Citation Nr: 22017529 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 13-30 525 DATE: March 25, 2022 ORDER Entitlement to service connection for non-obstructive coronary artery disease secondary to herbicide exposure is granted. REFERRED ISSUES In July 2010, the Veteran filed a VA Form 21-526 (VONAPP), seeking entitlement to service connection for "exposure to asbestos" and "exposure to ionizing radiation." These issues were acknowledged by the Regional Office in an August 2010 Notification Letter. Additionally, the issue of entitlement to a total disability rating based on individual unemployability (TDIU) was raised by the Veteran in his September 2010 VA Form 21-4138 Statement in Support of Claim. These matters are referred to the Agency of Original Jurisdiction for adjudication. See 38 C.F.R. § 20.904(b) (continuing to provide for referral of unadjudicated claims). FINDINGS OF FACT 1. The Veteran served in the Republic of Vietnam during the requisite period and exposure to herbicide agents is presumed. 2. The Veteran has been diagnosed with non-obstructive coronary artery disease, which is a type of ischemic heart disease. CONCLUSION OF LAW The criteria for entitlement to service connection for non-obstructive coronary artery disease secondary to herbicide exposure has been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Navy from March 1970 to December 1973, with service in the Republic of Vietnam. For his meritorious service, the Veteran was awarded (among other decorations) the Vietnam Service Medal and the Vietnam Campaign Medal. The Board of Veterans' Appeals (Board) thanks the Veteran for his service to our country. This matter is before the Board on appeal from a November 2010 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. The Veteran requested a Board hearing before a Veterans Law Judge in his October 2013 VA Form 9. However, in March 2022, the Veteran submitted a formal notification that he wished to withdraw the request for a BVA hearing. Therefore, the Board video-conference hearing request is considered withdrawn. See 38 C.F.R. § 20.704(e). Entitlement to service connection for non-obstructive coronary artery disease due to exposure to herbicides. Under the relevant law and regulations, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). 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. "Service in the Republic of Vietnam" includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 C.F.R. § 3.307(a)(6)(iii). If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases, to include ischemic heart disease, shall be service connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met even though there is no record of such disease during service provided further that the rebuttable presumption provisions of § 3.307(d) are also satisfied. Under 38 C.F.R. § 3.309(e), ischemic heart disease includes, but is not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina. The term ischemic heart disease does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke, or any other condition that does not qualify within the generally accepted medical definition of ischemic heart disease. 38 C.F.R. § 3.309(e), Note 2. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall resolve doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Factual Background and Analysis The Veteran's DD Form 215 (Correction to DD Form 214, Certificate of Release or Discharge from Active Duty) reflects the Veteran served in the Republic of Vietnam from November 1970 to November 1971. As such, exposure to herbicide agents is presumed. 38 C.F.R. § 3.307(a)(6). Next, the Veteran's post-service treatment records confirm the Veteran was admitted to the Prescott VAMC in April 2008 with dilated cardiomyopathy of uncertain etiology, atrial fibrillation of unknown duration, anasarca, and hypertension. The Veteran was referred for a cardiology consultation and underwent cardiac catheterization in January 2009. He was diagnosed with mild non-obstructive coronary artery disease and normal LV (left ventricular) function. See Prescott VAMC treatment records. The Veteran attended a VA examination in October 2010 and described a lack of stamina, shortness of breath, fatigue, and chest pain. The examiner reported a diagnosis of mild non-obstructive coronary artery disease without evidence of ischemic heart disease. The examiner remarked that non-obstructive means there is no ischemic result of the narrowing of the coronary arteries. In a December 2013 medical addendum, the VA examiner opined the Veteran does not have a diagnosis of ischemic heart disease. The examiner stated, "cardiac catheterization showed only mild non-obstructive coronary artery disease with no evidence of ischemia or changes in the vessels severe enough to cause ischemia. This has been well documented by cardiology consultants at both the Phoenix VA, as well as the Prescott VA, with the diagnosis of non-occlusive coronary artery disease. Occlusion is required to hamper blood flow to result in ischemic heart disease." The Board notes that the correct inquiry is whether a veteran has any type of coronary artery disease at all. Indeed, the Board notes that federal regulations do not distinguish between obstructive coronary artery disease and non-obstructive coronary artery disease. See 38 C.F.R. § 3.309 (e). Accordingly, the issue of entitlement to service connection for non-obstructive coronary artery disease becomes a legal question, not a medical question. The Veteran is presumed to have been exposed to herbicides and has been diagnosed with non-obstructive coronary artery disease. Thus, the Veteran is entitled to presumptive service connection. Resolving reasonable doubt in favor of the Veteran, he is entitled to prevail in his claim of entitlement to service connection for non-obstructive coronary artery disease. See 38 C.F.R. § 3.102. The nature and extent of the Veteran's heart disability is not before the Board at this time. Rebecca N. Poulson Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Grace Johnk, 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.