Citation Nr: 21073519 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 20-06 574 DATE: December 8, 2021 ORDER Entitlement to service connection for coronary artery disease is granted. Entitlement to service connection for diabetes mellitus, type II is granted. REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected coronary artery disease, is remanded. Entitlement to service connection for shortness of breath, to include as secondary to service-connected coronary artery disease, is remanded. Entitlement to service connection for valvular heart disease, to include as secondary to service-connected coronary artery disease, is remanded. Entitlement to service connection for cardiac dysrhythmia, to include as secondary to service-connected coronary artery disease, is remanded. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran's favor, he was exposed to herbicide agents during service, and his coronary artery disease is related to that exposure. 2. Resolving reasonable doubt in the Veteran's favor, he was exposed to herbicide agents during service, and his diabetes mellitus, type II is related to that exposure. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for coronary artery disease are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for diabetes mellitus, type II are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from December 1955 to June 1962, and from June 1966 to December 1977. He testified before the undersigned Veterans Law Judge during a September 2021 hearing. This matter is on appeal from an August 2018 rating decision. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). If a Veteran was exposed to an "herbicide agent," such as Agent Orange, used in support of the United States and allied military operations in the Republic of Vietnam from January 9, 1962, to May 7, 1975, then, absent affirmative evidence to the contrary, certain diseases, including ischemic heart disease (which includes coronary artery disease) and diabetes mellitus, type II, will be presumptively service connected even if there is no record of the disease in service. 38 U.S.C. §§ 1110, 1116; 38 C.F.R. §§ 3.307(a)(6), (d), 3.309(e). For United States Air Force Veterans serving at certain Royal Thai Air Bases (RTAFB) during the Vietnam era, including U-Tapao, herbicide exposure should be acknowledged on a facts found or direct basis if the Veteran served at one of the air bases as a security policeman, a security patrol dog handler, a member of a security police squadron, or otherwise served near the air base perimeter, as shown by military occupational specialty (MOS), performance evaluations, or other credible evidence. Special consideration is to be given to Veterans whose duties placed them on or near the perimeter of Thailand military bases. See also 38 C.F.R. § 3.307(a)(6)(ii). 1. Entitlement to service connection for ischemic heart disease 2. Entitlement to service connection for diabetes mellitus, type II The Veteran contends that he was exposed to herbicide agents in service. He testified that the barracks at U-Tapao were close to the perimeter of the base. He also testified that he and other service members would sit by the perimeter and socialize after work. September 2021 Hearing Transcript at 7-8. The Veteran's service in Thailand is conceded. See August 2018 rating decision. The Veteran is competent and credible to report that he spent time near the perimeter of U-Tapao base. There is no affirmative evidence contradicting the Veteran's assertions of being near the perimeter. Therefore, based on the Veteran's competent and credible testimony, the Board of Veterans' Appeals (Board) finds that he was exposed to herbicide agents while stationed at U-Tapao. Private disability benefits questionnaires (DBQs) dated in May 2017 reflect current diagnoses of coronary artery disease and diabetes mellitus, type II. Since the Board finds that the Veteran was exposed to herbicide agents, and as coronary artery disease and diabetes mellitus, type II are presumptively related to such exposure, service connection is granted. REASONS FOR REMAND 1. Entitlement to service connection for hypertension, to include as secondary to service-connected coronary artery disease, is remanded. 2. Entitlement to service connection for shortness of breath, to include as secondary to service-connected coronary artery disease, is remanded. 3. Entitlement to service connection for valvular heart disease, to include as secondary to service-connected coronary artery disease, is remanded. 4. Entitlement to service connection for cardiac dysrhythmia, to include as secondary to service-connected coronary artery disease, is remanded. The Veteran asserts that his hypertension, shortness of breath, valvular heart disease, and cardiac dysrhythmia are secondary to his now service-connected coronary artery disease. In light of the Board's grant, remand is necessary to provide the Veteran with a VA examination to determine the etiology of these disorder. In this regard, while a July 2018 VA examiner opined that hypertension is not caused by ischemic heart disease, no rationale was provided, nor did the examiner opine as to whether hypertension is aggravated by heart disease. Consequently, the opinion is not adequate. The matters are REMANDED for the following action: 1. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), make efforts to obtain all records identified by the Veteran, including any outstanding VA treatment records. 2. Schedule the Veteran for a VA examination by an appropriate clinician to determine the etiology of any diagnosed hypertension, shortness of breath, valvular heart disease, and cardiac dysrhythmia. (Multiple examinations may instead be conducted; the Board leaves this to the discretion of the Agency of Original Jurisdiction (AOJ) and the facility at which any examination is to be conducted.) The most up-to-date Disability Benefits Questionnaire(s) should be utilized. For any hypertension, shortness of breath, valvular heart disease, and cardiac dysrhythmia diagnosed, the examiner(s) is requested to review the record and offer an opinion as to whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that any diagnoses are related to the Veteran's military service, including his exposure to herbicide agents, or are caused or aggravated by the service-connected coronary artery disease. (If hypertension, shortness of breath, valvular heart disease, and/or cardiac dysrhythmia are found to have been aggravated by the service-connected coronary artery disease, the examiner should quantify the approximate degree of aggravation.) With regard to the Veteran's hypertension, the examiner should consider discuss the National Academy of Sciences (NAS) Institute of Medicine's conclusion that there is "sufficient evidence of an association" between herbicide exposure and hypertension. See NAS, Veterans & Agent Orange: Update 11 (2018). According to NAS, "[t]he sufficient category indicates that there is enough epidemiologic evidence to conclude that there is a positive association" between hypertension and herbicide agent exposure. A complete rationale should be given for all opinions and conclusions expressed. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Barstow, 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.