Citation Nr: 21012224 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 19-31 069 DATE: March 3, 2021 ORDER Entitlement to service connection for a heart disorder, to include hypertensive heart disease and atrioventricular heart block, is denied. FINDING OF FACT The Veteran’s heart disorders did not incur in and are not otherwise related to his military service, to include as due to Agent Orange exposure. CONCLUSION OF LAW The criteria for entitlement to service connection for a heart disorder have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from December 1962 to January 1967. This matter originally came before the Board of Veterans’ Appeals (Board) on appeal from a March 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2020, the Board remanded the matter for additional evidentiary development. Entitlement to service connection for a heart disorder Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) an in-service event or injury, 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). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Additionally, if a veteran was exposed to herbicide agents during active service, presumptive service connection is warranted for certain specified diseases. 38 C.F.R. §§ 3.307, 3.309. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. As noted by the February 2018 and December 2020 VA examiners, the Veteran has been diagnosed with hypertensive heart disease and atrioventricular heart block. Additionally, military personnel records confirm that the Veteran served on Board the U.S.S. Salisbury when the ship anchored in DaNang Harbor in February 1965, within the coastal waters of the Republic of Vietnam. An October 2020 Veterans Benefits Administration (VBA) research memorandum, as well as a November 2020 VA memorandum, verify the Veteran’s claimed exposure to herbicides. As such, the Veteran is presumed to have been exposed to tactical herbicides, such as Agent Orange, during service. 38 C.F.R. § 3.307; Procopio v. Wilkie, 913 F.3d 1371 (Fed. Cir. 2019). However, hypertensive heart disease and atrioventricular heart block are not included in the list of specified diseases for which presumptive service connection due to exposure is warranted. Id. The February 2018 and December 2020 VA examiners specifically stated that the Veteran’s heart disorders do not qualify within the generally accepted medical definition of ischemic heart disease (IHD). Additionally, while the Board acknowledges that the Veteran contends that he has a diagnosis of coronary artery disease (CAD) that warrants presumptive service connection, the clinical evidence of record does not indicate that the Veteran has a diagnosis of CAD at any time during the appeal period. Nevertheless, when a veteran is found not to be entitled to a regulatory presumption of service connection for a given disability, the claim must still be reviewed to determine whether service connection can be established on a direct basis. Combee v. Brown, 34 F.3d 1039, 1043-1044 (Fed.Cir.1994). As noted above, the Veteran has a current heart disability. Additionally, as previously mentioned, the Veteran is presumed to have been exposed to tactical herbicides, such as Agent Orange, during service. 38 C.F.R. § 3.307; Procopio, 913 F.3d 1371. Accordingly, the first two elements of direct service connection are met. As such, the question in this case is whether a causal relationship or nexus exists between the Veteran’s heart disorder and his exposure to herbicide agents in Vietnam. The Board finds the weight of the evidence is against the claim. While the Veteran was afforded VA examination in February 2018, the VA examiner did not provide a nexus opinion. In December 2020, pursuant to the May 2020 Board remand, the RO obtained an addendum opinion. The December 2020 VA examiner noted that the Veteran’s diagnosed heart conditions, hypertensive heart disease and atrioventricular heart block, are not considered ischemic heart disease. Additionally, the VA examiner noted that while the Veteran’s Agent Orange exposure is conceded, it is still less likely than not that his heart disorders incurred in or were caused by his military service, as Agent Orange exposure is not an established etiology of either of the Veteran’s heart disorders in the medical literature. The Board also notes that the medical opinion is consistent with other objective evidence of record. The service treatment records show normal findings on heart evaluation, including on separation from service examination in January 1967. Additionally, the post service medical evidence of record does not create a nexus between the Veteran’s disorders and service. There is also no competent medical opinion to the contrary. To the extent that the Veteran asserts his heart disorders were caused by Agent Orange exposure during active duty service, the Board finds that he is not competent to determine the etiology of such a disability, as it is a complex medical question beyond the ability of a layperson. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Accordingly, the preponderance of the evidence weighs against the claim and is not in equipoise. The claim for service connection for a heart disorder must be denied. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. B. Smith, Associate 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.