ISCHEMIC HEART DISEASE

M. C. GRAHAM · 2025 · Case ID: 25008711

DENIED

Summary

The veteran, who served in the Army from November 1972 to May 1979, appeals the denial of service connection for a heart disability and hypertension, both claimed as due to exposure to tactical herbicide agents. The veteran's service included time in Korea from February 1975 to June 1976. The Board previously issued multiple decisions on various issues, including remands and grants for other conditions. The current appeal stems from a July 2023 Court Memorandum Decision that vacated a prior Board decision and remanded the heart disability, hypertension, and bilateral hand disability issues for readjudication. Subsequent Board decisions granted service connection for carpal tunnel syndrome and arthritis of the hands, while remanding the heart and hypertension claims again. The Board reviewed the veteran's contention of exposure to tactical herbicide agents, specifically Agent Orange, in Korea, citing his service near the DMZ and his MOS as a heavy construction equipment operator. However, the Board found the evidence persuasively against exposure, noting that herbicide use in the Korean DMZ ended in 1969, years before the veteran's service there. Despite a July 2018 remand for verification of exposure, subsequent records, including an August 2023 RRC report, did not document the veteran's unit serving along the DMZ or the use of herbicides. The Board also considered the PACT Act, which mandates TERA medical opinions for certain claims. A June 2023 TERA memorandum indicated highly probable exposure due to the veteran's MOS. However, subsequent April 2024 and April 2025 VA medical opinions concluded that the veteran's heart conditions and hypertension were less likely than not caused by the indicated toxic exposure activities. These opinions cited the veteran's numerous non-TERA risk factors (obesity, smoking, age, etc.) as the primary causes, finding no evidence linking the conditions to exposure. The Board found these negative nexus opinions persuasive and uncontradicted, leading to the denial of service connection for both the heart disability and hypertension.

Rationale

Evidence persuasively against finding of exposure to tactical herbicide agents in service.; No etiological link found between heart conditions and toxic exposures.; Veteran's non-TERA risk factors (hypertension, obesity, smoking, age) outweigh TERA risk factors.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

13-31 265A

Full Decision Text

Citation Nr: 25008711
Decision Date: 07/01/25 Archive Date: 07/01/25

DOCKET NO. 13-31 265A
DATE: July 1, 2025

ORDER

Entitlement to service connection for a heart disability, claimed as due to exposure to tactical herbicide agents, is denied.

Entitlement to service connection for hypertension, claimed as due to exposure to tactical herbicide agents, is denied.

FINDINGS OF FACT

1. The evidence is persuasively against finding that the Veteran was exposed to tactical herbicide agents during service, to include during service in Korea from February 1975 to June 1976.

2. The evidence is persuasively against finding that the Veteran's heart disabilities or hypertension manifested in service or in the first post-service year, or that the Veteran's heart disabilities and hypertension are etiologically related to in-service injury, event, or disease.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a heart disability, claimed as due to exposure to tactical herbicide agents, have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for entitlement to service connection for hypertension, claimed as due to exposure to tactical herbicide agents, have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1131, 1137, 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 November 1972 to May 1979. The Board thanks the Veteran for his service to our country.

The Veteran testified before the undersigned at a Board videoconference hearing in March 2018; a transcript of the hearing is of record.

The Board remanded the issues currently remaining on appeal in July 2018. In February 2022, the Board denied entitlement to service connection for a heart disability, for hypertension, and for a disability of the bilateral hands. At that time, the Board remanded to the agency of original jurisdiction (AOJ) claims of entitlement to service connection for type-II diabetes mellitus and a liver disability, and entitlement to a total disability rating due to individual unemployability (TDIU). The Board resolved the Veteran's claim to establish permanent incapacity for self-support for his son A. F. in a separate decision issued in February 2022.

In August 2022, the Board issued a decision resolving the claims of entitlement to service connection for type-II diabetes mellitus and a liver disability, and entitlement to a TDIU for a period from November 27, 2016. At that time, the Board remanded the issue of entitlement to a TDIU for a period prior to November 27, 2016, to the AOJ. In January 2023, the Board issued a decision resolving the issue of entitlement to a TDIU for a period prior to November 27, 2016.

In March 2023, the Board issued another decision resolving other issues under a different docket number.

The case currently before the Board consists of service connection claims denied by the Board's February 2022 decision. The Veteran appealed the Board's February 2022 denials to the Court. In a July 2023 Memorandum Decision, the Court vacated the Board's February 2022 decision to the extent of these service connection issues (heart disability, hypertension, and additionally a bilateral hand disability issue); the Court remanded these issues back to the Board for readjudication consistent with the Court's decision.

In January 2024, the Board issued a decision granting service connection for carpal tunnel syndrome of the right and left hands, while remanding the issues of entitlement to service connection for arthritis of the right and left hands, heart disability, and hypertension.

In February 2025, the Board issued a decision granting service connection for arthritis of the right and left hands, while remanding the issues of entitlement to service connection for heart disability and hypertension.

The issues remanded by the Board in February 2025 have now returned to the Board for further appellate review.

Service Connection

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, 5107; 38 C.F
decision granting service connection for carpal tunnel syndrome of the right and left hands, while remanding the issues of entitlement to service connection for arthritis of the right and left hands, heart disability, and hypertension.

The issues remanded by the Board in February 2025 have now returned to the Board for further appellate review.

Service Connection

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, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (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).

Chronic diseases identified under 38 C.F.R. § 3.309(a) (including cardiovascular-renal disease) may be service connected if noted during service and either (1) are shown in service to be chronic, or (2) manifest with continuity of symptomatology. 38 C.F.R. § 3.303(b). To be shown in service to be chronic, the combination of manifestations must be sufficient to identify the disease entity and there must be sufficient observation to establish chronicity at the time; for example, a manifestation of joint pain is insufficient to permit service connection for arthritis. Id. Alternatively, these chronic diseases are presumptively service connected if they manifest to a degree of at least 10 percent within one year from the date of separation. 38 C.F.R. § 3.307(a)(3).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 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 the evidence is persuasively against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990).

1. Entitlement to service connection for a heart disability, claimed as due to exposure to tactical herbicide agents, is denied.

2. Entitlement to service connection for hypertension, claimed as due to exposure to tactical herbicide agents, is denied.

In addition to the general law concerning service connection, certain diseases associated with exposure to herbicide agents may be presumed to have been incurred in service even if there is no evidence of the disease in service, provided the requirements of 38 C.F.R. § 3.307(a)(6) are met. See 38 C.F.R. § 3.309(e). The types of diseases for which service connection may be presumed to be due to an association with herbicide agents include ischemic heart disease. Id.

Veterans who served in or near the Korean demilitarized zone (DMZ) are entitled to a presumption of herbicide exposure if they served during a specific timeframe. Effective February 24, 2011, VA promulgated a regulatory presumption for veterans who served at the Korean DMZ between April 1, 1968, and August 31, 1971. See Herbicide Exposure and Veterans With Covered Service in Korea, 76 Fed. Reg. 4245 (Jan. 25, 2011) (final rule) (adding 38 C.F.R. §§ 3.307(a)(6)(iv), 3.814(c)(2)). However, effective January 1, 2020, Congress extended the presumptive period to cover veterans who served at the Korean DMZ between September 1, 1967, and August 31, 1971. 38 U.S.C. § 1116B; see Blue Water Navy Vietnam Veterans Act of 2019, Pub. L. 116-23, § 3(a), 133 Stat. 966 (June 25, 2019) (codifying 38 U.S.C. § 1116B). On February 12, 2024, VA proposed to amend § 3.307(a)(6)(iv
(a)(6)(iv), 3.814(c)(2)). However, effective January 1, 2020, Congress extended the presumptive period to cover veterans who served at the Korean DMZ between September 1, 1967, and August 31, 1971. 38 U.S.C. § 1116B; see Blue Water Navy Vietnam Veterans Act of 2019, Pub. L. 116-23, § 3(a), 133 Stat. 966 (June 25, 2019) (codifying 38 U.S.C. § 1116B). On February 12, 2024, VA proposed to amend § 3.307(a)(6)(iv) to match the statute's specified timeframe. Updating VA Adjudication Regulations for Disability or Death Benefit Claims Related to Exposure to Certain Herbicide Agents, 89 Fed. Reg. 9803, 9805 (Feb. 12, 2024) (proposed rule).

On August 10, 2022, the President signed into law the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act). See 38 U.S.C. § 1116; Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), Pub. L. 117-168, § 303. Claims granted under the PACT Act, however, will be effective no earlier than August 10, 2022, the date of enactment of the Act.

The Veteran's July 2015 service connection claim, August 2016 Notice of Disagreement, December 2016 Substantive Appeal and statements received in May 2016, July 2021, December 2024, and April 2025 make it clear that he contends that his heart disability and hypertension are due to exposure to Agent Orange while serving in areas in Korea where tactical herbicide agents (such as Agent Orange) had been used or sprayed in the past. He states that Agent Orange remains in the soil for many years. The Veteran reported he used a scraper to bring sand from DMZ riverbeds to build barracks at Camp Hovey and Camp Casey. The Veteran testified that his unit served "on the DMZ." He has not contended, and the evidence does not suggest, that a heart disability and hypertension otherwise had their onset during or as a result of service or may be presumed to have had their onset during service as chronic diseases.

When neither the Veteran nor the record raises the theory of entitlement to service connection on a direct basis, the Board need not on its own initiative consider and discuss that theory. Therefore, the Board will not discuss theories of service connection other than exposure to Agent Orange while serving in Korea and other toxic exposures raised by the record in this case. Robinson v. Mansfield, 21 Vet. App. 545 (2008).

The Veteran's service personnel records reflect that beginning in June 1974 his Military Occupational Specialty (MOS) title was Crawler Tractor Operator, and he served in Korea from February 1975 to June 1976. Thus, exposure to herbicides cannot be conceded on a presumptive basis, as his service in Korea was several years after the timeframe specified ended in 1971. See 38 C.F.R. § 3.307(a)(6).

Moreover, the evidence is persuasively against finding that the Veteran was exposed to tactical herbicide agents during service, to include during service in Korea from February 1975 to June 1976.

The Board's July 2018 remand requested that the Agency of Original Jurisdiction (AOJ) forward all available information regarding the locations of the Veteran's service in Korea to the Joint Services Records Research Center (JSRRC) and any other appropriate resource, with a request that that the organization attempt to verify the Veteran's contention that he served in areas where tactical herbicide agents (such as Agent Orange) were used/sprayed in the past prior to his presence in Korea.

A February 2021 VA memorandum relates that the Army had closed JSRRC indefinitely due to the ongoing COVID pandemic. A Records Research Response, associated with the Veteran's e-folder in June 2021, relates that a researcher from the Veterans Benefits Administration, Compensation Service, Military Records Research Center, had completed comprehensive research. No evidence was located to support documentation of the claimed incident.

The Board acknowledges the Veteran's assertions that Agent Orange was still along the riverways when he was in Korea. He provided scientific treatise evidence concerning its residual presence and toxicity in Vietnam many years after it was used. However, the submitted evidence is general in nature and does not speak specifically to whether the Veteran was himself exposed to herb
in Korea.

In this regard, the Board points to the established fact that herbicide use near the Korean DMZ ended in 1969, several years before the Veteran's period of Korean service began in 1975. See McKinney v. McDonald, 796 F.3d, 1377, 1379 (Fed Cir. 2015). Under § 3.307(a)(6)(iv), the initial period during which service in or near the Korean DMZ would justify a presumption of herbicide exposure was initially set from April 1968 to July 1969. See McKinney, 796 F.3d at 1380. In the final rule, however, VA extended the period end date from July 31, 1969, to August 31, 1971. Herbicide Exposure and Veterans with Covered Service in Korea, 76 Fed. Reg. 4245, 4245-46 (Jan. 25, 2011). "In adopting this change, the VA explained that 'it is reasonable and consistent with the intent of Congress to concede exposure for veterans who served in or near the Korean DMZ after herbicide application ceased, because of the potential for exposure to residuals of herbicides applied in that area.'" McKinney, 796 F.3d at 1380 (quoting 76 Fed. Reg. at 4245). Thus, August 31, 1971, was established "as a reasonable outside date for residual exposure." Id.

The Board notes that the July 2023 Court Memorandum Decision discusses concerns with the Board's prior adjudication of entitlement to service connection for a heart disability and for hypertension. The Veteran contends that he was exposed to the residue of tactical herbicide agents during his service in Korea, specifically contending that his duties took him to the Korean DMZ. The Court's Memorandum decision's discussion identifies concerns about the adequacy of the Record Research Center (RRC) findings in June 2021 "to determine whether appellant served in areas where the military had used Agent Orange."

The Court's Memorandum Decision stated: "Given the Board's specific instructions for the RRC to determine whether appellant served in areas where the military had used Agent Orange, the Board should've explained if the additional development allowed it to answer that question." However, in the time that has passed after the Board's now-vacated prior decision on these issues, and after the July 2023 Court Memorandum Decision, a new August 2023 Records Research Center report has been added to the claims-file. The Board now responds to the Court's instruction by stating that the new development allows the Board "to determine whether appellant served in areas where the military had used Agent Orange."

The August 2023 Records Research Center report states, based upon available records submitted by the pertinent "Eighth US Army," for the relevant period, the research finding: "the records do not mention or document any specific duties performed by the Veteran[']s unit along DMZ," and "Records do not mention the use or storage of herbicides." The only basis of alleged in-service exposure to herbicides in this case is the Veteran's assertion that his service involved his presence along the DMZ, which is the location where Veteran argues that he encountered an environment where the military had previously used tactical herbicide agents. The record now reflects that service department resources do not document such service by the Veteran in the DMZ.

The August 2023 Records Research Center report has been of record and considered in the AOJ readjudications of this case during the processing of the Board's January 2024 and February 2025 remands. The Board also discussed this evidence in its January 2024 remand of these issues.

The Board has considered the concerns raised by the Court's Memorandum decision and its instruction that "the Board rereview whether VA substantially complied with its 2018 remand" and whether the evidence allows adjudication to "determine whether appellant served in areas where the military had used Agent Orange...." As discussed above, the AOJ developed an August 2023 Records Research Center report that complies with the Board's July 2018 remand directive to complete any further research it finds to be necessary to "attempt to verify the Veteran's contention that he served in areas where tactical herbicide agents (such as Agent Orange) [were] used / sprayed in the past prior to his presence in Korea." The Board finds VA satisfied its duty to assist in this regard and that further efforts to attempt to verify the Veteran's contention would be futile.

Additionally, there has been substantial satisfaction of the purposes of the July 2018 Board remand directive to make a clear conclusion as to this research inquiry such that "[i]f the Veteran's contention that he served in areas where tactical herbicide agents were previously utilized cannot be verified, the file must be so annotated, and the Veteran must be so notified." The August 2023 Records Research Center report documents in the file that research did not verify that the Veteran served anywhere in the DMZ; the DMZ is the area identified by the Veteran as where he encountered tactical herbicide agents that had been previously utilized. The Veteran has been notified of this information since, at the latest, the Board's January 2024 remand that discussed and quoted the pertinent findings of that August 2023 Records Research Center report; the Board discussed this evidence in direct response to the concerns regarding fulfillment of the July 2018 Board remand directives.

The Board has carefully considered the latest presentation of the Veteran's argument, submitted in an April 2025 statement by his representative, that is explained as follows:

please note the argument placed before the Board.... This argument is that his assigned duties took him to the DMZ.... The time period he performed this duty was just after the recognized time-period that Agent Orange was used along the DMZ in Korea.... [T]his combination of events/facts would have exposed him to Agent Orange, allowing the VA to grant SC Benefits for these conditions.

The Board understands the Veteran's argument and the reasoning behind it. However, the Board finds the evidence is persuasively against a finding of exposure to herbicides in service. There is nothing in the record, other than the Veteran's statements, that supports the claim in this regard. Whether viewed as reflecting an absence of evidence or substantive negative evidence, service department "records do not mention or document any specific duties performed by the Veteran[']s unit along DMZ." The Board does not find that this issue reaches relative equipoise. The Veteran's current hindsight recollections of his location, or believed location, relative to the Korean DMZ in the remote past of the mid-1970s, are not a sufficient basis upon which to find exposure to herbicides, particularly when combined with the fact that it is undisputed that he served approximately 5 to 6 years after herbicides were last used on the Korean DMZ.

In order to verify the Veteran's alleged exposure to tactical herbicide agents under the theory he has presented, the evidence must support finding both (1) that the Veteran's "assigned duties took him to the DMZ" as he asserts, and (2) that his presence in such location actually exposed him to persisting residuals of tactical herbicide agents despite occurring outside of the established presumptive window for such exposure at that location. In this case, the Veteran's argument does not succeed as discussed above. Thus, the Veteran's theory that he was exposed to herbicides in the DMZ is unsuccessful because the evidence does not establish that he served in the DMZ. His argument is unsuccessful regardless of any further complex scientific questions regarding the potential persistence of herbicides in the DMZ at any given time.

The Board acknowledges the Veteran's assertion, in his December 2024 correspondence, that there has been a different "failure of VARO to correctly follow BVA's directions." The Veteran expresses concern that "VARO did not ask [a VA examiner] any questions about how the persistency of Agent Orange would have affected or caused my current medical conditions
location. In this case, the Veteran's argument does not succeed as discussed above. Thus, the Veteran's theory that he was exposed to herbicides in the DMZ is unsuccessful because the evidence does not establish that he served in the DMZ. His argument is unsuccessful regardless of any further complex scientific questions regarding the potential persistence of herbicides in the DMZ at any given time.

The Board acknowledges the Veteran's assertion, in his December 2024 correspondence, that there has been a different "failure of VARO to correctly follow BVA's directions." The Veteran expresses concern that "VARO did not ask [a VA examiner] any questions about how the persistency of Agent Orange would have affected or caused my current medical conditions. This aspect of my claim is critical and has been overlooked by VARO." The April 2025 statement from the Veteran's representative also argues that "the Regional Office has not complied with the Board's direction" regarding a need "to look specifically into the issue of exposure to Agent Orange and the likelihood that this veteran did in fact come into contact with Agent Orange." The Veteran's representative objects to the fact that "the Regional Office requested the examiner's opinion based upon a TERRA [sic] of his MOS, not on the premise of his Agent Orange exposure as stated above and in the Board's 2 recent remands."

However, the Board's two recent remands specifically requested toxic exposure risk activity(ies) (TERA) medical opinions, not inquiries regarding Agent Orange or tactical herbicides. The Veteran's TERA history was the intended topic of inquiry for the needed development. Indeed, contrary to the statement from the Veteran's representative, the Board's February 2025 remand specifically addressed the Veteran's request for specific development and found it to be unwarranted: "The Board is unable to conclude that the Veteran's requested development for a VA examiner to opine about the effect of persisting residuals of Agent Orange upon the Veteran's health is warranted at this time."

Further medical opinion evidence regarding the alleged exposure to tactical herbicide agents or residuals of such herbicides in the DMZ is not warranted because the evidence is persuasively against a finding that the Veteran was exposed to tactical herbicide agents.

When the Board reviewed these issues in its now-vacated February 2022 decision, the Board determined that the evidence was persuasively against finding that the Veteran was exposed to tactical herbicide agents in service, and that there was no indication that the Veteran's claimed disabilities were otherwise related to service. Since that time, factors affecting the Board's review include not only the July 2023 Court Memorandum Decision, but also changes in the law and pertinent new content in the evidentiary record featuring a formal VA finding.

The PACT Act of 2022 establishes that when a veteran submits a claim for compensation with evidence of a disability and evidence of a toxic exposure risk activity (TERA) during active military service and such evidence is not sufficient to establish service connection for the disability, VA shall provide the veteran with a medical examination under 38 U.S.C. § 5103A(d) and obtain a medical opinion as to whether it is at least as likely as not that there is a nexus between the disability and the toxic exposure risk activity. See PACT Act, § 303 (codified at 38 U.S.C. § 1168).

The PACT Act further provides that, when presenting a medical opinion under this provision, the health care provider shall consider the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all toxic exposure risk activities of the veteran. Id. Such a requirement is not meant to be construed as requiring the health care provider to consider the synergistic, combined effect of each of the substances, chemicals, and airborne hazards identified in the list VA is required to establish and maintain in collaboration with the Department of Defense as specified in 38 U.S.C. § 1119(b)(2). Id.

In this case, a June 2023 VA TERA Memorandum provides that "Yes, the Veteran participated in a TERA." The Memorandum indicates that the Veteran's service involves "evidence of non-deployment related exposure... which is consistent with the circumstances of the Veteran's service." It cites: "DD214 ARMY: 05/27/1976-05/25/1979 - HON (MOS/21E - highly probable exposure) - 08/25/2016." This citation of the Veteran's MOS as a heavy construction equipment operator indicates VA recognition of highly probable exposure to toxic materials associated with heavy construction equipment operation.

The Veteran's medical reports of record show that he has current diagnoses of a heart disability and of hypertension. As the record establishes in-service toxic exposure risk activities (
participated in a TERA." The Memorandum indicates that the Veteran's service involves "evidence of non-deployment related exposure... which is consistent with the circumstances of the Veteran's service." It cites: "DD214 ARMY: 05/27/1976-05/25/1979 - HON (MOS/21E - highly probable exposure) - 08/25/2016." This citation of the Veteran's MOS as a heavy construction equipment operator indicates VA recognition of highly probable exposure to toxic materials associated with heavy construction equipment operation.

The Veteran's medical reports of record show that he has current diagnoses of a heart disability and of hypertension. As the record establishes in-service toxic exposure risk activities (TERA) consisting of exposure to toxic chemicals and materials associated with operating heavy construction equipment, a VA examination with a TERA nexus opinion was necessary. 38 U.S.C. § 1168(a). The Board remanded for this needed development in the January 2024 and February 2025 remands of these issues.

The January 2024 Board remand of these issues directed that the AOJ schedule the Veteran for examinations of his heart and hypertension disabilities to develop TERA medical opinions pursuant to Section 303 of the PACT Act. The resulting April 2024 VA medical opinion indicates that the provider was not made aware of all of the necessary information regarding the Veteran's toxic exposures. In addition to the June 2023 TERA memorandum referenced in the Board's remand directives, there has more recently been a further February 2024 TERA memorandum added to the record with greater detail concerning the Veteran's in-service toxic exposures. However, the Board determined (as discussed in its February 2025 remand) that the April 2024 VA medical opinion did not have the benefit of reviewing either of these TERA memoranda and was notably hindered in efforts to provide informed conclusions in this case. The Board explained its reasons for finding the April 2024 VA medical opinion to be inadequate in the February 2025 remand; for the purposes of the current Board decision, the Board limits its discussion to finding that the April 2024 VA medical opinion presents no findings favorable to the Veteran's claims and is inadequate for the Board to rely upon as evidence against the claims.

Following the Board's latest remand, a pair of April 2025 VA medical opinions address the TERA queries pertinent to this case.

The April 2025 VA medical opinion addressing the heart issue concludes: "The claimed Supraventricular arrhythmia (supraventricular tachycardia), Valvular Heart Disease, Hypertensive heart disease, Left atrial dilation, and Right atrial dilation condition was less likely than not ... caused by the indicated toxic exposure activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran to [include] environmental hazards." The conclusion is presented with a lengthy statement of rationale that cites the Veteran's various "outside of military service" risk factors for his heart disease. The rationale discusses the Veteran's in-service toxic exposure history, accounting for pertinent details:

... PPE was reportedly not used. The frequency of exposure is reported as daily. The route of exposure is described as inhalation. The duration of exposure is described as November 9, 1972 to May 25, 1979. The reported activity that resulted in exposure is described as MOD heavy construction equipment operator and grader/d[o]zer operator[.] The place of exposure is Korea. This is based upon claimed exposure(s) to environmental hazards: high exposure probability to burn pits, asbestos, exhaust fumes, diesel, ethanol, lead, phosphorus, s[ty]phnic acid, lubricants, petroleum, PCBs, benzene2-butanonecarbon tetrachloride[]trichlorethylene (TCE) perchloroethylene, toluene, vinyl chloride halogenated hydrocarbons.

The VA examiner's rationale additionally contemplated "high exposure probability" for "trichloroethylene, perchloroethylene, methylene chloride, cadmium, chromium, waste exposure, solvents, paints, lacquer, enamel, urethane, adhesives, glue, paint strippers, fuel hydraulic fluids as MOS heavy construction equipment operator and grader/d[o]zer operator in Korea." The same VA examiner also indicated, in the accompanying opinion addressing hypertension, consideration of "high exposure probability" for "trihalomethanes, p-xylene, oils, acetone, isopropyl, o-xylene, lead, m-xylene, naphthalene, toluene, vanadium, iron, chromate, zinc chromate
rationale additionally contemplated "high exposure probability" for "trichloroethylene, perchloroethylene, methylene chloride, cadmium, chromium, waste exposure, solvents, paints, lacquer, enamel, urethane, adhesives, glue, paint strippers, fuel hydraulic fluids as MOS heavy construction equipment operator and grader/d[o]zer operator in Korea." The same VA examiner also indicated, in the accompanying opinion addressing hypertension, consideration of "high exposure probability" for "trihalomethanes, p-xylene, oils, acetone, isopropyl, o-xylene, lead, m-xylene, naphthalene, toluene, vanadium, iron, chromate, zinc chromate, MEK, methanol."

The VA examiner cited review of the pertinent information, including the "entire 20,708 page e-file," "the veteran's lay statement," and "The TERA memo and Job Aids were reviewed." The VA examiner identified that "The Veteran's risk factors include hypertension, obesity, smoking, advanced age, stress, and pulmonary disease."

The VA examiner explains that "[t]he Veteran[']s Valvular Insufficiency, which affects the mitral tricuspid and aortic valves, is due to age related val[v]u[la]r laxity." The VA examiner explains that "Hypertensive heart disease (HHD) or LVH, is due to the increased afterload resulting from hypertension.... No evidence in the job aids or medical literature points to any link to exposure." The VA examiner also explains that "Lastly, atrial dilation, or enlargement of the atria, is typically caused by increased pressure or volume overload due to conditions such as hypertension, heart valve disease, or atrial fibrillation. It can also result from chronic lung diseases or cardiomyopathies that strain the heart over time." "This is an injury from overuse or trauma and I found no evidence that an exposure event caused this type of injury."

The VA examiner's analysis discusses: "The veteran's complex medical history - including hypertension, obesity (BMI: 54.9), advanced age (71), diabetes mellitus, sleep apnea, COPD, atrial fibrillation (AFib), and a history of smoking - collectively creates a high-risk cardiovascular profile." The VA examiner then explains, at length, the medical complexities and mechanisms involved in this analysis finding that the cited risk factors form "a strong multifactorial foundation for the development and progression of all the mentioned cardiac conditions." Finally, the VA examiner arrives at the outcome: "I found no evidence that an exposure event caused the veteran's cardiovascular conditions. The literature and Job aids do not support such a link."

The accompanying April 2025 VA medical opinion addressing the hypertension issue, from the same VA physician, concludes: "The Hypertension (HTN) condition was less likely than not ... caused by the indicated toxic exposure activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran to [include] environmental hazards." The rationale discusses the Veteran's in-service toxic exposure history, accounting for pertinent details in the same fashion as described in the Board's discussion of the VA medical opinion concerning the heart disability issue, above.

The VA examiner cited review of the pertinent information of record, featuring the complete claims-file, in the same fashion as the above-discussed VA medical opinion concerning the heart disability issue.

The VA examiner explains: "According to the Mayo Clinic 'For most adults, there's no identifiable cause of high blood pressure....'" The VA examiner further quotes the Mayo Clinic information regarding the medical understanding of hypertension's etiological profile and notes the Veteran's non-TERA factors of "obesity, smoking and hyperlipidemia for example." The VA examiner states: "At no point in the Veteran's entire efile, medical literature or job aid was objective evidence found that links this vet's HTN to exposure.... The non-TERA factors far outweigh the TERA risk factors. The job aids and literature do not support such an association."

The Board finds that the April 2025 VA medical opinions, informed by review of the evidence, consideration of the substantially correct facts, and citation of medical literature, is adequate and probative evidence indicating that there is no etiological link between the Veteran's claimed disabilities and the toxic exposures shown to have occurred during his military service. There is no contrary medical opinion of record, nor any other competent evidence indicating that the Veteran's hypertension and heart disabilities are etiologically related to his military service. As the negative VA medical nexus opinions are probative and uncontradicted, they are persuasive.

There is no competent evidence of record probatively indicating
the TERA risk factors. The job aids and literature do not support such an association."

There is no competent evidence of record probatively indicating any etiological nexus between the Veteran's claimed disabilities and the Veteran's military service. The Veteran's lay assertions are not competent to establish the medical nexus between an in-service event and the current disability necessary to support the claim. While the Veteran believes that his hypertension and heart disabilities are related to an in-service injury, event, or disease, he is not competent to provide a nexus opinion in this case.

Because there is an absence of competent probative supporting evidence of a nexus to service, the third Shedden element for establishing direct service connection has not been satisfied. The Board finds that the evidence of record persuasively weighs against finding that a medical nexus exists between the Veteran's current claimed disabilities and any in-service injury, event or disease.

In light of the above, the Board finds that the evidence is persuasively against a finding that the Veteran was exposed to herbicides in service. Further, the evidence is persuasively against finding that the Veteran's claimed disabilities are otherwise related to service, to include with consideration of his in-service TERAs. Accordingly, the claims must be denied. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

M. C. GRAHAM

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Barone, Alexander

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.

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