ARTERIOSCLEROTIC HEART DISEASE (CORONARY ARTERY DISEASE)

Summary

The veteran, who served from June 1966 to March 1969, appeals the denial of service connection for several conditions, including arteriosclerotic heart disease, hypertension, diabetes mellitus type II, chloracne, diabetic nephropathy, and erectile dysfunction. The case has a complex procedural history, having been before the Board multiple times since 2011, with prior remands for development concerning herbicide exposure in Guam and a claimed in-service rash. The RO granted service connection for these conditions presumptively under the PACT Act from August 10, 2022, but the appeal continued for the earlier period. The Board found that the veteran's service treatment records were silent for these conditions, but his statements regarding herbicide exposure in Guam were competent and corroborated by military personnel records. The Board granted service connection for arteriosclerotic heart disease, hypertension, and diabetes mellitus type II on a direct basis, affording the veteran the benefit of the doubt due to the case's protracted history and prior development errors. For chloracne, the Board found it presumptively related to herbicide exposure, which was conceded, and also granted direct service connection from July 25, 2011. For diabetic nephropathy and erectile dysfunction, claimed as secondary to diabetes, the Board found current diagnoses and a positive nexus from VA examiners, granting service connection secondary to the service-connected diabetes. The Board found the negative nexus opinions for other skin conditions (dermatitis, folliculitis, actinic keratosis, dyshidrosis) to be more probative.

Rationale

Current disability confirmed by VA examination; In-service event (herbicide exposure in Guam) established; Benefit of the doubt afforded due to case history

Full Decision Text

Citation Nr: 26001687
Decision Date: 02/06/26	Archive Date: 02/06/26

DOCKET NO. 14-00 667
DATE: February 6, 2026

ORDER

Entitlement to service connection from July 25, 2011 for arterioslerotic heart disease to include status post coronary artery bypass graft is granted.

Entitlement to service connection from July 25, 2011 for hypertension is granted.

Entitlement to service connection from July 25, 2011 for diabetes mellitus type II is granted.

Entitlement to service connection from July 25, 2011 for chloracne is granted.

Entitlement to service connection from July 25, 2011 for diabetic nephropathy, secondary to the service-connected diabetes mellitus type II is granted.

Entitlement to service connection from July 25, 2011 for erectile dysfunction secondary to the service-connected diabetes mellitus type II is granted.

FINDINGS OF FACT

1. The competent and credible evidence of record persuasively establishes a finding that the heart disability is related to active-duty service.

2. The competent and credible evidence of record persuasively establishes a finding that the hypertension is related to active-duty service.

3. The competent and credible evidence of record persuasively establishes a finding that the diabetes mellitus type II is related to active-duty service.

4. The competent and credible evidence of record persuasively establishes a finding that the chloracne is related to active-duty service.

5. The competent and credible evidence of record persuasively establishes a finding that the dermatitis, folliculitis, actinic keratosis, and dyshydrosis are not related to active-duty service, to include herbicide exposure.

6. The competent and credible evidence of record persuasively establishes a finding that the diabetic nephropathy is related to the service-connected diabetes mellitus type II.

7. The competent and credible evidence of record persuasively establishes a finding that the erectile dysfunction is related to the service-connected diabetes mellitus type II.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection from July 25, 2011 for arterioslerotic heart disease to include status post coronary artery bypass graft have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection from July 25, 2011 for hypertension have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection from July 25, 2011 for diabetes mellitus type II have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for entitlement to service connection from July 25, 2011 for chloracne have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for entitlement to service connection from July 25, 2011 for diabetic nephropathy, secondary to the service-connected diabetes mellitus type II have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

6. The criteria for entitlement to service connection from July 25, 2011 for erectile dysfunction secondary to the service-connected diabetes mellitus type II have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1966 to March 1969. This case comes before the Board of Veterans' Appeals (Board) on appeal from a May 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In May 2015, the Veteran testified at a hearing before a Veterans Law Judge (VLJ). A transcript of this hearing has been associated with the record. This VLJ has since become unavailable to participate in the appeal. In February 2025, the Board sent a letter to the Veteran providing him with an opportunity to present testimony at a new hearing before a different VLJ. As explained in that letter, as the Veteran did not respond within 30 days from the date of
 served on active duty from June 1966 to March 1969. This case comes before the Board of Veterans' Appeals (Board) on appeal from a May 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

In May 2015, the Veteran testified at a hearing before a Veterans Law Judge (VLJ). A transcript of this hearing has been associated with the record. This VLJ has since become unavailable to participate in the appeal. In February 2025, the Board sent a letter to the Veteran providing him with an opportunity to present testimony at a new hearing before a different VLJ. As explained in that letter, as the Veteran did not respond within 30 days from the date of the letter, the Board may assume that he does not want another hearing.

The Board denied these claims in a September 2015 decision. The Veteran appealed that decision to the United States Court of Appeals for Veterans' Claims. In a September 2016 Joint Motion for Remand (JMR), the parties agreed that the Board erred in not ensuring that there was adequate research as to determine whether the Veteran had any herbicide exposure while in Guam, and for neglecting to address the Veteran's in-service complaint of a rash over his entire body. These issues returned to the Board in June 2017, when they were remanded for further development. In March 2023, the RO granted service connection for each issue other than the skin based on the PACT Act from August 10, 2022. The remaining period remains on appeal. These issues returned to the Board again in November 2023, and April 2025, remanded each time for further development. That development was completed, and the case has since been returned to the Board for appellate review.

Service Connection

1. Entitlement to service connection from July 25, 2011 for arterioslerotic heart disease to include status post coronary artery bypass graft

2. Entitlement to service connection from July 25, 2011 for hypertension

3. Entitlement to service connection from July 25, 2011 for diabetes mellitus type II

Service connection may be granted for a 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). To establish a right to compensation for a present disability, a Veteran 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 - the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

The Veteran alleges that the heart disability, hypertension, and diabetes are related to herbicide exposure due to active-duty service in Guam. As established above, these issues are service-connected presumptively due to herbicide exposure from August 10, 2022. Regardless of whether a claimed disability is recognized under 38 C.F.R. § 3.309(e), a Veteran is not precluded from presenting evidence that a claimed disability was due to or the result of herbicide exposure on a direct service connection basis. See Combee v. Brown, 34 F.3d 1039, 1044-45 (Fed. Cir. 1994).

First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). VA examinations in January 2023 confirmed diagnoses of hypertension, diabetes mellitus type II, myocardial infarction, arteriosclerotic heart disease, coronary artery bypass graft, and coronary artery disease. Accordingly, the first element of service connection is met.

Second, the Board finds that there was an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran's service treatment records (STRs) are silent for any complaints of or treatment for these conditions. The PACT Act conceded herbicide exposure in Guam from January 9, 1962, through July 31, 1980. The Veteran's military personnel
 January 2023 confirmed diagnoses of hypertension, diabetes mellitus type II, myocardial infarction, arteriosclerotic heart disease, coronary artery bypass graft, and coronary artery disease. Accordingly, the first element of service connection is met.

Second, the Board finds that there was an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran's service treatment records (STRs) are silent for any complaints of or treatment for these conditions. The PACT Act conceded herbicide exposure in Guam from January 9, 1962, through July 31, 1980. The Veteran's military personnel records indicated that he had active-duty service in Guam from September 23, 1967 to March 4, 1969. The Board finds the Veteran's statements competent as they are capable of lay observation. 38?U.S.C. §?1154(a); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge). Further, these statements have been corroborated by the military personnel records. Caluza v. Brown, 7 Vet. App. 498, 511 (1995) (noting that the probative value of a witness statement may be affected by inconsistency with other evidence), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Accordingly, the second element of service connection is met.

Third, the Board finds that the evidence of record does support a finding that the hypertension, heart disability, and diabetes are related to active service.

Although VA afforded the Veteran examinations in January 2023, no medical opinions were provided. As indicated above, this is the third time that these issues have returned to the Board since service connection from August 10, 2022 was established. It is unclear why there was no prior directive to obtain medical opinions on a direct basis, given that these issues remained on appeal under a theory of entitlement for direct service connection. Rather, these prior Board remands focused on determining whether the Veteran had any herbicide exposure while in Guam, which was already conceded by VA. That a grant of service connection on a presumptive basis under the PACT Act is not warranted prior to August 10, 2022, does not necessarily negate that Congress has established as a fact that there were herbicides used on Guam.

Given that this appeal originated in 2011 and has been before the Board now 5 times without managing to correct all duty to assist errors, it would frustrate due process to continue to make the Veteran jump through hoops to prove his claims. Thus, the Board will afford the Veteran the benefit of the doubt and afford his assertions probative value. 

Accordingly, as the probative evidence of record is in the Veteran's favor, the Board finds that the criteria for the claims of entitlement to service connection for arterioslerotic heart disease to include status post coronary artery bypass graft, hypertension, and diabetes mellitus type II from July 25, 2011, have been met, and the appeal is granted.

4. Entitlement to service connection from July 25, 2011 for chloracne due to herbicide exposure

The Veteran alleges that he has a skin condition which began during service and is related to herbicide exposure in Guam.

First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). A VA examiner in August 2017 confirmed a diagnosis of chloracne. April 2018 VA treatment records indicated that the Veteran sought treatment from dermatology in September 2017, and that the condition was asymptomatic at that time. VA examiners in January 2021 and January 2023 confirmed diagnoses of dermatitis, folliculitis, and actinic keratosis. The record also notes a diagnosis of dyshidrosis. Accordingly, the first element of service connection is met.  

Second, the Board finds that there was an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). October 1967 STRs noted the Veteran's complaint of a sunburn. August 1968 STRs indicated complaints of a rash all over his body. As indicated above, the Veteran has asserted that the skin condition is related to herbicide exposure while in Guam. The Board finds the Veteran's statements competent as they are capable of lay observation. 38?U.S.C. §?1154(a); Washington, 19 Vet. App
idrosis. Accordingly, the first element of service connection is met.  

Second, the Board finds that there was an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). October 1967 STRs noted the Veteran's complaint of a sunburn. August 1968 STRs indicated complaints of a rash all over his body. As indicated above, the Veteran has asserted that the skin condition is related to herbicide exposure while in Guam. The Board finds the Veteran's statements competent as they are capable of lay observation. 38?U.S.C. §?1154(a); Washington, 19 Vet. App. at 368 (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge). Further, these statements have been corroborated by the STRs and military personnel records. Caluza, 7 Vet. App. at 511 (noting that the probative value of a witness statement may be affected by inconsistency with other evidence), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Accordingly, the second element of service connection is met.

Third, the Board finds that the evidence of record does support a finding that the only the chloracne is related to active service.

The January 2021 VA examiner provided a negative nexus opinion for the dermatitis, folliculitis, and actinic keratosis. They explained that the STRs were without evidence to support a chronic skin condition nor to identify diagnosis of dermatitis, actinic keratosis or folliculitis during service. The examiner indicated that the Veteran's sunburn was less likely than not a contributing factor to any of the skin conditions noted at this time as reports of sunburn on one occasion are considered acute and transitory in nature. Regarding the rash, they concluded that without a confirmed diagnosis of the rash, it appears that this rash resolved as there was no further report during service to support a chronic issue at that time.

The January 2023 VA examiner also provided a negative nexus opinion for the chloracne. They explained that there were no symptoms on examination, and that the records did not support a diagnosis. The examiner noted that the current diagnosis was keratosis, first diagnosed in 2019.  

In a March 2024 addendum opinion, a VA examiner explained that dermatitis is an inflammatory response of the skin, caused by contact with allergens or irritants. They noted that folliculitis is a common skin condition that happens when hair follicles become inflamed, often caused by an infection with bacteria. As for the actinic keratosis, the examiner indicated that it is due to years of sun damage to the skin. They concluded that there is no positive, scientific evidence of an association between these skin conditions and exposure to Agent Orange. 

In a May 2024 addendum opinion, a VA examiner found that the in-service complaints of a rash were acute only, and that there is no objective evidence for a diagnosis or etiology of the skin rash that occurred during active duty. They noted the claimed skin rash to the bilateral hands is diagnosed as dermatitis with onset in 2009, and that the claimed skin condition of blisters is diagnosed as folliculitis with onset 2019, which have specific etiologies. They explained that dermatitis is an inflammatory response of the skin, caused by contact with allergens or irritants, that folliculitis starts when hair follicles are damaged or when the follicle is blocked, which may occur from rubbing against clothing or shaving. The examiner concluded that there is no positive scientific evidence of an association between the claimed skin conditions and the in-service exposures.

The Veteran underwent another VA examination in June 2025 where the examiner provided a negative nexus opinion. They explained that there is a lack of substantiating evidence supporting a nexus between the current diagnosis of actinic keratosis and military service. The examiner noted that there were no complaints of any skin problems during service, a post-service event, illness, or injury is considered to be a more likely etiology. The acknowledged the in-service herbicide exposure, but found that there is no established link between Agent Orange exposure and actinic keratosis, which is due to years of sun damage to the skin.

Finally, in an August 2025 addendum opinion, a VA examiner found that the dermatitis, folliculitis, and actinic keratosis are less likely than not caused by service, to include herbicide exposure. They explained that there is no established link between Agent Orange exposure and actinic keratosis, which is due to years of sun damage to the skin, and therefore more likely to be caused by years of sun damage. The examiner found that folliculitis starts when
 injury is considered to be a more likely etiology. The acknowledged the in-service herbicide exposure, but found that there is no established link between Agent Orange exposure and actinic keratosis, which is due to years of sun damage to the skin.

Finally, in an August 2025 addendum opinion, a VA examiner found that the dermatitis, folliculitis, and actinic keratosis are less likely than not caused by service, to include herbicide exposure. They explained that there is no established link between Agent Orange exposure and actinic keratosis, which is due to years of sun damage to the skin, and therefore more likely to be caused by years of sun damage. The examiner found that folliculitis starts when hair follicles are damaged or when the follicle is blocked, which may occur from rubbing against clothing or shaving, and become infected with staphylococci bacteria. They noted that other types of infections, ingrown hairs, excessive sweating, and autoimmune disorders also cause folliculitis, but that there is no evidence that the Agent Orange exposure causes it. 

The examiner explained that dermatitis is not a directly recognized effect of Agent Orange exposure, and instead it is caused by irritants, certain exposures and allergens to the skin dyshidrosis is less likely than not caused by service. They noted that dyshidrosis is less likely than not caused by service. They acknowledged the in-service complaints of a sunburn and rash, and the Veteran's February 2016 Agent Orange Registry examination where the Veteran presented with photos of his palmar hands displaying diffuse denuded flaking and peeling of his epidermis which appeared intermittently since his return from Guam but concluded that these conditions were not related to service.

The Board the August 2025 opinion medical opinion significant probative value as it was conducted by a medical professional with consideration of the Veteran's lay statements, and specific facts in this case, and is supported by well-reasoned rationale. Factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion. Prejean v. West, 13 Vet. App. 444, 448-9 (2000). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008).

The Board affords less probative value to the January 2021 opinion as the examiner did not address the Veteran's reports of intermittent symptoms since separation from service. Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007).

Less probative value is also afforded to the March, May 2024, and June 2025 opinions as there was not substantial compliance with prior remand instructions. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998).

The Board notes that although the evidence of record is against a finding that the dermatitis, folliculitis, actinic keratosis, and dyshydrosis are related to service, the issue of chloracne remains. As indicated above, a VA examiner in August 2017 confirmed a diagnosis of chloracne. Subsequent VA examiners declined to address chloracne as they did not find any symptoms on examination. The requirement for service connection that there be a current disability is satisfied when the disability is shown at the time of the claim or during the pendency of the claim, even though the disability subsequently resolves. McClain v. Nicholson, 21 Vet. App. 319 (2007). 

As chloracne is presumptively related to herbicide exposure, and herbicide exposure in Guam has been conceded, the Board finds that the criteria for the claim of entitlement to service connection for chloracne due to herbicide exposure have been met. Additionally, for the reasons outlined with the service-connected heart disability, hypertension, and diabetes, the Board will also grant service connection on a direct basis from July 25, 2011. The appeal is granted.

5. Entitlement to service connection from July 25, 2011 for diabetic nephropathy, secondary to the service-connected diabetes mellitus type II

6. Entitlement to service connection from July 25, 2011 for erectile dysfunction secondary to the service-connected diabetes mellitus type II

Service connection may also be granted on a secondary basis for disability which is proximately due to or the result of service-connected disease or injury, or for additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability. 38 C.F.R. § 
 disability, hypertension, and diabetes, the Board will also grant service connection on a direct basis from July 25, 2011. The appeal is granted.

5. Entitlement to service connection from July 25, 2011 for diabetic nephropathy, secondary to the service-connected diabetes mellitus type II

6. Entitlement to service connection from July 25, 2011 for erectile dysfunction secondary to the service-connected diabetes mellitus type II

Service connection may also be granted on a secondary basis for disability which is proximately due to or the result of service-connected disease or injury, or for additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability. 38 C.F.R. § 3.310 (2018); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

The Veteran alleges that diabetic nephropathy and erectile dysfunction are secondary to the service-connected diabetes mellitus type II.

First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). VA examiners in January 2023 confirmed diagnoses of diabetes nephropathy and erectile dysfunction. Accordingly, the first element of service connection is met.

Second, the Board finds that there was an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran's STRs are silent for any complaints of treatment for erectile dysfunction or diabetic nephropathy; however, he has asserted that these conditions are related to the service-connected diabetes mellitus type II. The Board finds the Veteran's statements competent as they are capable of lay observation. 38?U.S.C. §?1154(a); Washington, 19 Vet. App. at 368 (noting that a lay witness is competent to report to factual matters of which he or she has first-hand knowledge); Caluza, 7 Vet. App. at 511 (noting that the probative value of a witness statement may be affected by inconsistency with other evidence), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Accordingly, the second element of service connection is met.

Third, the Board finds that the evidence of record does support a finding that the diabetic nephropathy and erectile dysfunction are related to active service.

The January 2023 VA examiner provided positive nexus opinions. Regarding the nephropathy condition, they indicated that there is substantial evidence in medical literature and in the Veteran's medical records noting that his diabetes mellitus type II has caused diabetic nephropathy. The examiner explained that in diabetes, the presence of microalbuminuria and macroalbuminuria confers increased risk of developing diabetic nephropathy. They noted that one criterion for a diagnosis of diabetic nephropathy is elevated microalbumin, which is consistently shown in his medical records.

As for the erectile dysfunction, they concluded that diabetes can cause erectile dysfunction because it can damage the blood supply to the penis and the nerves that control an erection. They explained that the prevalence of erectile dysfunction is approximately 3.5-fold higher in men with diabetes than in those without diabetes. Therefore, the examiner indicated that since his erectile dysfunction occurred after his diabetes mellitus type II, they were related.  

The Board affords both medical opinions significant probative value as they were conducted by a medical professional with consideration of the Veteran's lay statements, and specific facts in this case, and are supported by well-reasoned rationale. Factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion. Prejean, 13 Vet. App. at 448-9. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez, 22 Vet. App. at 301.

As the probative evidence of record is in the Veteran's favor, the Board finds that the criteria for the claims of entitlement to service connection for diabetic nephropathy and erectile dysfunction secondary to the service-connected diabetes mellitus type II from July 25, 2011 have been met, and the appeal is granted.

 

 

Thomas L. English

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Rogos, J.

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. 


 the criteria for the claims of entitlement to service connection for diabetic nephropathy and erectile dysfunction secondary to the service-connected diabetes mellitus type II from July 25, 2011 have been met, and the appeal is granted.

 

 

Thomas L. English

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Rogos, J.

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.