Citation Nr: 20009880 Decision Date: 02/05/20 Archive Date: 02/05/20 DOCKET NO. 17-20 546 DATE: February 5, 2020 ORDER Entitlement to service connection for coronary artery disease (CAD) is granted. Entitlement to service connection for bilateral hearing loss is granted. FINDINGS OF FACT 1. The evidence of record is evenly balanced as to whether the Veteran has CAD (as opposed to non-obstructive CAD); in-service herbicide exposure has been established. 2. The Veteran’s bilateral hearing loss is etiologically related to his active service. CONCLUSIONS OF LAW 1. The criteria to establish service connection for CAD have been met. 38 U.S.C. §§ 1110, 5107(b) (West 2012); 38 C.F.R. § 3.309(e) (2018). 2. The criteria to establish service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1110, 5107(b) (West 2012); 38 C.F.R. §§ 3.303, 3.385 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from December 1967 to December 1970. In December 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is associated with the file. Service Connection 1. Entitlement to service connection for CAD Having reviewed the evidence of record, the Board finds that the evidence is evenly balanced as to whether service connection for CAD is warranted. Resolving any reasonable doubt in the Veteran’s favor, service connection is therefore established. 38 U.S.C. § 5107(b). VA laws and regulations provide that if a Veteran was exposed to Agent Orange during service, certain listed diseases are presumptively service-connected. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.309(e). In the case at hand, the Veteran’s in-service herbicide exposure has been conceded. See June 2014 Rating Decision. As to presumptive conditions, 38 C.F.R. § 3.309(e) lists the diseases covered by the regulation. That list includes ischemic heart disease (to include CAD). However, the issue at hand is whether the Veteran has CAD. The record reflects a diagnosis for non-obstructive CAD, as noted in a June 2014 VA heart exam report. The June 2014 VA examiner also indicated that the Veteran does not have ischemic heart disease. The examiner cited a June 2013 report signed by a cardiologist indicating non-obstructive CAD. As to this notation, the Regional Office reasoned that the cardiologist diagnosed non-obstructive coronary artery with no signs of ischemia on objective cardiac testing, and because this heart condition is not a form of ischemic heart disease, this condition is not one of the chronic diseases that the VA has conceded as associated with exposure to certain herbicide agents. However, the June 2014 assessment is not entirely adequate. At the outset, the Board notes that the June 2014 VA assessment was not based on objective cardiac testing. Instead, the examiner reviewed the record and indicated a diagnosis per treatment reports of record. Specifically, the June 2014 VA examiner noted a June 2013 diagnosis for non-obstructive CAD. However, the VA examiner did not address diagnoses of record indicating CAD (with no indication as non-obstructive). For example, while some treatment notes list the Veteran’s CAD as non-obstructive, other reports of record only indicate CAD. Because the Veteran had both diagnoses during the appeal period, the June 2014 VA examiner needed to address the diagnosis for CAD as well and whether it was accurate or in error. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). While this is a medical determination, the Board does not find that remand is necessary. As the record reflects a diagnosis for CAD, the Board resolves any reasonable doubt in the Veteran’s favor and determines that he has a qualifying disability. As such, service connection for CAD as due to herbicide exposure is granted. 2. Entitlement to service connection for bilateral hearing loss Service connection for hearing loss is established. The record reflects a current diagnosis for bilateral hearing loss. As to in-service noise exposure, the Board acknowledges that the Veteran’s military occupation specialty as a stock clerk does not have a high probability of noise exposure. However, he asserts that his duties also exposed him to ammo explosions in service. See August 2014 Notice of Disagreement. The Board has no reason to doubt the credibility of these assertions and also note that they are consistent with the nature of serving during a war. As such, in-service noise exposure is conceded, and the remaining issue is a nexus. Regarding a nexus, a June 2015 VA opinion negates a link between the Veteran’s hearing loss and his active service. However, as the examiner failed to address the Veteran’s lay reports, i.e. those of ammo exposure, the opinion is not adequate. While there is also no positive opinion of record linking the Veteran’s hearing loss to his active service, the Veteran has indicated, in sum, that he has been suffering from symptoms of hearing loss starting in service and continuing to the present day. In weighing the Veteran’s statements, the Board notes that he is competent to assert the presence of symptoms subject to lay observation. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board also has no reason to doubt the credibility of the Veteran’s statements and as such finds them probative. Given the Veteran’s credible statements of continuing symptoms and the lack of an adequate negative nexus opinion, the Board finds that service connection for bilateral hearing loss is warranted. See 38 C.F.R. § 3.303(a) (service connection must be considered on the basis of the places, types, and circumstances of his service as shown by his service records, the official history of each organization in which he served, his medical records, and all pertinent medical and lay evidence). Accordingly, the appeal for service connection for bilateral hearing loss is granted. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Smith, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.