Citation Nr: A21020403 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 191217-154820 DATE: December 22, 2021 ORDER Entitlement to service connection for a heart disorder, including coronary artery disease, is granted. FINDING OF FACT The evidence of record, viewed in total, reflects a diagnosis of coronary artery disease. CONCLUSION OF LAW The criteria for service connection for a heart disorder, including coronary artery disease, have been met. 38 C.F.R. §§ 3.307, 3.309(e). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1962 to June 1972. The Veteran died during the pendency of the appeal. The Appellant is his surviving spouse. This matter is before the Board of Veterans' Appeals (Board) on appeal of an August 2018 rating decision of the Department of Veterans Affairs (VA). On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (to be codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). This law creates a new framework for Veterans dissatisfied with VA's decision on their claim to seek review. In December 2019, the Veteran submitted a VA Form 10182 (Decision Review Request: Board (Notice of Disagreement)) and selected the AMA Hearing Board review option, subsequent to initiating a legacy appeal on an August 2018 rating decision. Accordingly, the Board may only consider the evidence of record at the time of the December 2019 Statement of the Case regarding the claimed for a heart disorder, as well as any evidence submitted at the hearing or within 90 days thereof. 38 C.F.R. § 20.302(a). Subsequently, the Board was notified that the Veteran died in March 2021. That same month, the Veteran's surviving spouse submitted a claim for Dependency and Indemnity Compensation (DIC). A claim for accrued benefits, survivors' pension, or DIC benefits by an eligible person is deemed to include a request to substitute if a claim for periodic monetary benefits, or an appeal of a decision with respect to such claim, was pending before the agency of original jurisdiction or the Board when the claimant died. See 38 C.F.R. § 3.1010(c)(2). The Veteran's surviving spouse was substituted as the Appellant for the purpose of processing the Veteran's claim to completion. See Breedlove v. Shinseki, 24 Vet. App. 7 (2010). The Appellant appeared at a hearing before the undersigned Veterans Law Judge in August 2021. A transcript of the hearing is in the Veteran's file. Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). VA laws and regulations provide that a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam war (i.e., January 9, 1962, to May 7, 1975), shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence to the contrary. 38 U.S.C. § 1116(a)(3); 38 C.F.R. § 3.307(a)(6)(iii). The Veteran's service in Vietnam is confirmed; therefore Agent Orange exposure is conceded. See also June 2021 Rating Decision. The Veteran contended that he was entitled to service connection for a heart disorder. The Board notes that effective August 31, 2010, ischemic heart disease (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 Prinxmetal's angina), is included as a disease associated with herbicide exposure under 38 C.F.R. § 3.309(e). A veteran is entitled to a presumption of service connection if he is diagnosed with coronary artery disease associated with exposure to certain herbicide agents, if he served in the Republic of Vietnam during the prescribed period. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e). A review of the record shows that prior to the submission of the VA Form 10182, the Veteran was afforded a VA examination in June 2018. A diagnosis of heart disease with mitral valve insufficiency was provided. While the examiner noted that the Veteran's heart conditions did not qualify within the generally accepted medical definition of ischemic heart disease, no explanation for this conclusion was provided. Daily doses of diltiazem medication, not indicated to control hypertension, hyperlipidemia, and/or prophylaxis, were noted. The Veteran was also noted to take three medications for hypertension and one for hyperlipidemia. The echocardiogram results showed an abnormal left ventricular ejection fraction. Also indicated was that the Veteran had metabolic equivalents (METs) results of greater than 3-5 METs with activities such as light yard work and brisk walking. It was noted that the METs level was due solely to the heart condition. Mitral, tricuspid, aortic, and pulmonary regurgitation was noted. A private medical record associated with the Veteran's claims file in August 2021, within 90 days after the Appellant's hearing, shows that in March 2021, the Veteran had a history of sudden cardiac arrest with uncertain initial rhythm and a history of coronary artery disease status post left circumflex with stenting. It was noted that the Veteran was on Warfarin. This record reflects treatment at the time of death. Viewing all of this evidence in total, the Board finds that the preponderance of the evidence supports a finding of coronary artery disease at the time of death. The June 2018 VA examination report contains a notation that no ischemic heart disease was shown, but no explanation is given for this conclusion. An explanation in this case would have been particular important, given the Veteran's medications, echocardiogram findings, METs findings, and echocardiogram findings. These findings are all suggestive of a very significant heart disease picture. Moreover, the March 2021 treatment record indicates a sudden cardiac arrest and a history of coronary artery disease with stenting, and at that point the Veteran was taking Warfarin as well. This evidence, taken as a whole, supports the conclusion that the Veteran had coronary artery disease at the time of death. Given his exposure to Agent Orange and the applicable VA regulations, the Board finds that service connection is warranted on a presumptive basis, and the claim is granted. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Evans, A-L 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.