Citation Nr: 20030164 Decision Date: 04/29/20 Archive Date: 04/29/20 DOCKET NO. 19-12 621 DATE: April 29, 2020 ORDER Service connection for coronary artery disease (also claimed as myocardial infarction and peri-infarct and heart disease) is granted. Service connection for Parkinson’s disease is granted. REMANDED Service connection gastroesophageal reflux disease (GERD) is remanded. Service connection for hypertension is remanded. Service connection for sleep apnea is remanded. Service connection for traumatic brain injury (TBI) is remanded. Service connection for urinary tract infection is remanded. Service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depression, is remanded. Whether new and material evidence has been submitted to reopen a claim for a spine disorder, to include degenerative spine acute arthritis (now claimed gait and joints), is remanded. FINDINGS OF FACT 1. Resolving all doubt in favor of the Veteran, coronary artery disease is etiologically related to the Veteran’s service. 2. Resolving all doubt in favor of the Veteran, Parkinson’s disease is etiologically related to the Veteran’s service. CONCLUSIONS OF LAW 1. The criteria for service connection for coronary artery disease have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for Parkinson’s disease have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty from June 1966 to June 1969. This matte comes on appeal from a November 2016 rating decision. The Board notes that in a March 2019 rating decision, the RO granted service connection for allergic rhinitis. That matter is not before the Board. Service Connection Entitlement to service connection for (1) coronary artery disease and (2) Parkinson’s disease. The Veteran contends that he developed coronary artery disease and Parkinson’s disease due to herbicide agent exposure, including Agent Orange, during service in Thailand during the Vietnam Era. The Veteran has a current diagnoses of coronary artery disease (as indicated in VA medical records and a January 2014 private medical record by Dr. S.P.H.) and Parkinson’s disease (as indicated in a November 2018 letter by private physician Dr. R.S.B.). As such, the question before the Board is whether it is etiologically related to service. Regulations provide that if a veteran was exposed to an herbicide agent during active service, presumptive service connection is warranted for ischemic heart disease. 38 C.F.R. § 3.309(e). Helpful, but non-binding, guidance by VBA Manual M21-1, IV.ii.1.H.5.b. shows that a declassified Department of Defense report written in 1973, Project CHECO Southeast Asia Report: Base Defense in Thailand 1968-1972, contained evidence that there was a significant use of herbicides on the fenced-in perimeters of military bases in Thailand to remove foliage that provided cover for enemy forces. VA determined that herbicides used on the Thailand base perimeters may have been tactical and procured from Vietnam, or a strong, commercial type resembling tactical herbicides. The Veteran has provided several statements attesting to exposure to Agent Orange in Thailand. Service personnel records and the Veteran’s statements, such as from June 2005, indicate that he was sent to multiple bases while working as an engineer and in construction. In addition to working between different bases, the Veteran also indicated that they cleared land and put up a fence to build hooches, as indicated in a June 2015 lay statement. His service personnel records, such as unit histories, support those statements. Thus, while there is no definitive proof that the Veteran was in fact exposed to herbicides in service, given the place, type, and circumstances of his service and the fact that he is diagnosed with a disease associated with herbicide exposure, the case is at least in relative equipoise on the question of whether the Veteran’s coronary artery disease and Parkinson’s disease are due to in-service herbicide exposure. As such, resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran’s coronary artery disease and Parkinson’s disease are due to in-service herbicide agent exposure. As the Board is fully granting these claims, the Veteran is not prejudiced by the failure to obtain records noted in the Remand portion below for the other issues on appeal. Service connection for coronary artery disease and Parkinson’s disease is warranted. REASONS FOR REMAND The claims for service connection for: (1) GERD, (2) hypertension, (3) sleep apnea, (4) TBI, (5) urinary tract infection, (6) an acquired psychiatric disorder, to include PTSD and depression, (7) and a back disorder (on a new and material basis) are remanded. The records indicate that there may be outstanding and relevant Social Security Administration (SSA) records, as reported by the Veteran in a February 2017 statement and July 2009 VA medical record. Also, in a February 2019 statement, the Veteran indicated that he started receiving psychiatric treatment from VA in 2004. A remand is required to allow VA to request these records. Although the Veteran received a July 2016 VA examination, a new VA examination is necessary. The prior VA examination was inadequate as it did not clearly address the depressive disorder claim and mischaracterized the evidence of record. In a February 2020 correspondence, the Veteran’s attorney argued that hypertension developed due to herbicide agent exposure. A VA medical opinion should be obtained to address this claim. The matters are REMANDED for the following actions: 1. Obtain the Veteran’s federal records from (1) SSA and (2) any unassociated VA medical records, to specifically include any prior to April 2005. Document all requests for information as well as all responses in the claims file. If no such records exist, that fact should be clearly noted. 2. After the above development has been accomplished, schedule the Veteran for a psychiatric examination to determine the nature and etiology of any acquired psychiatric disorder. If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to a verified in-service stressor. If any other acquired psychiatric disorders are diagnosed, the examiner must opine whether each diagnosed disorder is at least as likely as not related to an in-service injury, event, or disease. 3. After the record development has been accomplished, obtain a VA medical opinion by an appropriate clinician to determine the nature and etiology of any hypertension. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including herbicide agent exposure. The need for an examination is left to the discretion of the opinion provider. The examiner is reminded that when a veteran is found not to be entitled to a regulatory presumption of service connection for a given disability the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis. The claims file should be reviewed and a full explanation as to any opinion reached should be provided. The provider should consider the February 2020 statement provided by the Veteran’s attorney addressing the claim. 4. Perform any additional development deemed warranted, to possibly include VA examination(s) if indicated. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Lindio 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.