Citation Nr: 18148967 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 17-58 050 DATE: November 8, 2018 REMANDED Entitlement to service connection for a heart disorder as a result of exposure to herbicide agents is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1964 to June 1968, to include service in the Republic of Vietnam. He claims entitlement to service connection for a heart disorder, to include bradycardia and cardiac arrhythmia as a result of his exposure to herbicide agents in the Republic of Vietnam. See December 2015 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits. The Board notes that the Veteran’s service in the Republic of Vietnam is confirmed by his service personnel records, including his DD-214. As such, his exposure to herbicide agents is presumed. 38 U.S.C. § 1116 (f) (2012); 38 C.F.R. § 3.307 (a)(6)(iii) (2017). In April 2016, the Veteran underwent a VA examination. The examiner noted his diagnosis of supraventricular arrhythmia, but concluded that such did not qualify within the generally accepted medical definition of ischemic heart disease. The examiner did not provide any further opinion as to whether the Veteran’s supraventricular arrhythmia was related to his military service, including his presumed exposure to herbicide agents. The Board notes that the United States Court of Appeals for the Federal Circuit has held that a claimant is not precluded from establishing service connection for a disease claimed to be related to herbicide exposure, as long as there is proof of such direct causation. See Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed. Cir. 1994). Thus, despite the fact that supraventricular arrhythmia does not qualify as ischemic heart disease, and thus is not presumed to be related to his in-service exposure to herbicide agents, the Veteran may still establish service connection on a direct basis. Subsequent VA treatment records indicate that the Veteran has also been diagnosed with multifocal premature ventricular complexes, atrial fibrillation, and congestive heart failure. See May 2017 VA Neurology Note; March 2017 VA Anesthesiology Pre-Operative E & M Note. Given the evidence showing additional diagnoses related to the Veteran’s heart, and the fact that the April 2016 VA examination report did not offer an opinion as to whether the Veteran’s supraventricular arrhythmia was related to his military service, including his presumed exposure to herbicide agents, the Board finds that a new VA examination is necessary. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). On remand, any outstanding VA treatment records should be associated with the claims file. Additionally, the Veteran should be given the opportunity to identify any outstanding evidence pertinent to the claims on appeal. The matter is REMANDED for the following action: 1. Associate any VA treatment records dated after July 25, 2017, with the Veteran’s claims file. 2. Give the Veteran an additional opportunity to identify any outstanding pertinent evidence that has not already been associated with the claims file. The AOJ should then attempt to obtain those records if the Veteran provides the appropriate authorization. 3. Schedule the Veteran for a VA examination to determine whether any currently-diagnosed heart disorder had its onset during, or is otherwise related to his military service, to include his presumed exposure to herbicide agents. The entire record, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Any indicated evaluations, studies, and tests should be conducted. Following a review of the entire record, the examiner should address the following questions: (a) Identify any currently-diagnosed heart disorder(s). In this regard, please address the Veteran’s VA treatment records that note bradycardia, supraventricular arrhythmia, multifocal premature ventricular complexes, atrial fibrillation, and congestive heart failure. (b) For each currently-diagnosed heart disorder(s), please indicate whether such qualifies within the generally accepted medical definition of ischemic heart disease. (c) If any currently-diagnosed heart disorder(s) does not qualify within the generally accepted medical definition of ischemic heart disease, is it at least as likely as not (i.e., a 50 percent or greater probability) that such is related to his military service, to include his presumed exposure to herbicide agents? A negative opinion as to whether any currently-diagnosed heart disorder(s) is related to the Veteran’s presumed exposure to herbicide agents cannot be based exclusively on the fact that the disorder(s) is not on VA’s list of disabilities presumed to be related to herbicide agents. This is because service connection can be established for diseases not on VA’s presumptive list, should the evidence indicate a direct relationship exists between this Veteran’s disability and his exposure. A clearly-stated rationale for any opinion offered should be provided. 4. Thereafter, and after any further development deemed necessary, the issue on appeal should be reajudicated. If the benefits sought on appeal are not granted, the Veteran and his representative should be provided with a supplemental statement of the case and afforded the appropriate opportunity to respond. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD James R. Springer, Associate Counsel