Citation Nr: 21024388 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 10-29 668 DATE: April 22, 2021 ORDER 1. A rating of more than 50 percent for posttraumatic stress disorder (PTSD) from June 22, 2009 to February 13, 2018 is denied. 2. A rating of more than 70 percent for PTSD since February 13, 2018 is denied. 3. Service connection for a bilateral eye disorder, including glaucoma, is denied. 4. Service connection for a prostate disorder, including benign prostatic hypertrophy (BPH), is denied. REMANDED 5. The issue of service connection for hypertension is remanded. FINDINGS OF FACT 1. From June 22, 2009 to February 13, 2018, the Veteran’s PTSD manifested with occupational and social impairment with reduced reliability and productivity due to disturbances of motivation and mood and difficulty establishing and maintaining effective work and social relationships. 2. Since February 16, 2018, the Veteran’s PTSD manifested with occupational and social impairment due to additional symptoms of near-continuous depressed mood, suspiciousness, irritability, panic attacks occurring weekly or less often, chronic sleep impairment, poor memory and concentration, and difficulty in adapting to stressful circumstances (including work or a worklike setting). 3. The probative medical evidence indicates the Veteran’s bilateral eye disorders were not caused by herbicide exposure and are not otherwise related to service. 4. The probative medical evidence indicates the Veteran’s prostate disorder was not caused by herbicide exposure and is not otherwise related to service. CONCLUSIONS OF LAW 1. The criteria for a rating of more than 50 percent for PTSD during the period of June 22, 2009 to February 13, 2018 were not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.14, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for a rating of more than 70 percent for PTSD since February 13, 2018 have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326(a), 4.7, 4.14, 4.130, DC 9411. 3. The criteria for service connection for a bilateral eye disorder, including glaucoma, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 4. The criteria for service connection for a prostate disorder, including BPH, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (b); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from October 1965 to October 1967. He served in the Republic of Vietnam and his military decorations include the National Defense Service Medal and the Combat Medical Badge. Effective November 2018, the Veteran has a total disability evaluation based on individual unemployability (“TDIU”). In August 2020, the Board of Veterans’ Appeals (Board) remanded this matter to the Agency of Original Jurisdiction (AOJ) to obtain addendum medical opinions addressing the cause of the Veteran’s hypertension, prostate condition and eye condition. The AOJ obtained addendum opinions in December 2020 and February 2021. Review of the completed development reveals that, at the very least, substantial compliance with the Board’s remand directives was obtained. Stegall v. West, 11 Vet. App. 268 (1998). The August 2020 remand also directed the AOJ to assist the Veteran in obtaining any outstanding non-VA treatment records. Later in August 2020, the AOJ requested that the Veteran identify any outstanding treatment records and return an authorization to disclose information (VA Form 21-4142) to obtain these records. To date, the Veteran has not completed the necessary authorization. Under these circumstances, VA will not undertake any further effort to assist the Veteran in obtaining non-VA records. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (“the duty to assist is not always a one-way street. If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence.”). 1. Entitlement to a rating of more than 50 percent for PTSD from June 22, 2009 to February 13, 2018, and a rating of more than 70 percent thereafter Disability ratings are determined by applying criteria set forth in VA’s Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes (DCs). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations should be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. In disability rating cases, VA assesses the level of disability from the initial grant of service connection or a year prior to the date of application for an increased rating and determines whether the level of disability warrants the assignment of different disability ratings at different times over the course of the claim, a practice known as “staged ratings.” See Fenderson v. West, 12 Vet. App. 119, 126 (1999); see also Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007) (holding that staged ratings may be warranted in increased rating claims). In assigning a higher disability rating, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). From June 22, 2009 to February 13, 2018, the Veteran’s PTSD was evaluated as 50 percent disabling. Since February 13, 2018, his PTSD has been evaluated as 70 percent disabling. The Veteran has been in receipt of a total disability evaluation based on individual unemployability (TDIU) since November 15, 2018. The Veteran’s PTSD is evaluated under DC 9411, which assigns ratings based on particular symptoms and the resulting functional impairments. See 38 C.F.R. § 4.130. DC 9411 provides: A 50 percent rating is assigned for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; A 70 percent rating is assigned for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships; A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, DC 9411. During a September 2009 VA examination, the Veteran reported symptoms of insomnia, daytime fatigue, irritability, anger, anxiety, depressed mood, and re-experiencing combat trauma through nightmares and intrusive daytime memories. He reported his overall mood significantly shifted from “jolly” to mildly depressed. The Veteran indicated his psychiatric symptoms occurred daily, were moderate to severe, although he stated he ignored them while he was working. He denied missing time from work due to his mental health symptoms. The Veteran reported good relationships with all his family members. However, he reported that fatigue, irritability, and anger caused work-related stress and difficulty interacting with coworkers. The examiner noted the Veteran had normal personal hygiene, normal speech, normal impulse control, and no memory loss or impairment. The Veteran denied suicidal ideation or intent. During a June 2012 VA examination, the Veteran reported anxiousness, suspiciousness, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty establishing and maintaining work and social relationships, and difficulty adapting to stressful circumstances including work or a work-like setting. He reported his wife died in 2011 and that his son lived with him since her death. The Veteran reported attending church on a regular basis, and occasionally socializing with fellow church members and family members. The Veteran reported that he retired in February 2011, after having some problems getting along with coworkers. He reported participating in a PTSD support group through VA for the past year, with improvement in his psychiatric symptoms. The VA examiner concluded that the Veteran’s PTSD caused occupational and social impairment with reduced reliability and productivity. The examiner noted the Veteran’s symptoms seemed slightly worse than in the prior VA examination. He indicated the Veteran could manage his own finances. The Veteran was afforded an additional VA psychiatric examination in June 2014. The VA examiner indicated the Veteran’s PTSD caused occupational and social impairment due to mild or transient symptoms, with a decrease in work efficiency and ability to perform occupational tasks only during periods of significant stress. The Veteran reported he spent most of his time at home with his son, although he visited siblings and grandchildren occasionally. While he continued to attend church regularly, he reported a decreased interest in socializing, even with family. The VA examiner noted the Veteran actively participated in a PTSD support group. The Veteran continued to report irritability, depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, and difficulty establishing and maintaining work and social relationships. During a February 2018 VA examination, the Veteran reported symptoms including anxiety, depressed mood, suspiciousness, panic attacks occurring weekly or less often, chronic sleep impairment, circumstantial speech, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The VA examiner indicated the Veteran’s PTSD caused occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The Veteran continued to report regular contact with family members, although he stated he had no friends. He reported that participation in a monthly PTSD support group was helpful, and he denied any hospitalizations due to psychiatric reasons. His speech was clear, his grooming and hygiene were good, and he could manage his finances. The Veteran denied experiencing depersonalization, derealization, or auditory/visual hallucinations. During a December 2018 VA examination, the Veteran reported attending a PTSD support group on a weekly, rather than monthly, basis. The VA examiner noted symptoms of irritability, hypervigilance, chronic sleep impairment, depression, anxiety, suspiciousness, mild memory loss, difficulty adapting to stressful circumstances including work or a work-like setting, and difficulty establishing and maintaining effective work and social relationships. The examiner indicated the Veteran’s PTSD resulted in occupational and social impairment with reduced reliability and productivity. The Veteran continued to deny auditory/visual hallucinations, his grooming and hygiene were good, and his speech was logical. However, the examiner noted the Veteran’s poor ability to tolerate stress when communicating with others, even family members, and poor concentration and memory due to emotional issues and sleep interference. During an October 2019 VA examination, the Veteran reported that he regularly kept in contact with his son, daughter and grandchildren. He reported he was capable of handling activities of daily living (ADLs) on his own. He reported that he mostly stayed home and watched television due to his high blood pressure and heart problems. The Veteran continued to participate in a PTSD support group, which he enjoyed. His behavior, speech and thought processes were within normal limits and he denied suicidal ideation. The examiner indicated the Veteran’s PTSD caused occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. From June 22, 2009 to February 13, 2018, the Veteran’s PTSD manifested with occupational and social impairment with reduced reliability and productivity due to disturbances of motivation and mood and difficulty establishing and maintaining effective work and social relationships. Given these symptoms, the 50 percent rating already in effect for this period is appropriate. See 38 C.F.R. § 4.130, DC 9411. A rating of more than 50 percent is not warranted prior to February 13, 2018 because the record does not indicate that the Veteran had occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Although he reported mood disturbances, he was noted to have good family relationships, and his judgment and thinking were within normal limits. Since February 16, 2018, the Veteran’s PTSD manifested with occupational and social impairment due to additional symptoms of near-continuous depressed mood, suspiciousness, irritability, panic attacks occurring weekly or less often, chronic sleep impairment, poor memory and concentration, and difficulty in adapting to stressful circumstances (including work or a worklike setting). Additionally, the December 2018 VA examiner noted the Veteran had difficulty communicating with others, including close family members. Given these symptoms, the 70 percent rating already in effect is appropriate. See 38 C.F.R. § 4.130, DC 9411. A rating of more than 70 percent is not warranted at any point during the appellate period because the record does not show that the Veteran has total occupational and social impairment. Although he is in receipt of a TDIU for occupational impairment due to PTSD, the Veteran has consistently maintained strong familial relationships. Additionally, he has not been found to have demonstrated grossly inappropriate behavior, he is able to perform ADLs, and no examiner has concluded he is a danger to himself or others. For the reasons above, the preponderance of the evidence is against awarding an increased rating, the claim is denied. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). “To establish a right to compensation for a present disability, a Veteran 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’ - the so-called ‘nexus’ requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d); see Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Certain disorders, listed as “chronic” in 38 C.F.R. § 3.309 (a) and 38 C.F.R. § 3.303 (b), are capable of service connection based on a continuity of symptomatology without respect to an established causal nexus to service. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Hypertension is among the chronic diseases listed under 38 C.F.R. § 3.309 (a), and therefore presumptive service connection provisions based on “chronic” in-service symptoms and “continuous” post-service symptoms under 38 C.F.R. § 3.303 (b) apply. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a “chronic disease” in service or “continuity of symptoms” after service, the disease shall be presumed to have been incurred in service. 38 C.F.R. § 3.303 (b). Additionally, where a veteran served ninety days or more of active service, and certain chronic diseases, such as hypertension, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309 (a). While the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 C.F.R. § 3.307 (a)(6)(iii). Given the Veteran’s service in the Republic of Vietnam during the presumptive period, his exposure to herbicide agents is presumed. To benefit from the presumption of service connection for diseases associated with herbicide exposure, the Veteran must have one of the diseases listed in 38 C.F.R. § 3.309 (e). Hypertension, glaucoma and BPH are not among the diseases listed. Id. Therefore, presumptive service connection due to herbicide agent exposure is not warranted. However, the Veteran is not prevented from establishing service connection on a direct basis. Combee v. Brown, 34 F.3d 1039, 1042 (Fed Cir. 1994). In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination about the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994). When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether a veteran’s disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno, 6 Vet. App. 465, 469. Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303 (2007). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau, 492 F.3d 1372, 1377. In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104 (a). When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. Bilateral eye disorder, including glaucoma The Veteran was diagnosed with neovascular glaucoma of the right eye in 2005 and primary open-angle glaucoma in the left eye, also in 2005. He has also been diagnosed with pseudophakia and central retinal vein occlusion of the right eye, and a cataract in both eyes. He contends his eye disorders are related to service. The STRs are silent for symptoms, diagnoses or treatment for glaucoma or other eye-related problems. During his enlistment examination, the Veteran demonstrated 20/20 vision and his clinical evaluations were normal. The Veteran’s 1967 separation examination report also indicated 20/20 vision and normal clinical evaluations. In his separation report of medical history, the Veteran denied ever having had “eye trouble.” At separation, the Veteran was assigned a “1” rating for the “E” category under the PULHES profile system, indicating that the Veteran’s eyes were at high level of fitness. See Odiorne v. Principi, 3 Vet. App. 456, 457 (1992); ((observing that the “PULHES” profile reflects the overall physical and psychiatric condition of the veteran’s capacity and stamina (“P”); upper extremities (“U”); lower extremities (“L”); hearing (“H “); eyes (“E”) and psychiatric condition (“S”); assessed on a scale of 1 (high level of fitness) to 4 (a medical condition or physical defect which is below the level of medical fitness for retention in the military service)). Post-service medical records document diagnosis and treatment for glaucoma in 2004 and cataracts in 2009, but do not address the etiology of those conditions or link them with the Veteran’s military service. In a February 2018 medical opinion, a VA ophthalmologist reviewed the Veteran’s history of glaucoma and cataract removal and noted that the Veteran’s glaucoma was neovascular in origin. The examiner explained that neovascular glaucoma originates with diabetes and not herbicides, and that herbicides alone are not known to directly cause cataracts or glaucoma. The Veteran was afforded an additional VA eye examination in December 2020. During the examination, he reported having eye irritation during service. The VA optometrist who examined the Veteran opined that the Veteran’s bilateral glaucoma and Descemet’s membrane condition was caused by his central retinal vein occlusion. The examiner noted that hypertension is a risk factor for developing central retina vein occlusion, however the Veteran’s hypertension is not service-connected and his separation examination showed normal blood pressure. The examiner also noted the Veteran was prediabetic and that the Veteran’s cataracts were likely related to his prediabetes. The examiner further explained that the Veteran’s pseudophakia is a result of cataract surgeries and therefore not related to service. The preponderance of the evidence is against finding service connection for an eye disorder. The February 2018 and December 2020 VA opinions indicated that the Veteran’s glaucoma, cataracts, and other eye conditions are not related to herbicide exposure and are likely diabetic in origin. There is no probative medical evidence linking the Veteran’s current eye disorders with any disease, injury or event during active service. Without evidence of a nexus, or link, between the Veteran’s current diagnoses and his military service, the claim is denied. Although the Veteran has consistently asserted his current eye disorders are related to service, as a lay person, he is not competent to give an opinion on the etiology of his condition(s). See Jandreau, supra. Additionally, while the Veteran is competent to report irritated eyes during service, his report is heavily outweighed by his separation physical examination report, where he specifically denied eye trouble, had 20/20 vision, and was assigned a ‘1’ in his PULHES evaluation. He lacks the medical expertise to offer an opinion that eye irritation during service lead to his current glaucoma and other eye conditions. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. 3. Prostate disorder, including BPH The Veteran contends his BPH and voiding dysfunction was caused by herbicide exposure or is otherwise related to service. The claims file indicates that the Veteran has been tested for, but never diagnosed with prostate cancer. STRs contain no references to BPH, urinary problems, or other prostate-related symptoms or diagnoses. As stated above, the Veteran’s entrance and separation examination reports indicated normal clinical evaluations. In his September 1967 separation report of medical history, the Veteran denied “frequent or painful urination” and reported being in good health. Post-service medical records document treatment for BPH, voiding/urinary dysfunction, and erectile dysfunction as early as 2009. The Veteran reports his prostate conditions began in approximately 2005. During the February 2018 VA examination, the Veteran reported his BPH began in the 1990s. The VA examiner noted that BPH has not been found to be related to herbicide exposure and that the Veteran was not diagnosed with BPH until several decades after service separation. The Veteran was afforded an additional VA examination in December 2020. He reported that he had been tested for prostate cancer but biopsies were negative. The VA examiner noted the Veteran’s history of obesity, hypertension/hyperlipidemia, prediabetes, and erectile dysfunction. In a February 2021 opinion, the December 2020 VA examiner highlighted that the Veteran did not have prostate problems during service and that the Veteran does not currently have prostate cancer. The examiner indicated that the onset of the Veteran’s urinary problems had not been documented, although medical records showed treatment for BPH and urinary problems beginning in 2009, 42 years after the Veteran separated from service. The examiner noted that in January 2020 the Veteran had a body mass index (BMI) of 39 and his prostate weighed 50 grams. He explained that toxic chemicals in the herbicide Agent Orange have been found to affect male reproductive health by limiting the growth of the prostate and disturbing the male endocrine and reproductive systems. The examiner indicated that studies have shown that BPH is actually less common among veterans exposed to herbicides, as BPH is characterized by an enlarged prostate. He also explained that nearly all males experience some form of prostate obstruction and related urinary problems as they age, regardless of whether they were exposed to herbicides. Based on this evidence, the examiner concluded the Veteran’s prostate condition was not likely related to service. The preponderance of the evidence is against finding service connection for a prostate disorder. There is no evidence of a prostate disorder or related symptoms until over four decades after service. While the absence of medical records alone is insufficient to deny the claim, the probative medical evidence indicates the Veteran’s current prostate condition is age-related. The February 2021 VA opinion is probative because it thoroughly explained how BPH is actually less common in veterans exposed to herbicides because herbicide exposure has been found to shrink, rather than enlarge the prostate. As the probative medical evidence indicates the Veteran’s current condition is not related to service, the “nexus” or causation element of service connection has not been met and the claim is denied. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, supra. REASONS FOR REMAND 5. The issue of service connection for hypertension is remanded. The Board has determined that an additional theory of entitlement to service connection for hypertension has been raised by the record and the matter is therefore remanded for the following: 1. BACKGROUND FOR THE RO ADJUDICATOR: The Veteran was afforded a VA hypertension examination in February 2018. He reported he was diagnosed with hypertension in the 1970’s during a routine examination. The VA examiner noted that hypertension is not one of the diseases associated that is presumed to be associated with herbicide exposure. However, in a February 2021 addendum to the December 2020 examination report, the same VA examiner noted the Veteran’s diabetes mellitus (DM) and coronary artery disease (CAD). Both DM and CAD are presumptively linked to herbicide exposure, and the Veteran is presumed to have been exposed to herbicides because he served in Vietnam. A theory of entitlement to service connection for DM is therefore raised and must be adjudicated by the RO. The remand directives follow: 2. Determine if the Veteran is entitled to service connection for DM and/or CAD through the provisions of presumptive service connection for these disorders in the case of those veterans who served in Vietnam. If so, conduct any appropriate development and adjudication of the claim of service connection for hypertension as secondary to these disorders, if service connected. 3. Conduct any other appropriate development and appellate proceedings. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Hiaasen The Board’s decision in this case is binding only with respect to this matter. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.