Citation Nr: 18159290 Decision Date: 12/19/18 Archive Date: 12/18/18 DOCKET NO. 17-06 096 DATE: December 19, 2018 ORDER Entitlement to service connection for coronary artery disease is granted. FINDINGS OF FACT 1. The Veteran’s DD form 214 establishes that he served in the Republic of Vietnam during the Vietnam era, and therefore, is presumed to have been exposed to herbicide agents. 2. The most probative evidence establishes that the Veteran has been diagnosed with coronary artery disease to a compensable degree within the appellate period, which is presumptively linked to in-service herbicide agent exposure. CONCLUSION OF LAW The criteria for entitlement to service connection for coronary artery disease are met. 38 U.S.C. §§ 1110, 1116; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from June 1968 to August 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2016 rating decision issued by a Regional Office (RO) of the United States Department of Veterans Affairs (VA) In the January 2017 substantive appeal, the Veteran waived his right to an optional Board hearing. The undersigned Veterans Law Judge has been assigned to adjudicate this appeal pursuant to 38 C.F.R. § 19.3(a). Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing service connection on a direct basis requires evidence demonstrating: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called “nexus” requirement. See id.; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Additionally, service connection for certain diseases, including coronary artery disease (characterized as ischemic heart disease), may be granted based on presumed exposure to certain herbicide agents—even though there is no record of such disease during service—if manifested to a compensable degree or more at any time after service. Presumed exposure to an herbicide agent applies to any veteran who had active military, naval, or air service for at least 90 days, during the period beginning on January 9, 1962 and ending on May 7, 1975, in the Republic of Vietnam or other locations if the conditions of service involved duty or visitation in Vietnam. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e), 3.313. “Service in the Republic of Vietnam” includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 C.F.R. § 3.307(a)(6)(iii). The Veteran’s DD form 214 confirms that the Veteran served in the Republic of Vietnam from July 17, 1969 until January 1, 1971; thus, he is presumed to have been exposed to herbicide agents during his active duty service. The dispositive issue in this appeal is whether the Veteran has carried a current disability of coronary artery disease within the appellate period. The Veteran’s VA treatment notes document a long history of chronic chest pains, medically managed and under observation by a private cardiologist. In January 2016, the Veteran underwent a cardiac stress test. Based on the results of this diagnostic testing, the Veteran’s private cardiologist diagnosed him with coronary artery disease, native, and chest pain. In April 2016, a VA examiner reviewed the results of the January 2016 stress test and opined that the results “DID NOT show changes consistent with ischemia. [T]he perfusion imaging was normal. [N]o other regional wall abnormalities.” (emphasis in original). The VA examiner concluded that the Veteran did not have evidence of coronary artery disease, as his stress test and echocardiogram were both normal. The VA examiner noted that the Veteran had not undergone cardiac catheterization to confirm the presence of coronary artery disease, and that a December 2011 CT scan showing coronary calcifications was not diagnostic or specific for the presence of coronary artery disease. The April 2016 VA examiner declined to diagnose the Veteran with an active cardiac diagnosis. Despite the April 2016 VA examiner’s conclusions, a subsequent June 2016 CT coronary angiograph showed that the Veteran’s right coronary artery was heavily calcified in the proximal portion eccentrically, suggesting a moderate to severe degree of obstruction. The CT angiograph also revealed that the left anterior descending artery had diffuse calcific plaque proximally, suspicious for obstructive narrowing. Based on these diagnostic reports, the Veteran underwent placement of stents in the right coronary artery and the left anterior descending artery. The Veteran’s VA treatment records document a diagnosis of coronary artery disease beginning in August 2016. After a comprehensive review of the medical evidence, the Board finds that the Veteran has carried an active diagnosis of coronary artery disease within the appellate period, sufficient to warrant presumptive service connection under 38 C.F.R. §§ 3.307(a)(6), 3.309(e). The Board grants more evidentiary weight to the Veteran’s private cardiologist’s January 2016 diagnosis of coronary artery disease over the April 2016 VA examiner’s conclusion that the Veteran had no cardiac diagnosis. The private cardiologist has trained and specialized in nuclear cardiology, indicating he has significant experience interpreting cardiac diagnostic test results, so there is no reason to accord his opinion less weight. Moreover, the rationale for the VA examiner’s negative opinion was the lack of diagnostic testing confirming artery disease, yet following the Veteran’s June 2016 CT coronary angiograph results, and subsequent stenting of his heart, the VA treatment records show diagnosis of coronary artery disease. This also weighs against the VA examiner’s conclusion. The evidence further establishes that the Veteran’s coronary artery disease is treated with continuous medication, thereby establishing that this disability has manifested to a compensable degree under Diagnostic Code 7005 within the appellate period. See August 2016 VA treatment records prescribing clopidogrel, as well as amlodipine besylate. At a minimum, there is sufficient medical evidence to place the case in equipoise as to whether the Veteran has been diagnosed with coronary artery disease to a compensable degree within the appellate period. Since he is presumed to have been exposed to herbicide agents during his Vietnam service, entitlement to service connection is granted on a presumptive basis. 38 U.S.C. §§ 1110, 1116; 38 C.F.R. §§ 3.303, 3.307(a)(6), 3.309(e). MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Galante, Associate Counsel