CORONARY ARTERY DISEASE (CAD)

J.P. NORMAN · 2026 · Case ID: A26019651

MIXED

Summary

The Veteran, who served from May 1975 to April 1986, appeals the denial of service connection for coronary artery disease (CAD). The Board granted service connection for CAD on a presumptive basis under the PACT Act, recognizing the Veteran's service in Guam from 1976 to 1978 and the presumptive link between CAD and herbicide exposure in that region. The Veteran also claimed service connection for CAD on a direct basis, citing chest pain documented in service treatment records. The Board found that while the Veteran had a current diagnosis of CAD and reported in-service chest pain, there was insufficient competent medical evidence to establish a nexus to service. Citing the McLendon standard, the Board determined that a VA examination was necessary to assess the in-service onset of CAD and the etiology of the condition. Therefore, the claim for direct service connection for CAD was remanded for a new VA examination to address these issues. The Board noted that any evidence submitted that could not be considered due to procedural limitations would be handled by the agency of original jurisdiction during the remand proceedings.

Rationale

PACT Act expanded presumptive herbicide exposure to Guam.; CAD is an enumerated disease under 38 U.S.C. § 1116.; Service records confirm in-service presence in Guam.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

201201-125091

Full Decision Text

Citation Nr: A26019651
Decision Date: 03/04/26 Archive Date: 03/04/26

DOCKET NO. 201201-125091
DATE: March 4, 2026

ORDER

Entitlement to service connection for coronary artery disease (CAD) pursuant to the PACT act is granted.

REMANDED

Entitlement to service connection for CAD on a basis other than the PACT act is remanded.

FINDING OF FACT

The Veteran has a current diagnosis of CAD and served on active duty in Guam or American Samoa or in the territorial waters of Guam or American Samoa from January 9, 1962, through July 30, 1980.

CONCLUSION OF LAW

The criteria for service connection for CAD are met. 38 U.S.C. §§ 1110, 1116, 1116A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309; the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, Pub. L. No. 117-168 § 3373, 136 Stat. 1759 (2022).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from May 1975 to April 1986.

In the December 1, 2020, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on August 22, 2024.

Therefore, the Board may only consider the evidence of record at the time of the November 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran [or representative] at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claim of entitlement to service connection on a basis other than the PACT act, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

As a preliminary matter, the rating decision on appeal initially denied the issue of service connection for CAD due to a lack of new and relevant evidence. The Veteran submitted an updated statement of treatment from his doctor with his supplemental claim for the issue. As this evidence was not previously before the AOJ it satisfies the requirement of being "new" evidence. As the treatment record reflects treatment for the condition asserted to be service connected, the Board finds that it also satisfies the "relevant" aspect. As new and relevant evidence has been found in the instant case, the Board may therefore proceed with consideration of the matter on the merits.

1. Entitlement to service connection for CAD pursuant to the PACT act is granted.

The Veteran asserts that entitlement to service connection for CAD.

Service connection may be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents, even though there is no record of such disease during service in a veteran who had active military, naval, air, or space service, during the period beginning on January 9, 1962, and ending on May 7, 1975, in the Republic of Vietnam, including the waters offshore, and other locations if the conditions of service involved duty or visitation in Vietnam. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e)(c), 3.313. This presumption may be rebutted by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307, 3
record of such disease during service in a veteran who had active military, naval, air, or space service, during the period beginning on January 9, 1962, and ending on May 7, 1975, in the Republic of Vietnam, including the waters offshore, and other locations if the conditions of service involved duty or visitation in Vietnam. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e)(c), 3.313. This presumption may be rebutted by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307, 3.309.

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, was enacted on August 10, 2022. See PACT Act, Pub. L. No. 117-168 § 3373, 136 Stat. 1759 (2022). Section 403 of the PACT Act expands the presumption of in-service herbicide agent exposure to additional territories and countries, including Guam or American Samoa or in the territorial waters of Guam or American Samoa from January 9, 1962, through July 31, 1980. Id. at § 403 (codified as amended at 38 U.S.C. § 1116).

Service personnel records show that the Veteran had active service in Guam from 1976 to 1978.

The Veteran has a current diagnosis of CAD as evidenced by treatment records furnished by the Veteran's treating cardiologist. CAD is an enumerated disease under 38 U.S.C. § 1116. Thus, all elements required for presumptive service connection are met.

Based on the foregoing, the CAD is presumptively related to the Veteran's exposure to herbicide agents during service. Service connection for CAD is GRANTED.

REASONS FOR REMAND

1. Entitlement to service connection for CAD on a basis other than the PACT act is remanded.

As discussed above, the Veteran is in receipt of service connection for CAD associated with herbicide agent exposure pursuant to the PACT Act. VA is prohibited from assigning an effective date for that grant earlier than the date of the enactment of the PACT Act.

The Veteran filed his supplemental claim for service connection for CAD secondary to his service-connected CAD on November 12, 2020. Given this length of time that the Veteran has been pursuing his claim for service connection for CAD, the issue of entitlement to service connection for this disability on a basis other than the PACT Act remains before the Board.

Service connection may be granted on a direct basis for a disability resulting from personal injury suffered or disease contracted, or for aggravation of a preexisting injury suffered or disease contracted, in the line of duty in active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).

The Veteran has asserted that his CAD first manifested in service as evidenced by reports of chest pain he made while in service and which are documented in the service treatment records. To date, no VA examination has been provided to assess whether the chest pains reported during service constitute an in-service onset for the disability.

In McLendon v. Nicholson, 20 Vet. App. 79, 84-86 (2006) the United States Court of Appeals for Veterans Claims (Court) stated that there were four elements to consider when determining if a medical examination is necessary. The Court held that VA must provide an examination where there is: (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies; (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim.

As previously discussed, the Veteran is found to have a current diagnosis of CAD in satisfaction of the first element and there is documentation of chest pain in the Veteran's file in satisfaction of the second element of an in-service incurrence.

The Board finds that it is well established that chest pains are a primary associated symptom of CAD. See Coronary Artery Disease, Mayo Foundation for Medical Education and Research, (Accessed Feb. 19, 2026) https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/syc-20350613.

Finally
but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim.

Finally, as no competent medical opinion has been associated with the claims file which addresses a nexus between the reported chest pain during service and the Veteran's current diagnosis, there is insufficient evidence to make a decision on the claim.

As all elements of the McLendon standard have been met, the Board finds that it was a pre-decisional duty to assist error to not provide the Veteran with an examination to assess service connection for CAD. A remand is required to correct that error before an adjudication can be made for the issue.

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination to determine the nature and etiology of the Veteran's CAD.

The examiner must review the service treatment records concerning chest pain and opine on whether it is more likely than not that the reports constitute an in-service onset of CAD.

The examiner must opine whether any other in-service incurrence is more likely than not the cause of the Veteran's current diagnosis of CAD.

A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance. If the examiner opines that any of the above questions cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided.

J.P. Norman

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Arner, Jonathan T.

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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