Citation Nr: 21028120 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 16-34 922 DATE: May 10, 2021 ORDER Service connection for coronary artery disease is granted. REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for kidney cancer, to include as due to exposure to herbicide agents, is remanded. Entitlement to service connection for skin cancer, to include as due to exposure to herbicide agents, is remanded. FINDINGS OF FACT 1. The Veteran is presumed to have been exposed to herbicide agents coincident with his service in the Republic of Vietnam. 2. The Veteran's coronary artery disease, which has manifested to a compensable degree, is presumptively related to his acknowledged in-service exposure to herbicide agents. CONCLUSION OF LAW The criteria for service connection for coronary artery disease have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 4.104, Diagnostic Code 7005. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from September 1967 to September 1969. This case is before the Board of Veterans' Appeals (Board) on appeal from an October 2013 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. In that rating decision, the RO denied entitlement to service connection for heart condition, PTSD, kidney cancer, and skin cancer. The Veteran's notice of disagreement was received in November 2013. The RO issued a statement of the case in May 2016. The Veteran's VA Form 9, substantive appeal to the Board, was received in July 2016. The Veteran was scheduled to testify at a Board (virtual) hearing. The Veteran cancelled the hearing request in December 2020. Entitlement to service connection for coronary artery disease, claimed as heart condition and as due to exposure to herbicide agents. The Veteran contends his coronary artery disease is the result of herbicide exposure while stationed in Vietnam. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). As relevant to the instant case, the law provides a presumption of service connection for certain diseases associated with exposure to herbicide agents that become manifest within a specified time period, even if there is no record of evidence of such disease during the period of service. Veterans 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, are presumed to have been exposed to herbicide agents. 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6). "Service in the Republic of Vietnam" includes service on the landmass, inland waterways, and in the territorial sea extending 12 nautical miles from the shores of that nation. For those veterans who have been exposed to herbicide agents, certain diseases, to include ischemic heart disease (including coronary artery disease), are acknowledged to be presumptively related to such exposure. 38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e). The diseases listed at 38 C.F.R. § 3.309(e) shall have become manifest to a degree of 10 percent or more at any time after service with exceptions not applicable in the instant case. 38 C.F.R. § 3.307(a)(6)(ii). According to the Veteran's March 1969 military personnel records and DD-214, the Veteran was stationed in the Republic of Vietnam during service and, as such, his in-service exposure to herbicide agents is presumed. Additionally, the Veteran has a current diagnosis of coronary artery disease as evidenced by a May 2019 Kingman Heart Center medical record. Further, the evidence shows such disease manifested to a compensable degree of at least 10 percent or more after service. Specifically, the medical evidence of record indicates the Veteran's coronary artery disease has required continuous medication. 38 C.F.R. § 4.104, Diagnostic Code 7005. Consequently, service connection is warranted for coronary artery disease, as such is presumptively related to the Veteran's acknowledged in-service exposure to herbicide agents. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS FOR REMAND Entitlement to service connection for an acquired psychiatric disorder, to include PTSD. The Veteran contends he has PTSD related to combat while in service. As the Veteran's military personnel records and DD-214 indicate he served in combat, his reported in-service stressor is conceded. In January 2013, a licensed social worker at The Vet Center provided a diagnosis of PTSD without an underlying rationale as to the etiology of such. The Veteran was then afforded a VA PTSD examination in October 2013. The VA examiner acknowledged the January 2013 PTSD diagnosis, noted the Veteran's combat stressor, but did not make a formal diagnosis of PTSD. Upon review, the Board notes that all previous examinations were presumably performed under the Diagnostic and Statistical Manual of Mental Disorders (DSM -IV), while VA currently operates under the updated Diagnostic and Statistical Manual of Mental Disorders (DSM-V). In light of such new guidance and the aforementioned conflicting evidence of record regarding a current diagnosis, the Board finds a new VA examination is necessary to determine whether the Veteran has a current acquired psychiatric disorder, to include PTSD, related to service. Entitlement to service connection for kidney cancer, to include as due to exposure to herbicide agents. Entitlement to service connection for skin cancer, to include as due to exposure to herbicide agents. The Veteran asserts he has kidney cancer and skin cancer related to his in-service exposure to herbicide agents. VA treatment records dated in June 2013 note "right kidney removed," pre-cancerous skin history, colorectal cancer, and prostate cancer. VA's duty to assist includes, when necessary, conducting a thorough and comprehensive medical examination. See McClendon v. Nicholson, 20 Vet. App. 79 (2006); 38 C.F.R. § 3.159 (c)(4). In the instant case, the record indicates current diagnoses referrable to kidney cancer and skin cancer and, as noted above, the Veteran's in-service exposure to herbicide agents is presumed. However, the Board cannot make a fully informed decision on the Veteran's claims for service connection for kidney cancer and skin cancer as the record does not contain adequate medical examinations and associated opinions concerning the nature and etiology of the Veteran's claimed disorders. Accordingly, a remand is necessary to afford the Veteran appropriate medical examination(s) to determine the nature and etiology of his claimed kidney cancer and skin cancer. The matters are REMANDED for the following actions: 1. Schedule the Veteran for appropriate mental health examinations, to include a VA PTSD examination, to determine the nature and etiology of any current acquired psychiatric disorder, to include PTSD. The examiner should note review of this remand and the entire claims file. The examiner's attention is directed to: (a) the January 2013 Vet Center PTSD diagnosis (b) the February 2013 Vet Center PTSD assessment and screening, and (c) the October 2013 VA PTSD examination. The examiner then should address the following inquiries: (A) Identify all current acquired psychiatric disorders that have been present at any point pertinent to the Veteran's claim, even if such is asymptomatic or has since resolved, that meet the DSM-V. In this regard, the examiner should address the evidence reflecting diagnoses of PTSD. (B) If a diagnosis of PTSD is rendered, the examiner should state the stressor on which such is based, to include whether such is the result of combat activity. (C) For each currently diagnosed acquired psychiatric disorder other than PTSD, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that any such disorder is related to the Veteran's military service. In rendering his or her opinion, the examiner is advised that the sole basis of a negative opinion cannot be the fact that the Veteran's service treatment records are silent as to any complaints, treatment, or diagnosis referable to an acquired psychiatric disorder. A complete rationale should be provided for any opinion rendered. 2. Schedule the Veteran for a VA examination in order to determine the nature and etiology of the Veteran's claimed kidney cancer. Forward the record and a copy of this remand to the examiner. The examiner should note review of this remand and the entire claims file. The examiner's attention is directed to the June 2013 Prescott VAMC treatment records. Following review of the record, the examiner should address the following inquiries: (A) Identify the nature of the Veteran's kidney disease. (B) Is it at least as likely as not (i.e., a 50 percent or greater probability) that any current kidney disease had its onset in, or is otherwise related to, the Veteran's military service, to include his acknowledged exposure to herbicide agents? The examiner must note that the service connection may still be established on a direct basis for a disorder for which presumptive service connection does not apply. A complete rationale for any opinion must be provided. 3. Schedule the Veteran for a VA examination in order to determine the nature and etiology of the Veteran's claimed skin cancer. Forward the record and a copy of this remand to the examiner. The examiner should note review of this remand and the entire claims file. The examiner's attention is directed to the June 2013 Prescott VAMC treatment records. Following review of the record, the examiner should address the following inquiries: (A) Identify the nature of the Veteran's skin disease. (Continued on the next page) (B) Is it at least as likely as not (i.e., a 50 percent or greater probability) that any skin disease had its onset in, or is otherwise related to, the Veteran's military service, to include his acknowledged exposure to herbicide agents? The examiner must note that the service connection may still be established on a direct basis for a disorder for which presumptive service connection does not apply. A complete rationale for any opinion must be provided. M. M. Celli Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Ardalan, 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.