Citation Nr: 18123714 Decision Date: 08/02/18 Archive Date: 08/02/18 DOCKET NO. 15-27 851 DATE: August 2, 2018 REMANDED Entitlement to service connection for arteriosclerosis, to include as secondary to exposure to herbicide agents, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1969 to May 1971. In February 2018, the Veteran testified in a videoconference hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is of record and has been reviewed. The Board acknowledges that the claims file contains an October 2006 denying service connection for coronary artery disease. Thereafter, in August 2011, the RO reconsidered the claim pursuant to the litigation in Nehmer v. Department of Veterans Affairs, but continued to deny the claim, finding that the Veteran did not have a heart disability that had a positive association with exposure to herbicide agents. In December 2015, the RO reopened and denied the claim this time indicating there was no diagnosed disability. In a statement in support of claim dated in October 2005, the Veteran indicated that he suffered from conditions such as “CAD (I had a stroke).” During his February 2018 Board hearing, the Veteran testified that his claim for arteriosclerosis of the carotid artery intended to include the heart as well. Given the procedural and medical history, the Board recharacterizes the claim to one of service connection for arteriosclerosis, regardless of what artery is affected. To the extent that the recharacterization of the claim includes arteriosclerosis of the heart, the Board finds that the Veteran’s hearing testimony is new and material to the claim, allowing for the claim to be reopened. After a careful review of the record, the Board finds that a remand is necessary in order to provide the Veteran with a new VA examination. Notably, the record contains April 2011 and December 2015 VA examinations for heart disabilities, which contain conflicting evidence as well as conflicting evidence in the medical treatment records. Notably, the April 2011 VA examiner indicated that the Veteran had had a stroke in 2000 and that his “adenosine stress test was not consistent with ischemic heart.” Though, according to a December 2015 VA examination report, the diagnosis was coronary artery disease since December 3, 2001; however, later in the same examination report, the examiner noted that the Veteran had no heart condition that qualify within the generally accepted medical definition of ischemic heart disease (IHD). Moreover, numerous VA medical treatment records document abnormal T-wave with possible “inferolat[eral] ischemia,” ischemic changes, CAD, and a MRI dated in December 2001 showing “an ischemic stroke in the pontine area.” Accordingly, the Board finds that a comprehensive VA examination is necessary to determine the nature and etiology of any relevant disabilities. The matter is REMANDED for the following action: 1. Ensure that all outstanding VA treatment records are associated with the claims file. 2. Thereafter, provide the Veteran with an appropriate VA examination to the determine the nature and etiology of any currently diagnosed arteriosclerosis. After a complete review of the record and examination of the Veteran, the examiner is asked to respond to the following: (a) Indicate whether the Veteran has had a stroke/ residual thereof, or arteriosclerosis of the carotid arteries since the date of claim. See earlier 2001 private records showing diagnosis of ischemic stroke. (b) Indicate whether the Veteran has had coronary artery disease/ischemic heart disease since the date of claim. (c) For each currently diagnosed disability, provide an opinion whether it is at least as likely as not (50 percent or greater probability) related to the Veteran’s active duty service, including conceded exposure to herbicide agents in Vietnam. (d) Provide an opinion as to any etiological relationship between any currently diagnosed coronary artery disease and arteriosclerosis of the carotid arteries. Also in rendering the CVA opinion, the VA examiner is advised that the NAS IOM’s Veterans and Agent Orange: Update 2012, concluded that there was “limited or suggestive” evidence of an association between herbicide exposure and CVAs/strokes. See Nat’l Acad. of Sci., Inst. of Med., Veterans & Agent Orange: Update 2012; see also Notice, 79 Fed. Reg. 20,308 - 20,313 (2014). The examiner should provide a complete rationale for all opinions. 3. Then, readjudicate the claim on appeal. If the benefits on appeal remain denied, furnish the Veteran and his representative with a copy of a supplemental statement of the case and allow an appropriate time for response. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Yaffe, Associate Counsel