Citation Nr: 21040404 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 16-37 657 DATE: July 3, 2021 ORDER Entitlement to service connection for coronary arteriosclerosis is granted. REMAND Entitlement to service connection for hypertension is remanded. FINDING OF FACT VA treatment records include a diagnosis of coronary arteriosclerosis. CONCLUSION OF LAW The criteria for entitlement to service connection for a heart condition have been met. 38 U.S.C. §§ 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1969 to September 1973, to include service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) from an April 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. The case was last before the Board in November 2019 and has returned to the Board for further appellate review. Service Connection Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Generally, to prove service connection there must be: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). For purposes of establishing service connection for a disability resulting from exposure to herbicide agents, a veteran who had active service in the Republic of Vietnam during the Vietnam Era, beginning on January 9, 1962, and ending on May 7, 1975, will be presumed to have been exposed to an herbicide agent during that service, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. 38 U.S.C. § 1116(f); 38 C.F.R. §§ 3.307(a), 3.309(e). The applicable criteria provide that a disease associated with exposure to certain herbicide agents, listed in 38 C.F.R. § 3.309(e), will be considered to have been incurred in service under the circumstances outlined in this section even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307(a). Ischemic heart disease is a listed disease under 38 C.F.R. § 3.309(e). 1. Entitlement to service connection for a heart condition The Veteran seeks service connection for a heart condition, which he asserts is related to service. Upon review of the evidence, the Board finds that the most probative evidence of record is against a finding that the Veteran's current heart condition is related to service. The Veteran's VA treatment records note presumed mild coronary artery disease in November 2012 and September 2014. Additionally, other VA treatment records note a diagnosis of coronary arteriosclerosis on the active problem list, including records in 2019 and 2020. The Veteran underwent a VA examination in March 2015, during which the examiner concluded that the Veteran did not have a current diagnosis of a heart condition. During a January 2021 VA examination, the examiner indicated the Veteran had diagnoses of premature ventricular contractions and right branch bundle block. After review of the record and examination of the Veteran, the examiner explained that medical records do not support finding that the Veteran has a current diagnosis of ischemic heart disease. The examiner acknowledged the VA treatment records which indicate the Veteran has a diagnosis of mild coronary artery disease and history of coronary arteriosclerosis. However, the examiner noted that the stress test in November 2012 revealed an exercise induced ischemic EKG response to regadenoson injection and a November 2016 revealed normal sinus rhythm. As such, the examiner opined that the Veteran's claimed heart condition was less likely than not incurred in or caused by service. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran currently suffers from coronary arteriosclerosis. Thus, after resolving all doubt in favor of the Veteran, service connection for coronary arteriosclerosis is granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). REASONS FOR REMAND 2. Entitlement to service connection for hypertension is remanded. While the VA examiners opined that the Veteran's hypertension was not caused by service or his PTSD, an opinion has not been obtained concerning whether the Veteran's hypertension has been aggravated by the PTSD. Moreover, the January 2021 VA examiner indicated that there has not been an established correlation between hypertension and exposure to herbicide agents in Vietnam. However, the National Academy of Science (NAS) Institute of Medicine's Veterans and Agent Orange: Update 11 (2018) upgraded hypertension from its previous classification in the category of "limited or suggestive" evidence of an association with exposure to Agent Orange to the category of "sufficient" evidence of an association. Thus, an addendum opinion is needed. The matter is REMANDED for the following action: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his hypertension. After securing any necessary releases, request any relevant records identified. In addition, obtain updated VA treatment records. If any requested records are unavailable, the Veteran should be notified of such. 2. Obtain an addendum medical opinion concerning the claim for service connection for hypertension. If a new examination is deemed necessary to respond to the questions presented, one should be scheduled. After review of the claims file, the examiner should respond to the following: a. Is it at least as likely as not (50 percent probability or greater) that this Veteran's hypertension is etiologically related to herbicide agent exposure in Vietnam? The examiner should explain why or why not, to include addressing the Institute of Medicine's Veterans and Agent Orange: Update 11 (2018) that upgraded hypertension from its previous classification in the category of "limited or suggestive" evidence of an association with exposure to Agent Orange to the category of "sufficient" evidence of an association. b. If not related to herbicide agent exposure, is it at least as likely as not that the Veteran's hypertension is aggravated (worsened beyond normal progression) by the service-connected PTSD? If so, the examiner should attempt to quantify the degree of worsening beyond the baseline level of the hypertension. 3. If the claim remains denied, issue a supplemental statement of the case. K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Lance, 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.