Citation Nr: 21009443 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 19-00 246 DATE: February 22, 2021 ORDER The claim of entitlement to service connection for ischemic heart disease is granted. REMANDED The claim of entitlement to service connection for a heart condition, to include complete blockage of the left subclavian artery, atherosclerosis, and carotid artery narrowing is remanded. FINDINGS OF FACT 1. The Veteran served in the Republic of Vietnam during the Vietnam era. 2. Resolving reasonable doubt in favor of the Veteran, evidence of record reflects a present diagnosis of ischemic heart disease. CONCLUSION OF LAW The criteria for entitlement to service connection for ischemic heart disease 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 FINDING AND CONCLUSION The Veteran had honorable active duty service with the United States Marine Corps from September 1963 to September 1967, to include service in the Republic of Vietnam. The instant matter is on appeal from a November 2016 rating decision. The Board previously denied these issues in an August 2019 decision. The Veteran moved to vacate the decision, and the Board granted this motion in December 2020. Thus, the issues have returned to the Board for readjudication. 1. The claim of entitlement to service connection for ischemic heart disease Generally, service connection will be granted for a disability resulting from an injury or disease caused or aggravated by service. 38 U.S.C. §§ 1110. A grant of service connection for a disability requires: (1) a present disability or persistent or recurrent symptoms of a disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (“nexus”) between the present disability and the in-service event, injury, or disease. 38 C.F.R. § 3.303; see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Absent affirmative evidence to the contrary, veterans who served in the Republic of Vietnam, including the territorial waters of Vietnam, during the Vietnam Era are presumed to have been exposed to certain herbicide agents. 38 U.S.C. §§ 1116, 1116A; 38 C.F.R. § 3.307; see also Procopio v. Wilkie, 913 F.3d 1371, 1376 (Fed. Cir. 2019). If a veteran was exposed to a herbicide agent (to include Agent Orange) during active service, the following diseases shall be service-connected if the requirements of 38 C.F.R. § 3.307 (a)(6) are met, even though there is no record of such disease during service, provided that the rebuttable presumption provisions of 38 C.F.R. § 3.307 (d) are also satisfied: AL amyloidosis, chloracne or other acneform disease consistent with chloracne, type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes), Hodgkin’s disease, 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 Prinzmetal’s angina), all chronic B-cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia), multiple myeloma, non-Hodgkin’s lymphoma, Parkinson’s disease, early-onset peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), and soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma). The term ischemic heart disease does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke, or any other condition that does not qualify within the generally accepted medical definition of ischemic heart disease. 38 C.F.R. § 3.309 (e). In the present case, the Veteran served in the Republic of Vietnam during the Vietnam era. For honorable service as a crew member with the 1st Marine Aircraft Wing, he was awarded the Armed Forces Expeditionary Medal. Accordingly, exposure to herbicide agents is conceded. The evidence of record also reflects a present diagnosis of ischemic heart disease. VA treatment records reflect a finding of mild coronary artery disease in 2005 with records from April 2019 noting a present diagnosis of ischemic heart disease. Ischemic heart disease is a disease subject to the herbicide agent presumption of 38 U.S.C. § 1116 and 38 C.F.R. § 3.309. As such, the Veteran is entitled to service connection for ischemic heart disease. REASONS FOR REMAND 1. The claim of entitlement to service connection for a heart condition, to include complete blockage of the left subclavian artery, atherosclerosis, and carotid artery narrowing is remanded. The Board regrets the additional delay, but remand is necessary in order to obtain an adequate VA medical opinion regarding the remaining claimed heart disabilities. VA treatment records note a range of diagnoses, including blockage of the left subclavian artery, atherosclerosis, and carotid artery narrowing. Unfortunately, the November 2016 VA examination did not address these findings, and instead determined that the Veteran did not have a diagnosed heart condition. The subsequent addendum only addressed ischemic heart disease. As this contradicts the Veteran’s treatment records without sufficient explanation, remand is required in order to obtain a new medical opinion with regard to the remaining claimed heart conditions. The matters are REMANDED for the following action: 1. Obtain any relevant, outstanding VA treatment records that are not already associated with the claims file. If no records are available, the claims folder must indicate this fact and the Veteran should be notified in accordance with 38 C.F.R. § 3.159 (e). All attempts to contact the Veteran should be documented in the record. 2. Once the aforementioned development is complete, obtain a medical opinion with respect to the Veteran’s claimed heart condition. A new examination may be ordered if deemed necessary, and it may be conducted via telehealth or other electronic means, if feasible. A complete copy of the claims file must be provided to the examiner, including a copy of this remand. The examiner should take a history from the Veteran, and must consider lay reports of observable symptomatology. After a thorough review of the record, the examiner should opine as to the following: (a.) Identify any and all present diagnoses pertaining to the Veteran’s heart. (b.) For each identified diagnosis, is it at least as likely as not (i.e. a probability of 50 percent or more) that the identified diagnosis had its onset during active service or within one year of separation from service, or, otherwise resulted from active military service, to include as due to exposure to herbicide agents? To note, even if a particular diagnosis is not presumptively related to herbicide agent exposure, this presumption does not bar the finding of a direct etiological relationship. The examiner may not state that it is less likely as not that the Veteran’s identified diagnosis is related to active duty service because it is not a presumptive condition of herbicide agent exposure. The examination report should specifically state that a review of the record was conducted. The examiner should provide a complete rationale for all opinions provided. If an opinion cannot be provided without to resorting to mere speculation, the examiner should identify all medical and lay evidence considered in this conclusion, fully explain why this is the case and identify what additional evidence (if any) would allow for a more definitive opinion. 3. Following completion of the foregoing, the AOJ should review the record and readjudicate the claim on appeal. If it remains denied, the AOJ should issue an appropriate supplemental SOC, afford the Veteran and his representative an opportunity to respond, and return the case to the Board. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board H. Fisher, 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.