Citation Nr: 20040108 Decision Date: 06/11/20 Archive Date: 06/11/20 DOCKET NO. 17-65 693 DATE: June 11, 2020 REMANDED Service connection for a cardiovascular disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1968 to March 1972. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2016 rating decision. In March 2020, the Veteran testified before the undersigned at a videoconference hearing. Cardiovascular Disorder Prior to adjudication, the Board finds that additional development is necessary. The Veteran contends he has a cardiovascular disorder as secondary to lung scars, but he is not service-connected for any such scars (he is service-connected with a noncompensable rating for a left arm scar resulting from the removal of a cyst). He alternatively contends, however, that he has a cardiovascular disorder due to exposure to herbicides such as Agent Orange while serving on the USS Sacramento in the waters off the Republic of Vietnam (RVN). Service personnel records confirm that he was stationed aboard the USS Sacramento for almost all of his service. They additional confirm that this included time in the Vietnam Combat Zone. While available VA treatment records do not document a diagnosis of any heart disorder, they reveal that the Veteran has hypertension. These available VA treatment records are dated only through September 2017. As the Veteran testified that he receives no private health care, more updated VA treatment records very likely exist. Attempts must be made to obtain them. 38 U.S.C. § 5103A(c), 38 C.F.R. § 3.159(c)(2); Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). Indeed, it is particularly important to determine whether the Veteran has a cardiovascular disorder other than hypertension. This is because service connection for ischemic heart disease is presumed based on herbicide exposure during service in the RVN between January 9, 1962, to May 7, 1975. 38 U.S.C. §§ 1116(a)(1), (f); 38 C.F.R. §§ 3.307(a)(6); 3.309(e). Ischemic heart disease includes various myocardial infarctions, coronary artery disease, and various anginas. 38 C.F.R. § 3.309(e). Yet it does not include hypertension. Id., Note (2). Service in the RVN previously included serving aboard a ship in the country’s inland waters. 38 C.F.R. § 3.307(a)(6)(iii); Haas v. Peake, 525 F.3d 1168, 1180-1183 (Fed. Cir. 2008). It also now includes service aboard a ship offshore, defined as not more than 12 nautical miles away. 38 U.S.C. § 1116A (effective January 1, 2020); Procopio v. Wilkie, 913 F.3d 1371, 1380-1381 (Fed. Cir. 2019) (overruling Haas). This 12 nautical mile area has been demarcated by geographic names as well as latitude north and longitude east coordinates of various points. 38 U.S.C. § 1116A(d). A determination must be made as to whether the Veteran served within this area, even if hypertension is his only relevant diagnosis. Direct service connection based on herbicide exposure indeed is possible, even if presumptive service connection on this basis is precluded. Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed.Cir.1994). Finally, arrangements must be made for a VA medical opinion to be rendered if the Veteran’s ship is found to have been within 12 nautical miles of the RVN such that he was exposed to herbicides during service. Nothing further that the aforementioned development is required to adjudicate service connection for a cardiovascular disorder that qualifies as ischemic heart disease. Yet for his diagnosed hypertension and any other diagnoses that do not fall qualify as ischemic heart disease, the medical evidence is insufficient to determine if there is a nexus to in-service herbicide exposure. 38 U.S.C. § 5103A(d), 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Whether arrangements also should be made for an accompanying VA medical examination is left to the discretion of the clinician assigned to draft the opinion, particularly in light of the ongoing coronavirus pandemic. This matter is REMANDED for the following action: 1. Follow established procedure for obtaining the Veteran’s VA treatment records dated from September 2017 to present. 2. Use information from all appropriate sources, determine whether the Veteran served within 12 nautical miles of the RVN (as demarcated in 38 U.S.C. § 1116A(d)). 3. After completing paragraphs 1 and 2, and assuming the Veteran is found to have served within 12 nautical miles of the RVN, arrange for a qualified clinician to render a VA medical opinion. Whether another examination is needed during the ongoing coronavirus pandemic is left to this clinician’s discretion. The clinician specifically shall review the claims file and opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s hypertension and any other diagnosed cardiovascular disorder that does not qualify as ischemic heart disease is related to herbicide exposure during service. A detailed explanation is required to support each opinion. This means that medical principles and/or literature should be discussed as it relates to facts specific to the Veteran, as shown by the medical and non-medical/lay evidence. 4. Then readjudicate service connection for a cardiovascular disorder, to include hypertension and any other relevant diagnosis. If the claim remains denied, follow established procedure for returning it to the Board. Thomas H. O’Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Becker 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.