lack of any conflicting medical evidence, the board assigns great probative weight to the examiner’s rationale and conclusion. Thus, the preponderance of the medical evidence is against a finding that the Veteran has ischemic heart disease. While the Board acknowledges and does not doubt the sincerity of the Veteran’s statements alleging that he does in fact have an   ischemic heart disease, whether such a complex medical condition is present is a question beyond the scope of lay observation, and the Board must look to the medical opinions in the record. Therefore, the claim is denied. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. McCormick, Associate Counsel