Citation Nr: 21026826 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 17-46 453 DATE: May 4, 2021 REMANDED Entitlement to service connection for coronary artery disease (CAD), to include as secondary to herbicide and asbestos exposure, is remanded. Entitlement to service connection for hypertension, to include as secondary to herbicide exposure, is remanded. Entitlement to service connection for chronic obstructive pulmonary disease (COPD), to include as secondary to herbicide and asbestos exposure, is remanded. REASONS FOR REMAND The Veteran served from June 1969 to July 1970 with service in Vietnam. This matter comes before the Board of Veterans' Appeals (Board) from June 2017, July 2017, and February 2018 rating decisions by the Department of Veterans Affairs (VA), Veterans Benefits Administration (VBA), Regional Office (RO), which is the Agency of Original Jurisdiction (AOJ). The Veteran was afforded a virtual hearing before the undersigned Veterans Law Judge in March 2021. A transcript of the hearing has been associated with the Veteran's file. 1. Entitlement to service connection for CAD, to include as secondary to herbicide exposure, is remanded. 2. Entitlement to service connection for hypertension, to include as secondary to herbicide exposure, is remanded. 3. Entitlement to service connection for COPD, to include as secondary to herbicide exposure and asbestos, is remanded. The Veteran seeks service connection for CAD, hypertension, and COPD. Specifically, the Veteran contends his CAD and COPD are secondary to herbicide exposure and/or asbestos. To begin, the Board finds a remand is necessary in order to provide the Veteran with VA examinations and etiological opinions. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 C.F.R. § 3.159(c)(4)(i). Under McLendon, VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon, 20 Vet. App. at 79. The third prong, which requires that the evidence of record "indicate" that the claimed disability or symptoms "may be" associated with the established event, is a low threshold. McLendon, 20 Vet. App. at 83. Here, the Board finds the McLendon criteria have been satisfied. First, with regard to CAD, during his virtual hearing, the Veteran noted his medical records do not reveal a diagnosis of coronary artery disease. Phoenix VA Medical Center (VAMC) records specifically note that he does not have CAD but discuss his symptoms. Private medical evidence from Valley Heart Associates note the Veteran's chief complaint during an August 2020 visit was due to chest pain. Under assessment, the physician noted "transient cerebral ischemic attack, unspecified" and note he was prescribed clopidogrel and aspirin. The Veteran's record indicates he served in Vietnam with exposure to herbicides. For veterans presumed to have been exposed to herbicides, certain enumerated diseases shall be service connected even though there is no record of such disease during service, so long as the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met, and the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). The enumerated diseases which are deemed to be associated with herbicide exposure include coronary artery disease with valvular heart disease (ischemic heart disease). 38 C.F.R. § 3.309(e). Additionally, the Board will broaden the claim to service connection for a heart or circulatory disability to include CAD. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Therefore, given the Veteran's medical record discussing a cerebral ischemic heart attack and chest pains, his service in Vietnam with exposure to herbicides, the low threshold of the third prong, and that the Veteran has been not afforded a VA examination to determine if the Veteran has CAD or another heart related disability, the Board finds the four prongs of McLendon satisfied and that a remand is necessary in order to provide the Veteran with a VA examination and etiological opinion. Second, with regard to hypertension, the Board notes he has a current diagnosis of hypertension and also testified during his hearing and in a lay statement that he has been taking high blood pressure medication since he was 24. The Board finds the Veteran competent and credible to discuss his history regarding hypertension. As provided for above, the Veteran contends his hypertension may be related to exposure to herbicides. Additionally, the Veteran's service treatment records (STRs) indicate that on his exit examination, his blood pressure was 126/90 sitting and 130/80 recumbent. Therefore, given the Veteran's medical record discussing his hypertension diagnosis, his in-service exposure to herbicides in Vietnam, the low threshold of the third prong, and that the Veteran has not been afforded a VA examination, the Board finds the four prongs of McLendon satisfied. As such, a remand is also necessary in order to provide the Veteran with a VA examination and etiological opinion as to this claim. Finally, with regard to COPD, the Board notes the Veteran has a current diagnosis of COPD. As stated above, the Veteran's record indicates he served in Vietnam with confirmed exposure to herbicides. During his hearing, the Veteran testified that as part of his military occupational specialty (MOS) as a vehicle mechanic, he would work on brakes that would be covered with dust or red soot. Further, he testified that water from the showers would be filtered through asbestos. There is also evidence of complaints and treatment for dyspnea with chest pain in his STRs. The Veteran was provided a VA respiratory examination in July 2017 where the examiner confirmed his diagnosis of asthma and COPD. However, the Board finds the examination to be inadequate. The examiner stated the claim condition was less likely than not (less than 50 percent probability) incurred in or caused by his active duty service. The examiner's opinion only discussed whether his in-service bronchitis caused his COPD. The examiner did not fully address etiology. Therefore, given the evidence of a current diagnosis, confirmed exposure to herbicides, the low threshold of the third prong, and an inadequate VA examination, the Board finds the four prongs of McLendon have been satisfied and that a remand is also necessary to provide the Veteran with a VA examination and etiological opinion as to this claim. To conclude, the Board finds a remand necessary in order to provide the Veteran with VA examinations and etiological opinions regarding his heart/circulatory disability, hypertension, and COPD. The matters are REMANDED for the following actions: Schedule the Veteran for VA examinations with an appropriate examiner for his heart/circulatory disability to include coronary artery disease and cerebral ischemic attack, hypertension, and chronic obstructive pulmonary disease to determine the nature and etiology of these disabilities. The examiner must identify all disabilities and provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) his heart/circulatory disability, hypertension, and COPD were caused by or incurred in active duty service, to include the Veteran's exposure to herbicides and asbestos. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. DeBoer, 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.