Citation Nr: 18159304 Decision Date: 12/19/18 Archive Date: 12/18/18 DOCKET NO. 12-27 186A DATE: December 19, 2018 REMANDED Entitlement to service connection for cause of the Veteran’s death is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from February 1969 to January 1973, including combat service in Vietnam. He died in March 2011, and the appellant is his surviving spouse. This matter comes before the Board of Veterans’ Appeals (Board) from an October 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for cause of the Veteran’s death is remanded. The Veteran’s death certificate states his immediate cause of death was chronic obstructive pulmonary disease (COPD) disease, which the appellant attributes to herbicide agent exposure in Vietnam. The appellant further asserts that the Veteran’s heart problems caused or significantly contributed to his death. See November 2011 VA Form 21-4138, Statement in Support of Claim. The Veteran’s military occupational specialty (MOS) was medical assistant and he was aboard the USS Alamo (LSD-33) from July 1972 to October 1972, wherein he participated as a member of the TG 7615 ARG-B in contiguous waters off the Republic of Vietnam. See February 1973 Administrative Remarks in service personnel records. The USS Alamo is among the vessels identified as conducting troop, supply and equipment landings at Da Nang, Vung Tau, Song Bo De, An Thoi, and Tan My between August 1964 and October 1972. See Vietnam Era Navy Ship Agent Orange Exposure Development Site (last updated November 2, 2018). Given the Veteran’s MOS and service on the USS Alamo in 1972, the Board finds that he set foot in Vietnam and his exposure to herbicide agents during service is conceded. 38 C.F.R. § 3.307(a)(6)(iii). The Veteran was diagnosed with non-significant coronary artery disease in March 1987, and had a history of myocardial infarction continuously treated with medication. See March 1987 Private Hospital Discharge Summary; April 2010 letter from Dr. A.H.R. Ischemic heart disease, including myocardial infarction and coronary artery disease, is subject to presumptive service connection based upon conceded herbicide agent exposure if manifest to a compensable degree, as in this case. 38 C.F.R. §§ 3.307(a)(6)(ii), 3.309, 4.104, Diagnostic Codes 7005, 7006. Thus, on remand, an examiner should address whether the Veteran’s ischemic heart disease caused or contributed to his death, as well as whether his COPD had its onset in service or is otherwise related to service, including conceded herbicide agent exposure therein. The matter is REMANDED for the following action: Obtain a medical opinion as to the etiology of the Veteran’s death. The entire claims file and a copy of this REMAND should be made available to and reviewed by the examiner. The examiner must address the following questions: (a) Is it at least as likely as not (50 percent probability or more) that the Veteran’s fatal COPD had its onset in service or is otherwise related to service, to include presumed exposure to herbicide agents therein? In addressing this question, please discuss the November 1969 lung x-ray noting several calcified lesions as well as the April 2010 Dr. F.R. correspondence regarding the Veteran’s advanced chronic lung disease from his chronic smoking. Additionally, please do not rely solely on the lack of availability of presumptive service connection for COPD based on herbicide agent exposure to support a negative opinion, as that will be inadequate for rating purposes. (b) If not, is it at least as likely as not (50 percent probability or more) that the Veteran’s heart disease (coronary artery disease with history of myocardial infarction): (1) singly or jointly with some other condition, was the immediate or underlying cause of death or was etiologically related thereto; (2) contributed substantially or materially to the Veteran’s death; (3) combined with another disorder to cause death; and/or (4) aided or lent assistance to his death? In rendering this opinion, please specifically address the effects of the Veteran’s heart disability on a vital organ, and whether the heart disability had debilitating effects and general impairment of health that would render the Veteran less capable of resisting the effects of other disease or injury primarily causing death. A complete rationale must be provided for all opinions rendered. If you determine that you are unable to opine without resorting to speculation, please provide a basis for this conclusion. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Victoria L. Stephens, Associate Counsel