ARTERIOSCLEROTIC HEART DISEASE (CORONARY ARTERY DISEASE)

Summary

The Veteran, an Army veteran who served in Korea from January 1968 to October 1969, appeals the denial of service connection for ischemic heart disease, claiming it is due to herbicide agent exposure. The Board previously denied this claim, but the Court of Appeals for Veterans Claims (CAVC) remanded the case twice for further adjudication. The Veteran contends he served with the 2nd Battalion, 38th Infantry along the Korean Demilitarized Zone (DMZ) for 90 days, a unit identified by the Department of Defense (DoD) as operating in an area where herbicides were used. Evidence supporting this includes a fellow servicemember's statement and a September 1968 Special Order showing the Veteran was attached to the 2nd Battalion, 38th Infantry, with hostile fire pay authorized. Military pay vouchers also noted hostile fire pay for November 1968. While some records did not document the unit's involvement in specific operations or herbicide use, the Board found the totality of the evidence, resolving doubt in the Veteran's favor, established presumptive herbicide exposure. Given the Veteran has ischemic heart disease, a presumptive condition linked to herbicide exposure, and has met the criteria for presumptive exposure, service connection is granted. The Board found the Veteran's service along the DMZ, coupled with the specific unit attachment and pay voucher evidence, sufficient to establish presumptive herbicide exposure.

Rationale

Current diagnosis of ischemic heart disease; Presumptive link to herbicide exposure under 38 C.F.R. § 3.309(e); Presumptive exposure to herbicide agents established due to service near Korean DMZ

Full Decision Text

Citation Nr: 26003090
Decision Date: 03/06/26	Archive Date: 03/06/26

DOCKET NO. 17-62 328
DATE: March 6, 2026

ORDER

Entitlement to service connection for ischemic heart disease (coronary artery disease), as due to herbicide agent exposure on a presumptive basis, is granted.

FINDINGS OF FACT

1. The evidence is at least evenly balanced as to whether the Veteran was exposed to herbicide agents in Korea.

2. The Veteran has a current diagnosis of ischemic heart disease (coronary artery disease).

CONCLUSION OF LAW

The criteria for entitlement to service connection for ischemic heart disease, as due to in-service exposure to herbicide agents, have been met.  38 U.S.C. §§ 1110, 1116, 1116B, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran served honorably with the United States Army on active duty from January 1968 to October 1969, to include service in Korea.  

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

In November 2019, the Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge.  A transcript of the hearing has been associated with the claims file.

This file has an extensive procedural history.  The Board previously remanded the appeal in January 2020 and May 2021.  In May 2023, the Board denied the Veteran's claim for service connection for ischemic heart disease, to include as due to herbicide exposure.  The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court).  In January 2024, the Court issued an order granting a Joint Motion for Remand (JMR) which vacated the Board's May 2023 decision and remanded the matter for adjudication consistent with the instructions outlined in the JMR.  Most recently, a July 2024 Board decision denied entitlement to service connection for ischemic heart disease, to include as due to herbicide agent exposure.  The Veteran appealed to the Court, and in a June 2025 JMR, the Court vacated the Board's July 2024 decision and remanded the matter for adjudication consistent with the instructions outlined in the JMR.  The case has returned to the Board, and this decision is crafted to address the concerns raised in the JMR. 

Service Connection

Generally, establishing service connection requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

If a veteran was exposed to an herbicide agent (to include Agent Orange) during active military, naval, air, or space service, certain diseases, including ischemic heart disease, are considered service connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even if there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied.  38 U.S.C. § 1116(a)(2)(H), (M); 38 C.F.R. § 3.309(e).

There is also a presumption of exposure to herbicide agents for veterans who served in Korea near the Demilitarized Zone (DMZ) during the period beginning on September 1, 1967, and ending on August 31, 1971.  Prior to January 1, 2020, the presumption of in-service herbicide agent exposure in Korea was limited to certain veterans who served in Korea as part of a unit that, as determined by the Department of Defense, operated near the Korean DMZ (in an area where herbicide agents were known to have been applied) between April 1, 1968, and August 31, 1971.  38 U.S.C. § 1116B; 38 C.F.R. § 3.307(a)(6)(iv).  However, the Blue Water Navy Vietnam Veterans Act, codified at 38 U.S.C. § 1116B, extended the presumption of herbicide agent
1.  Prior to January 1, 2020, the presumption of in-service herbicide agent exposure in Korea was limited to certain veterans who served in Korea as part of a unit that, as determined by the Department of Defense, operated near the Korean DMZ (in an area where herbicide agents were known to have been applied) between April 1, 1968, and August 31, 1971.  38 U.S.C. § 1116B; 38 C.F.R. § 3.307(a)(6)(iv).  However, the Blue Water Navy Vietnam Veterans Act, codified at 38 U.S.C. § 1116B, extended the presumption of herbicide agent exposure to veterans who, during active military, naval, air, or space service, served in or near the Korean DMZ during the period beginning on September 1, 1967, and ending on August 31, 1971.  See 38 U.S.C. § 1116B.

The Department of Defense (DoD) has identified specific units it has cited that served in areas along the DMZ in Korea where herbicide agents were used.  The list of units can be found in VA's Adjudication Manual M21-1 VIII.i.1.A.3.c.

The Board has reviewed the entire record but will only discuss the evidence necessary to explain its decision.  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); 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 Veteran).

After careful consideration of the evidence, any reasonable doubt remaining, is to be resolved in favor of the Veteran.  38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3.  If the evidence is not in approximate balance or nearly equal, the claim is to be denied.  The United States Court of Appeals for the Federal Circuit clarified in Lynch v. McDonough that the proper standard of review is whether the factors are in an "approximate balance."  Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021) (en banc)).  Lynch held that the Veteran is entitled to the benefit of the doubt when the evidence is in an approximate balance or "nearly equal" and does not require the evidence to be in exact equipoise.  Id.

Entitlement to service connection for ischemic heart disease as due to herbicide agent exposure. 

As detailed above, the July 2024 Board decision was appealed to the Court, which granted a June 2025 JMR to vacate and remand the Board decision denying entitlement to service connection for ischemic heart disease.  Specifically, the parties agreed that the Board failed to substantially comply with the January 2024 JMR and failed to provide an adequate statement of reasons and bases.  The parties agreed to remand for the Board to address the military pay vouchers and the September 1968 Special Order, to include addressing its probative value as corroborative evidence that the Veteran served with the 2nd Battalion, 38th Infantry serving along the Korean DMZ and whether the evidence is sufficient to entitle him to presumptive service connection.  

As the record contains a diagnosis of ischemic heart disease, which may be presumptively linked to herbicide exposure, the Board turns to the remaining question of whether the Veteran was exposed to herbicide agents during service or may be presumed to have been exposed.

In that regard, the Veteran has contended that while he was initially assigned to the Battery A, 1st Target Acquisition Battalion, 25th Artillery, 2nd Infantry Division, which did not serve along the DMZ, he was temporarily (for 90 days) attached to the 2nd Battalion, 38th Infantry that did serve along the Korean DMZ as part of Operation Starlight.  See September 2016, Notice of Disagreement; November 2017, VA Form 9.  In support, a fellow servicemember, J.S., provided written correspondence indicating that he and the Veteran served on the Korean DMZ with the 2nd Battalion, 38th Infantry.  See February 2019, lay statement.

Service personnel records verify the Veteran's assignment to a unit identified by the DoD as operating in or near the Korean DMZ.  The Veteran's service records contain a September 1968 Special Order showing he was attached for duty to the 2nd Battalion, 38
nd Battalion, 38th Infantry that did serve along the Korean DMZ as part of Operation Starlight.  See September 2016, Notice of Disagreement; November 2017, VA Form 9.  In support, a fellow servicemember, J.S., provided written correspondence indicating that he and the Veteran served on the Korean DMZ with the 2nd Battalion, 38th Infantry.  See February 2019, lay statement.

Service personnel records verify the Veteran's assignment to a unit identified by the DoD as operating in or near the Korean DMZ.  The Veteran's service records contain a September 1968 Special Order showing he was attached for duty to the 2nd Battalion, 38th Infantry Unit, noting that the Veteran was to "[a]tch to: B Co. 2nd Bn, 38th Inf" for the "[p]urpose: For rats and qtrs" and with the special instructions that "[h]ostile fire pay is auth when substantiated by the statement of Commanding Officer or Personnel Officer."  The record also contains a DA Form 2139 (Military Pay Voucher) for pay period "1-31 Jan 1969" that notes under Remarks, "Due EM HFP for the month of Nov 68 as EM was on DMZ for pd 31 Oct-5 Nov 68."  Box 19 for Incentive/Special Pay is checked with "HFP" (hostile fire pay) written in the box.  Similarly, a December 16, 1968, DA Form 2139 noted "Due EM HFP for month of Nov 68."

In contrast, a May 2017 Defense Personnel Records Information Retrieval System record noted the 1969 history submitted by the 2nd Battalion, 38th Infantry and these do not document the units involvement in "Operation Starlight," or personnel from Battery A, 1st TAB, 25th Artillery assigned to the 2nd Battalion, 38th Infantry and the record does not document the use, storage, spraying, or transporting of Agent Orange or other tactical herbicides.  

An August 2022 Records Research Response noted the 2nd Battalion, 38th Infantry Unit history for 1969 which documents the units continued mission of performing defensive and anti-infiltration duty along the Korean DMZ, but the record does not document any temporary duties or recruiting from other units.

Taking into consideration the totality of the evidence, and resolving all reasonable doubt in favor of the Veteran, the record illustrates the Veteran operated in or near the DMZ, and, based on his dates of service in Korea, he qualifies for presumptive herbicide agent exposure under VA regulations.  On that basis, the Board finds that, as noted above, VA has a list of units identified by DoD as having served in an area in or near the DMZ.  See VA Adjudication Manual, M21-1, Part VIII, Subpart i, Chapter 1, Section A.  The evidence shows that during his military service in Korea, the Veteran temporarily served in one of those units (2nd Battalion, 38th Infantry) during the period when herbicides were used in Korea. 

The evidence shows that the Veteran has a current diagnosis of ischemic heart disease, which is a presumptive disease for herbicide agent exposure under 38 C.F.R. § 3.309(e).  Additionally, the Board has established that the Veteran was presumptively exposed to herbicide agents while serving in Korea.  Accordingly, the Board concludes that resolving all reasonable doubt in favor of the Veteran, service connection is warranted on a presumptive basis for his ischemic heart disease.

The appeal is granted. 

 

Evan M. Deichert

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Johnson, Krista M. (BVA)

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. 


 C.F.R. § 20.1303.