Citation Nr: 21040979 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 14-25 470 DATE: July 7, 2021 ORDER Entitlement to an evaluation in excess of 10 percent for hiatal hernia with GERD is denied. Entitlement to service connection for sleep apnea as secondary to PTSD is granted. Entitlement to an effective date prior to March 17, 2011 for the grant of service connection for a hiatal hernia with GERD is denied. Entitlement to an effective date prior to March 17, 2011 for the grant of service connection for PTSD with major depressive disorder is denied. Entitlement to an evaluation in excess of 70 percent for posttraumatic stress disorder (PTSD) with major depressive disorder is denied. Entitlement to a total disability rating based on unemployability (TDIU) is granted. REMANDED Entitlement to service connection for heart disease, to include as secondary to herbicide exposure in service, is remanded. FINDINGS OF FACT 1. The Veteran's hiatal hernia with GERD did not more nearly approximate symptoms that were productive of considerable impairment of health. 2. Resolving all doubt in the Veteran's favor, the Veteran's sleep apnea is secondary to his service-connected PTSD. 3. The Veteran's initial claim for entitlement to service connection for a hiatal hernia with GERD was received by VA on March 17, 2011. 4. The Veteran's initial claim for entitlement to service connection for PTSD with depressive disorder was received by VA on March 17, 2011. 5. During the period on appeal, the Veteran's service-connected PTSD resulted in no more than occupational and social impairment with deficiencies in most areas it did not result in total occupational and social impairment. 6. The Veteran's service-connected disabilities are of such severity as to preclude him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 10 percent for service-connected hiatal hernia with GERD have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1-4.7, 4.21, 4.114, Diagnostic Code 7346 (2019). 2. The criteria for service connection for sleep apnea as secondary to PTSD are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2019). 3. The criteria for the assignment of an effective date prior to March 17, 2011, for the grant of service connection for hiatal hernia with GERD have not been met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.1, 3.151, 3.400 (2019). 4. The criteria for the assignment of an effective date prior to March 17, 2011, for the grant of service connection for PTSD with depression have not been met. 38 U.S.C. §§ 5107, 5110 (2012); 38 C.F.R. §§ 3.1, 3.151, 3.400 (2019). 5. The criteria for a rating in excess of 70 percent rating for PTSD with depressive disorder have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411 (2019). 6. Resolving reasonable doubt in the Veteran's favor, the criteria for a TDIU are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.16 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1972 to June 1975. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a June 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. The Veteran was afforded a hearing before the undersigned in March 2021. A transcript of said hearing is of record. 1. Entitlement to an evaluation in excess of 10 percent for hiatal hernia with GERD The Veteran contends that he is entitled to a higher rating for his service-connected hiatal hernia with GERD. The Veteran's hiatal hernia with GERD is rated pursuant to 38 C.F.R. § 4.114, Diagnostic Code (DC) 7346, for hiatal hernia. Pursuant to DC 7346, a 10 percent disability rating is warranted for two or more of the symptoms for the 30 percent evaluation of less severity. A 30 percent evaluation is warranted for persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. The maximum 60 percent evaluation is warranted for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. For the reasons that follow, the Board finds that a rating in excess of 10 percent is not warranted, as the Veteran's hiatal hernia with GERD manifested in no more than two or more symptoms for the 30 percent evaluation of less severity. The Veteran underwent an examination in August 2011. The Veteran was diagnosed with a hiatal hernia, GERD and abdominal aortic aneurysm. Multiple episodes of gastroesophageal reflux were noted. The Veteran was afforded a VA examination in July 2019. The diagnosis of hiatal hernia with GERD was confirmed. Signs and symptoms were noted to include persistently recurrent epigastric distress; pyrosis; reflux; substernal pain; and sleep disturbance caused by esophageal reflux 4 or more times per year, lasting less than one day. Upper GI radiographic studies in August 2011 showed a moderate to large hiatal hernia with multiple episodes of gastroesophageal reflux disease witnessed to the thoracic inlet with delayed clearing. No significant functional impact was noted. The Veteran is competent to report his readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In this regard, the Board notes that the Veteran reported during the 2019 VA examination that his symptoms have not improved since the onset of the condition, and that he has elevation of the bed to help with said symptoms. Based on the aforementioned evidence, the Board finds that the Veteran's hiatal hernia with GERD manifested in two or more symptoms for the 30 percent evaluation of less severity throughout the appeal period, corresponding to the criteria for a 10 percent rating under DC 7346. A higher 30 percent rating under DC 7346 is not warranted unless there is persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. Here, persistently recurrent epigastric distress; pyrosis; reflux; substernal pain; and sleep disturbance caused by esophageal reflux 4 or more times per year, lasting less than one day were noted as comprising the Veteran's symptoms. However, the 2019 examiner specifically indicated that the Veteran's esophageal condition is not productive of considerable impairment of health or regurgitation. Additionally, review of the Veteran's VA medical records reflects that they are silent on treatment or identification of additional symptoms. Thus, the Veteran's hiatal hernia with GERD did not more nearly approximate persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A higher 30 percent rating under DC 7346 is not warranted. 2. Entitlement to service connection for sleep apnea as secondary to PTSD The Veteran contends his sleep apnea disability was caused or aggravated by his service-connected PTSD. In the alternative, the Veteran contends his sleep apnea was incurred in or caused by service, to include herbicide exposure. The Veteran's August 2010 VA treatment records indicate that the Veteran has a current diagnosis of sleep apnea. The January 2020 VA examiner opined that it is at least as likely as not that the Veteran's sleep apnea is proximately due to or the result of his service-connected PTSD. The examiner explained that beyond the known risk factors for sleep apnea, individuals with sleep apnea have been found to have a high prevalence of comorbid psychiatric conditions including PTSD, depression and other anxiety disorders. The examiner further noted that research suggests that civilians with PTSD have higher rates of sleep apnea than the general population. The examiner specified that similar to civilian samples, the prevalence of sleep apnea is higher in Veterans with PTSD. In support of this rationale, the examiner cited specific medical studies. In contrast, an addendum opinion dated in March 2020 reflects the opinion that the Veteran's sleep apnea was less likely than not aggravated by his PTSD. In support of this opinion, the examiner referenced a December 2019 PTSD treatment record which did not note associated symptoms such as sleep interruption. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current sleep apnea is proximately due to his service-connected PTSD. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for sleep apnea is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Effective Date Generally, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110(a) (2012); 38 C.F.R. § 3.400. When an award is based on a claim to reopen a previously denied claim, the effective date will be the date of receipt of the new (i.e., reopened) claim or the date entitlement arose, whichever is later, unless new and material evidence was received within the relevant appeal period. 38 C.F.R. § 3.400(q). In deciding this case based on its application of the law to the pertinent facts, the Board notes that the "date of receipt" of claim means the date on which the claim was received by VA, except as to specific provisions for claims received in the State Department, the Social Security Administration, or the Department of Defense. 38 C.F.R. § 3.1(r). 3. Entitlement to an effective date prior to March 17, 2011 for the grant of service connection for a hiatal hernia with GERD 4. Entitlement to an effective date prior to March 17, 2011 for the grant of service connection for PTSD with major depressive disorder The Veteran contends that the effective date for service connection of his hiatal hernia and PTSD should be prior to March 17, 2011. The record reflects that on March 17, 2011, the Veteran filed his initial claim for service connection for hiatal hernia and psychiatric disability, to include anxiety and depression. In a June 2013 rating decision, the hiatal hernia claim was granted, and the psychiatric claim was denied. Thereafter, the Veteran was granted service connection for PTSD with major depressive disorder in a November 2017 rating decision. The effective date assigned for the grant of both claims was March 17, 2011the date the initial claims were received by VA. Although the Veteran asserts in his appeal that he is entitled to an earlier effective date for the award of service connection for a hiatal hernia and psychiatric disability, considering the record in light of the governing legal authority, the Board finds that no earlier effective date is assignable. As previously noted, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. Here, the date the original claims for service connection were received is March 17, 2011 and is the currently-assigned effective date. Review of the entire claims file reflects that there is no evidence of a claim, either formal or informal, prior to March 17, 2011. The pertinent legal authority governing effective dates is clear and specific, and the Board is bound by such authority. As, on these facts, no effective date for the award of service connection for a hiatal hernia and psychiatric disability earlier than March 17, 2011 is assignable, the claim for an earlier effective date must be denied as without legal merit. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Increased Rating Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history, and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. The Board notes that while the regulations require review of the recorded history of a disability by the adjudicator to ensure an accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where an increase in the disability rating is at issue, the present level of the Veteran's disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). It is also noted that staged ratings are appropriate for any increased rating claim whenever the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). The Board has thoroughly reviewed all the evidence in the Veteran's claims file. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all the evidence submitted by the appellant or on her behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record, but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claims. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the appellant). The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and provide reasons for rejecting any evidence favorable to the Veteran. Equal weight is not accorded to each piece of evidence contained in the record; not every item of evidence has the same probative value. When all the evidence is assembled, 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 a claim, in which case, the claim is denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 5. Entitlement to an evaluation in excess of 70 percent for PTSD with depression The Veteran contends he is entitled to a disability rating in excess of 70 percent for his service-connected PTSD. Under the General Formula for Mental Disorders (General Formula), a 70 percent rating is assigned for PTSD when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. 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; or memory loss for names of close relatives, own occupation or own name. The Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 100 percent. The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 100 percent. The Veteran's symptoms more closely approximated the symptoms associated with a 70 percent rating, and resulted in a level of impairment that most closely approximated the level of impairment associated with a 70 percent rating. The Veteran was afforded a VA PTSD examination in May 2013. His confirmed diagnoses were PTSD and major depressive disorder. The Veteran's acquired psychiatric disability was assessed to be productive of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. It was noted that symptoms are severe. At the time of the examination, he stated he had been married twice, and due to his troubles, these relationships ended, including with his step kids and grandkids. However, he also indicated he was in a current relationship of 8 years with a domestic partner though the relationship is rocky due to his symptoms. He indicated he sometimes wakes up crying but cannot tell her what's wrong. He indicated he was working at a large hardware store until 2009, when he was awarded disability. He tried going back to work one year later as a corrections officer, but that lasted two weeks. He also reported starting a company trying to provide jobs and small business opportunities to veterans. Upon clinical examination, the Veteran's symptoms were noted to include depressed mood; anxiety; chronic sleep impairment; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. In addition, the examiner noted that the Veteran reported having increased nightmares; uncontrolled crying; avoidance of familiar activities such as flying; avoidance of friends and familiar hobbies; has increased irritability and decreased concentration; has hypervigilance; has suicidal ideations, though has no plan. The Veteran was afforded another VA examination in January 2018. His confirmed diagnoses were PTSD and major depressive disorder. The Veteran's acquired psychiatric disability was assessed to be productive of occupational and social impairment with reduced reliability and productivity. The Veteran reported being with his wife for the past 12 years, out of which he has been married for the past two. He stated he has children with whom he is estranged, and does not have friends nor engages in social activities. The Veteran indicated he had not worked for the prior 9 years due to health problems, and last worked in retail management, which he quit due to a heart condition and anger/irritability problems. He also stated he tried to become a corrections officer, but was too overwhelmed with anxiety. The Veteran reported severe symptoms of PTSD, including re-experiencing, hyperarousal and avoidance. Upon clinical examination, the Veteran's symptoms were noted to include depressed mood; anxiety; panic attacks that occur weekly or less often; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; impairment of short and long term memory; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances, including work or a worklike setting; and inability to establish and maintain effective relationships. The examiner noted that the Veteran was very distressed throughout the evaluation and cried frequently though he made a good effort, was engaged, and appeared to be a reliable historian. The Veteran was afforded another VA examination in November 2019. His confirmed diagnosis was major depressive disorder. The examiner assessed that the Veteran's PTSD was in remission. The Veteran's acquired psychiatric disability was assessed to be productive of 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. Upon clinical examination, the Veteran's symptoms were noted to include depressed mood; mild memory loss, such as forgetting names, directions or recent events; and difficulty in establishing and maintaining effective work and social relationships. Of record is also a private psychological opinion dated in October 2019. Diagnoses of PTSD and depression were confirmed. The Veteran's symptoms were noted to include insomnia, flashbacks, intrusive thoughts and dreams, fear, avoidance, irritability, rage/anger, anxiety and depression. The Veteran stated his attention and concentration are "not good at all and getting worse"; that he has focus and concentration problems; disturbed sleep; low energy. The Veteran reported an absent connection with his family and that he prefers to isolate from friends. His wife reported he becomes anxious when he leaves the house or around other people. She noted worsening isolation, loss of interest and overall avoidance related to hobbies and social outings. The Veteran was groomed appropriately; walked with an unsteady gait; was cooperative, attentive and maintained eye contact; he appeared to be a fair historian; his memory appeared mildly impaired; speech was slow and often slurred; thought process was linear and goal oriented but with a circumstantial tone; he reported intrusive thoughts and flashbacks; there was no evidence of psychosis; his affect was appropriate to his mood; his mood was dysphoric and depressed; he was oriented to all spheres; his focus and concentration were mildly impaired; his insight was intact and his judgment was fair. It was reported that the Veteran worked until about 10 years prior to the examination due to worsening mental state and medical issues. He reported disciplinary issues, conflicts, trust issues, suspiciousness and irritability. He reported being married three times, including currently, and not having children. Upon review of the evidence of record, to include VA and private treatment records, the October 2019 private examination, the May 2013, January 2018 and November 2019 VA examinations, and the Veteran's lay statements, the Board finds that the preponderance of the evidence shows that the Veteran's psychiatric disability was manifested primarily by symptoms associated with a 70 percent rating (suicidal ideation; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships). The Veteran has not exhibited symptoms associated with a 100 percent rating. Specifically, review of VA and private examinations reflects no report of symptoms such 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. The Board notes that the Veteran expressed suicidal ideation in May 2013, which is contemplated by the 70 percent criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). However, the Board finds that the evidence establishes that the severity, frequency, and duration of the Veteran's suicidal ideation has not risen to the level contemplated by the 100 percent disability rating, which identifies a persistent danger of hurting oneself. The Veteran regularly denied thoughts, intent, or a plan involving self-harm in existing treatment records, and during the November 2019 VA examination. The Board finds the level of impairment caused by the Veteran's symptoms more closely approximates the level associated with a 70 percent rating. The Veteran experienced occupational and social impairment with reduced reliability and productivity with deficiencies in most areas. Mental status examinations in VA and private treatment records, the May 2013 VA examination, and the Veteran's own private examination of 2019 specifically indicate that the Veteran's psychological disability picture is productive of occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. While the Board acknowledges the October 2019 private examiner's assessment that the Veteran has been unable to obtain and maintain substantial gainful employment since 2009 due to his psychological disability, the evidence overall does not demonstrate the level of impairment associated with a 100 percent rating. As noted above, the Veteran's other remaining symptoms were either contemplated by or more consistent with a 70 percent rating. Further, while the Veteran has been granted a total disability rating based on individual unemployability due to service-connected disability herein, he was not totally socially impaired. He is currently in a long-term relationship of 14 years and lives with his spouse. In short, the Board finds that the preponderance of the evidence weighs against finding that the severity, frequency, and duration of the Veteran's symptoms of PTSD have resulted in the level of impairment required for a 100 percent rating. The criteria for a 100 percent rating are not met, and the appeal must be denied. 6. Entitlement to a TDIU Total disability is considered to exist when there is any impairment which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340(a)(1). TDIU is granted where a Veteran's service-connected disabilities are rated less than total, but prevent him from obtaining or maintaining all gainful employment for which his education and occupational experience would otherwise qualify him. 38 C.F.R. § 4.16. The Veteran is in receipt of a schedular rating of 70 percent for his PTSD with depression for the entire period on appeal. As the Veteran is rated at 70 percent for his PTSD, he meets the schedular criteria of 38 C.F.R. § 4.16(a). Thus, the issue is whether his service-connected disabilities, including PTSD, have precluded him from engaging in substantially gainful employment (i.e., work that is more than marginal, which permits the individual to earn a "living wage"). See Moore v. Derwinski, 1 Vet. App. 356 (1991). Evidence of record reflects that the Veteran last engaged in substantially gainful employment in June 2009. See VA Form 21-8940. The Veteran reported that he had been working in retail. He reported that he could no longer work due to issues including depression and anxiety. The Board notes that of record is a private mental health evaluation dated in October 2019. Pertinently, the private provider assessed that unpredictable emotional states, anger, depression and anxiety manifested as flashbacks and hypervigilance have played a significant role in limiting the Veteran's ability to obtain and maintain gainful employment. The provider noted that coupled with concentration and sleep impairments, the Veteran could not seek or even attempt to be a viable job candidate - and even if employment was obtained, it is highly unlikely it would have been retained given a worsening clinical and symptom state. The provider assessed with reasonable medical probability, based on audio/visual examination statements and the provided records, that the Veteran was unable to obtain and maintain substantial gainful employment (i.e., earning above the poverty threshold) since at least 2009, and that his service-connected PTSD is sufficient to render him unable to obtain and maintain any form of substantially gainful employment in accordance with his occupational background and education level. While there are some conflicting medical reports of record in this regard, the Board finds that the Veteran's statements of record are credible, as they are consistent with the medical and documentary evidence of record. Furthermore, it is clear the Veteran's health situation due to his service-connected disabilities is severe, and a career in retail, which constitutes the majority of the Veteran's experience, would prove particularly challenging due to his symptoms of anti-social behavior, irritability, memory problems, anxiety and depressed mood. The Board finds that these symptoms are particularly preclusive of employment in this and similar fields requiring significant interaction with customers. Accordingly, based on all of the foregoing, the Board finds that entitlement to a TDIU is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to service connection for heart disease, to include as secondary to herbicide exposure in service, is remanded. The Veteran asserts that he developed a heart disability as a result of his exposure to herbicide agents, including Agent Orange, while serving in Korea near the Demilitarized Zone (DMZ). VA laws and regulations provide that, if a Veteran was exposed to herbicide agents during service, certain listed diseases, including coronary artery disease, are presumptively service connected. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.309(e). Effective January 1, 2020, under the Blue Water Navy Act of 2019, VA enumerated presumptive exposure to herbicides for veterans serving in the Korean Demilitarized Zone (DMZ) from September 1, 1967 to August 31, 1971. 38 U.S.C. § 1116B. Here, however, the Veteran entered active duty in 1972, and served in Korea from February 1973 for a period exceeding two years, after the presumptive period. See DD Form 214. While a development letter was sent to the Veteran in July 2019 requesting additional information regarding the nature of his service and exposures, no additional development is of record. The Bord notes that the Veteran submitted a newspaper article dated in May 2011, indicating that defoliants including Agent Orange were sprayed in South Korea, including along the DMZ, until 1995 during the Veteran's service period. At the May 2020 hearing before the undersigned, the Veteran testified that he was exposed to Agent Orange while serving in Korea. Specifically, the Veteran testified that Agent Orange was both used along the DMZ and also stored and used in bases, along airfields. He testified being around Agent Orange drums all the time, and that he witnessed the spraying directly. Review of the Veteran's personnel records reflects that the Veteran served at Camp Page, which was in close proximity to the DMZ. Although the Veteran served in Korea outside of the presumptive time period prescribed by 38 U.S.C. § 1116B, the Veteran can still prove exposure to herbicide agents on a facts-found basis. Thus, on remand, the AOJ should seek verification of the Veteran's exposure to herbicide agents, to include while stationed in proximity to the DMZ. The matter is REMANDED for the following action: Attempt to verify the Veteran's asserted in-service exposure to herbicide agents. If more details are needed, contact the Veteran to request the information. If there is still insufficient information to verify exposure to herbicide agents, issue a Formal Finding outlining the steps taken to assist the Veteran and notify the Veteran of VA's inability to verify the in-service herbicide agent exposure. If it is necessary to submit multiple requests spanning 60-day timeframes during the Veteran's service in Korea, then such requests should be submitted. Thereafter, complete any additional development deemed necessary to properly adjudicate the Veteran's claim. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Comninos, Georgio 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.