ISCHEMIC HEART DISEASE

Summary

The Veteran, an Air Force Veteran who served from December 1964 to December 1967, including service in the Republic of Vietnam, appeals the denial of service connection for a heart disability, claimed as abnormal heart. The Board recharacterized the claim to encompass ischemic heart disease, including myocardial infarction and atherosclerotic cardiovascular disease, based on new diagnoses. The Veteran's claim for presumptive service connection for ischemic heart disease is based on in-service exposure to herbicide agents, which is presumed due to his Vietnam service. The Board reviewed multiple prior decisions and remands, noting the RO's substantial compliance with previous directives. The Veteran presented evidence including March 2024 and May 2024 VA examinations diagnosing ischemic heart disease, and VA concessions of herbicide exposure in March 2021, February 2023, and April 2023 memoranda. The Board found that ischemic heart disease is presumptively related to herbicide exposure under 38 C.F.R. § 3.309(e). Applying the benefit of the doubt doctrine, the Board found the criteria for service connection met. Service connection for ischemic heart disease, including acute, subacute, and old myocardial infarction and atherosclerotic cardiovascular disease, is granted.

Rationale

Presumptive service connection for ischemic heart disease met; In-service exposure to herbicide agents conceded; Benefit of the doubt applied

Full Decision Text

Citation Nr: 26003755
Decision Date: 03/24/26	Archive Date: 03/24/26

DOCKET NO. 20-25 001
DATE: March 24, 2026

ORDER

Service connection for ischemic heart disease, to include acute, subacute, and old myocardial infarction and atherosclerotic cardiovascular disease (claimed as abnormal heart), is granted.

FINDING OF FACT

The Veteran's ischemic heart disease, to include acute, subacute, and old myocardial infarction and atherosclerotic cardiovascular disease, is presumptively related to his in-service exposure to herbicide agents.

CONCLUSION OF LAW

The criteria for service connection for ischemic heart disease, to include acute, subacute, and old myocardial infarction and atherosclerotic cardiovascular disease, have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service in the Air Force from December 1964 to December 1967, including service in the Republic of Vietnam.

This matter comes before the Board of Veterans' Appeals (Board) from a January 2017 decision by the Department of Veterans Affairs (VA) Regional Office (RO). 

This matter has come before the Board several times previously, most recently in March 2024. At that time, in pertinent part, the Board remanded for the RO to obtain outstanding records and to obtain an opinion regarding whether the Veteran's sinus bradycardia was related to his in-service exposure to toxins, including coal dust inhalation and herbicide agent exposure. The RO has substantially complied with the Board's remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998).

Service connection for ischemic heart disease, to include acute, subacute, and old myocardial infarction and atherosclerotic cardiovascular disease (claimed as abnormal heart)

The Veteran asserts entitlement to service connection for a heart disability, which he contends is related to in-service exposure to herbicide agents and coal dust.

When this matter was previously before the Board, the issue was characterized as sinus bradycardia (claimed as abnormal heart). However, after the Board's previous remand, the Veteran was also diagnosed with heart disabilities of acute, subacute, or old myocardial infarction; atherosclerotic cardiovascular disease; congestive heart failure; valvular heart disease; pulmonary hypertension; right basilar effusion with adject atelectasis/infiltrates; and right/left atrial dilation. To ensure full consideration of the Veteran's claim, the Board has recharacterized the claim to one for a heart disability (claimed as abnormal heart). See Clemons v. Shinseki, 23 Vet. App. 1, 5-6, 8 (2009).

Generally, service connection requires: (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. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 

If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases are service connected even if there is no record of such disease during service. As relevant here, these diseases include ischemic heart disease, including but not limited to acute, subacute, and old myocardial infarction and atherosclerotic cardiovascular disease. 38 C.F.R. § 3.309(e).

VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay testimony is competent to prove that a claimant exhibited certain lay-observable symptoms and the time that those symptoms appeared. Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006).

In
clerotic cardiovascular disease. 38 C.F.R. § 3.309(e).

VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154(a). Lay testimony is competent to prove that a claimant exhibited certain lay-observable symptoms and the time that those symptoms appeared. Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006).

In determining the probative value to be assigned to a medical opinion, the Board must consider three factors: whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case; whether the medical expert provided a fully articulated opinion; and whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the appellant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776, 777-79 (Fed. Cir. 2021). 

In this case, the requirements for presumptive service connection for ischemic heart disease, to include acute, subacute, and old myocardial infarction and atherosclerotic cardiovascular disease, are met. 

First, March 2024 and May 2024 VA examinations diagnosed the Veteran with, among other disabilities, acute, subacute, or old myocardial infarction and atherosclerotic cardiovascular disease. The Veteran thus has a present heart disability of ischemic heart disease, including acute, subacute, and old myocardial infarction and atherosclerotic cardiovascular disease.

Second, in March 2021, February 2023, and April 2023 memoranda, VA conceded that the Veteran was exposed to herbicide agents. Such exposure is presumed based on the Veteran's service in the Republic of Vietnam in 1967. 38 U.S.C. § 1116; 38 C.F.R. § 3.307(a)(6).

Lastly, as noted above, ischemic heart disease, including but not limited to acute, subacute, and old myocardial infarction and atherosclerotic cardiovascular disease, is presumptively related to in-service exposure to herbicide agents. 38 C.F.R. § 3.309(e).

The requirements for service connection for ischemic heart disease, to include acute, subacute, and old myocardial infarction and atherosclerotic cardiovascular disease, are thus met. Service connection is granted.

 

 

D. SMART

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Mansfield, 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.