CORONARY ARTERY DISEASE (CAD)

L. HOWELL · 2025 · Case ID: A25014980

DENIED

Summary

The veteran, who served in the Air Force from May 1971 to April 1975, including service at Korat Royal Thailand Air Force Base, appeals the denial of service connection for a cardiovascular (CV) disorder on a basis other than the PACT Act. The Board previously granted service connection for a CV disorder under the PACT Act, but this decision addresses only direct causation and other presumptive bases excluding the PACT Act. The veteran has a diagnosed coronary artery disease (CAD) with a bypass surgery in 2012, satisfying the first element of direct service connection. However, the service treatment records (STRs) do not indicate any in-service complaints, treatment, or diagnosis of a CV disorder or related symptoms. The separation examination was normal. No health care professional established a direct link between the veteran's service and the CV disorder. Presumptive service connection was also denied, as no chronic CV disease was shown in service, and there was no continuity of symptomatology since service, with the first diagnosis occurring nearly 30 years post-service. The Board also found no support for presumptive service connection based on manifestation within one year of separation. Regarding herbicide exposure at Korat AFB, the veteran's administrative specialist duties, as documented in performance reports, did not involve regular contact with the base perimeter. While the veteran testified to walking near the perimeter and guarding it, this was not supported by objective evidence and was outweighed by the lack of documentation. The Board found that the veteran's duties did not qualify him for direct herbicide exposure under VA regulations, which require regular, prolonged contact with the perimeter, unlike security personnel. Therefore, service connection for a CV disorder on a direct causation basis or due to herbicide exposure was denied.

Rationale

No in-service complaints, treatment, or diagnosis of CV disorder or symptoms.; Separation examination reflected normal heart/vascular evaluation.; No direct nexus established by healthcare professional.; No chronic CV disease shown in service or continuity of symptomatology.; Veteran's duties did not involve regular contact with base perimeter for herbicide exposure.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

191209-54202

Full Decision Text

Citation Nr: A25014980
Decision Date: 02/19/25 Archive Date: 02/19/25

DOCKET NO. 191209-54202
DATE: February 19, 2025

ORDER

Service connection for a cardiovascular (CV) disorder on a basis other than the Sergeant Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act) is denied.

FINDINGS OF FACT

1. The Veteran served on active duty from May 1971 to April 1975 to include service at Korat Royal Thailand Air Force Base.

2. The evidence does not support herbicide exposure on a presumptive or direct causation basis prior to August 10, 2022.

CONCLUSION OF LAW

A CV disorder, diagnosed as coronary artery disease (CAD), was not directly incurred in service, was not presumed to have been incurred in service based on chronicity/continuity, nor was it due to herbicide exposure on a direct causation basis. 38 U.S.C. §§ 1101, 1110, 1112, 1116, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303(a), 3.307, 3.309 (2024).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

On August 10, 2022, President Biden signed into law the PACT Act. Among other things, it established a presumption for herbicide exposure to service in Thailand during the period from January 9, 1962, to June 30, 1976, without regard to the veteran's base location or military job specialty. See 38 U.S.C. § 1116(d)(2); 38 C.F.R. § 3.307.

In August 2023, the Veteran testified before a Veterans Law Judge. A copy of the transcript has been associated with the claims file. In December 2023, the Board granted service connection for a CV disorder on a presumptive basis pursuant to the PACT Act. The Veteran appealed to the Veterans Claims Court.

In August 2024, the Court Clerk granted a joint motion for partial remand (JMPR), partially vacated the Board's decision, and remanded the claim to the Board. The claim is again ready for adjudication. Thus, the Board will only address service connection for a CV disorder on theories of entitlement other than under the PACT Act as outlined in the August 2024 JMPR.

Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

Service connection may be granted on a presumptive basis (chronicity/continuity) for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307.

Notwithstanding the foregoing provisions regarding presumptive service connection, a veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

Turning first to direct service connection, the record reflects that the Veteran was diagnosed with CAD in 2002. In addition, a May 2017 private clinician noted that the Veteran's medical history included CAD and a coronary artery bypass surgery (CABG) in 2012. As such, a CV disorder has been shown, and the first element has been met.

As to in-service incurrence, the service treatment records (STRs) do not reflect complaints of, treatment for, or a diagnosis of a CV disorder or any symptoms reasonably attributed to a CV disorder such as chest pain or shortness of breath. Further, the February 1975 separation examination reflected a normal clinical evaluation of the heart and vascular system. Therefore, a CV disorder was not shown in service and the medical evidence does not support direct service connection.

To the extent that the Veteran asserts a nexus between a CV disorder and service, no health care professional has established a direct link between the Veteran's service and the CV disorder. As such, the medical evidence does not support service connection on a direct basis.

As arteriosclerosis and cardiovascular-renal disease are chronic diseases under 38 C.F.R. § 3.309, presumptive service connection will be considered; however, no chronic CV disease was shown in service. As noted, the STRs are silent for complaints of, treatment for, or a diagnosis of a CV disorder or any symptoms consistent with a CV disorder. Therefore, the medical evidence does not support presumptive service connection on a "chronic disease or injury shown in service" basis.

Next, the medical evidence does not support presumptive service connection based on continuity of symptomatology since service. Specifically, the medical evidence shows that CAD was first noted in 2002, more than 27 years after discharge. As such, the medical evidence does not support service connection on a "continuity of symptomatology" basis.

Further, a CV disorder did not manifest itself to a degree of 10 percent or more within one year from the date of separation of service. The Veteran separated from service in 1975 but did not note symptoms until 2002 at the earliest, nearly 30 years later. This evidence does not support presumptive service connection on a "manifest within one-year from separation" basis. Therefore, the medical evidence does not support presumptive service connection on any basis.

Next, the will consider whether a CV disorder is due to herbicide exposure, including Agent Orange, during service in Thailand on a direct causation basis. Prior to the implementation of the PACT Act, VA determined that special consideration of herbicide exposure on a factual or facts-found basis should be extended to veterans whose duties place them on or near the perimeters of certain Royal Thai Air Force Bases (RTAFB), including Korat AFB.

Additional consideration was required as to whether a veteran's MOS was such as to indicate the performance of duties on a base perimeter as a security policeman, security patrol dog handler, member of the security police squadron, or otherwise was in regular contact with the air base perimeter as shown by evidence of daily work duties, performance evaluation reports, or other credible evidence.

Turning to the evidence, the Veteran served at Korat Air Force Base in Thailand beginning in 1971 through September 1972. Accordingly, service in Thailand during the Vietnam War era is established. He contends that the barracks was located along the perimeter of the base, and he walked near the perimeter to get to various squadron offices in the performance of his duties.

Further, he contends that his duties required him to come within 300 to 400 yards of the perimeter when distributing documentation to various squadron offices to include security forces. In addition, he claims that he worked as a security augmentee, and his duties included guarding the perimeter. Also, during the Board hearing, he indicated his duties and off-duty activities took him outside the base perimeter. He noted he left the base to pick up supplies and eat some meals.

The personnel records were reviewed. A September 1972 Airmen Performance Report (APR) indicated that the Veteran's military occupational specialty (MOS) at Korat AFB was an administrative specialist. His duties included administrative, clerical, and postal and distribution functions. Also, he maintained publications, filed and assisted in the control and accountability of all documentations, received and routed messages, and typed correspondence and reports in draft and final form. From this job description, there is no indication that his duties required him to have regular contact on the base perimeter.

Further, the personnel records are silent for any assignment involving security around the perimeter of the base. Specifically, the Veteran's supervisor's comments on multiple APRs discussed his attributes and contributions to the squadron; however, none of the APRs from Korat AFB indicated participation on a security detail.
's military occupational specialty (MOS) at Korat AFB was an administrative specialist. His duties included administrative, clerical, and postal and distribution functions. Also, he maintained publications, filed and assisted in the control and accountability of all documentations, received and routed messages, and typed correspondence and reports in draft and final form. From this job description, there is no indication that his duties required him to have regular contact on the base perimeter.

The Veteran's lay testimony alone regarding his work as a security augmentee is insufficient to show duties along the perimeter of the base as the objective evidence does not support this assertion. As such, the personnel records do not support a finding that he regularly worked at or near the perimeter of the base.

To the extent that the Veteran asserted that his duties regularly involved service at or near the perimeter of the base, such statements are inconsistent with, and outweighed by, additional evidence of record that does not otherwise document regular duties on or near the base perimeter.

The Board has considered the Veteran's lay statements that his barracks was located near the perimeter, and he walked to various squadron facilities that brought him near the perimeter; however, this does not qualify him for exposure to herbicides on a direct causation basis. VA has not specifically enumerated what area is considered the "base perimeter;" however, the Board finds that the perimeter does not include the barracks and squadron offices hundreds of yards from the perimeter, and that "regularly worked at or near the perimeter" does not include entering or leaving the base entrance.

Specifically, in considering service connection on a direct causation basis, VA has limited direct exposure to those veterans whose daily duties required them to consistently spend significant periods of time on or near the base perimeter where herbicides were likely used.

VA listed three MOS's that had consistent, prolonged exposure to the air base perimeter: security policeman, security patrol dog handler and member of a security police squadron. Servicemembers with these MOS's spent multiple hours a day policing the base perimeter, looking for signs of infiltration or potential places of infiltration along the perimeter fence. In doing so, they had significant personal contact with the areas in which herbicides were known to have been used.

These individuals were exposed to herbicide agents; that is, the servicemembers who had significant contact with the location where herbicides were known to be used were likely exposed to those agents. The fact that the Veteran walked from his barracks to the supply squadron daily or occasionally took a jeep across the base was not equivalent to those whose job was to constantly patrol or work on the perimeter itself.

The regulations do not anticipate that service connection is warranted for duties as described by the Veteran or for walking to nearby offices or to and from work. To do so would render the qualifiers (security policeman, security patrol dog handler, member of a security police squadron, or others who served near the base perimeter) meaningless as nearly every person who walked around the base, lived in the barracks, and entered or exited the base would presumably qualify for service connection on a direct causation basis.

Next, no health care professional has established that service connection is warranted on an actual direct causation basis nor has the Veteran offered any evidence or argument that service connection on a direct causation basis is warranted other than by the fact of serving on the base itself.

In sum, prior to the implementation of the PACT Act, exposure to herbicide was not conceded. As the evidence does not support direct exposure due to the Veteran's duties and no health care professional has established service connection based on actual causation, the evidence does not support service connection under Combee.

Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

L. HOWELL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board B. J. Ferguson, 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.

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