Citation Nr: 20021171 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 17-23 906 DATE: March 24, 2020 REMANDED Entitlement to service connection for a kidney disorder, claimed as renal cysts, as due to herbicide exposure is remanded. Entitlement to service connection for a heart condition, claimed as coronary artery disease, as due to herbicide exposure is remanded. REASONS FOR REMAND The Veteran served in the United States Army from August 1967 to April 1969, including service in the Republic of Vietnam (RVN) during the Vietnam era. This appeal comes to the Board of Veterans’ Appeals (Board) from a Department of Veterans Affairs (VA) July 2014 rating decision of the Agency of Original Jurisdiction (AOJ). 1. Entitlement to service connection for a kidney disorder, claimed as renal cysts, as due to herbicide exposure is remanded. 2. Entitlement to service connection for a heart condition, claimed as coronary artery disease, as due to herbicide exposure is remanded. The Veteran contends that his kidney and heart conditions are the result of being exposed to herbicide agents, such as Agent Orange while in deployed to the RVN. The Board notes that the evidence of record shows that the Veteran was in the RVN during the Vietnam era, and thus exposure to herbicide agents is conceded. Service connection generally requires (1) evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) competent evidence of a causal relationship, or nexus, between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). If a veteran was exposed to herbicide agents during active military, naval, or air service, certain specified diseases, such as ischemic heart disease, may be service connected if the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § § 3.307 (a)(6)(iii) are met, even though there is no record of such disease during service. 38 C.F.R. §§ 3.307 (d), 3.309(e). However, the Board notes that the Veteran in the past he experienced strokes and has had several surgeries to implant stents into his heart. The Veteran has been diagnosed with hypertension. Medical records from 2002 through 2009 show that the Veteran has been treated for coronary artery disease, but recent medical records do not show a diagnosis of that condition. Furthermore, the Veteran has been diagnosed with cystic kidney disease, but that condition is not presumed to be the result of exposure to herbicide agents. While the Veteran is competent to provide lay testimony regarding contemporary medical diagnoses, the etiology of cystic kidney disease is a complex medical determination that can only be made by a qualified professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this case, the AOJ denied the Veteran's claim, in part, based on his assertion of presumptive service connection as due to herbicide agent exposure while stationed in the RVN. However, there is an important consideration even if the Veteran does not have a qualifying condition for presumptive service connection.. Significantly, a claimant is not precluded from establishing service connection for a disease claimed to be related to herbicide agent exposure, as long as there is proof of such direct causation. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Based on the foregoing, the Board finds that a remand is necessary to fully develop the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate examiner with sufficient expertise in cardiac diseases to determine whether the Veteran has ischemic heart disease, coronary artery disease, or any other diagnosed heart condition. The examiner shall be provided a copy of the entire claims file as well as a copy of these remand directives. The examiner shall provide the following opinions: (a.) If the Veteran has a diagnosed heart condition that is not presumptively caused by exposure to herbicide agents such as ischemic heart disease (defined by regulation as including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina), is it as least as likely as not (50 percent chance or greater) that the diagnosed heart condition was incurred in service to include due to exposure to herbicide agents in service. The examiner shall address the Veteran’s medical records showing past treatment for coronary artery disease. The examiner shall provide a detailed rationale for all medical opinions provided. If an opinion cannot be rendered without resorting to mere speculation, the examiner shall explain why that is the case. 2. Schedule the Veteran for an examination by an appropriate examiner with sufficient expertise in renal diseases to determine the etiology of the Veteran’s cystic kidney disease. The examiner shall be provided a copy of the entire claims file as well as a copy of these remand directives. The examiner shall provide the following opinions: (a.) Whether it is as least as likely as not (50 percent chance or greater) that the Veteran’s cystic kidney disease was incurred in or is a result of his service to include in-service exposure to herbicide agents. The examiner shall provide a detailed rationale for all medical opinions provided. If an opinion cannot be rendered without resorting to mere speculation, the examiner shall explain why that is the case. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Neville, 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.