Citation Nr: 21065993 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 16-56 613 DATE: October 28, 2021 ORDER Entitlement to service connection for cardiomyopathy, to include as related to toxic herbicide exposure, is granted. Entitlement to service connection for kidney failure, to include as secondary to cardiomyopathy, is granted. FINDINGS OF FACT 1. The Veteran's cardiomyopathy was etiologically related to service. 2. The Veteran's kidney failure was proximately due to his cardiomyopathy. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for cardiomyopathy, to include as related to toxic herbicide exposure, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.1000. 2. The criteria for entitlement to service connection for kidney failure, to include as secondary to cardiomyopathy, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.1000. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1963 to June 1967. He died in February 2017. At the time of the Veteran's death, he had an appeal pending regarding entitlement to service connection for a heart condition and kidney failure. The appellant is his surviving spouse. The Board recognizes the appellant's desire to opt-in to the RAMP program. However, as the Veteran's appeal had already been certified to the Board it was not eligible for the RAMP program. As such, the appeal with be processed under the Legacy system. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. §§ 3.303(a), 3.304, 3.307, 3.309, 3.310. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). VA regulations state that a veteran who served in the Republic of Vietnam during the period from January 9, 1962 to May 7, 1975, shall be presumed to have been exposed to toxic herbicides during such service. 38 C.F.R. § 3.307(a)(6)(iii). Service connection is warranted for Ischemic Heart Disease where a veteran has been exposed to toxic herbicide agents during active military service. In fact, service connection is warranted even if the disorder was not shown during active duty. 38 C.F.R. § 3.309(e). A non-presumptive disease may still be entitled to service connection on a direct basis if the medical evidence supports a relationship between that disease and exposure to an herbicide agent. Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). 1. Entitlement to service connection for cardiomyopathy. 2. Entitlement to service connection for kidney failure. The appellant contends that the Veteran's cardiomyopathy and resulting chronic renal failure are attributable to active service. After a review of the evidence, the Board finds that service connection is warranted. In this case, exposure to toxic herbicide agents during service in the Republic of Vietnam is conceded. In April 1999, the Veteran underwent a heart transplant secondary to dilated cardiomyopathy. It is unclear from the medical evidence whether the Veteran's cardiomyopathy qualified as Ischemic Heart Disease (IHD) for the purposes of the presumption. The Veteran was afforded a VA examination in June 2014. Unfortunately, the opinion only focused on the residuals of the Veteran's heart transplant and did not address whether the underlying cardiomyopathy qualified as IHD. Fortunately, a new VA examination is not necessary as the Board finds that service connection is warranted on a direct basis. The Veteran submitted a positive nexus opinion from his private treatment provider in February 2015 expressing a link between his cardiomyopathy and exposure to toxic herbicides in service. The Board finds this opinion as persuasive as any negative evidence of record. As the evidence is in relative equipoise, the Board affords the Veteran the benefit of the doubt and finds that a nexus has been established between his cardiomyopathy and active service. As to the Veteran's kidney failure, medical records from July 2014 clearly show that the Veteran's end stage renal failure was a direct result of his cardiomyopathy induced heart transplant. As such, service connection is warranted on a secondary basis. In summary, after resolving all doubt in the Veteran's favor, the Board finds that the Veteran's cardiomyopathy and resulting kidney failure are directly related to active service. See Gilbert v. Derwinski, 1 Vet. App. 49, 5557 (1990). Accordingly, the claim is granted. 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. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Daniel Ballinger, Associate Counsel