ARTERIOSCLEROTIC HEART DISEASE (CORONARY ARTERY DISEASE)

Summary

The Veteran, a Marine Corps Veteran who served from January 1969 to October 1970, including service in Guam and Okinawa, appeals the denial of service connection for coronary artery disease (CAD) and short-term memory loss. The Veteran contended that his CAD was related to toxic exposure during service, specifically in Guam. The Board granted service connection for CAD on a presumptive basis under the PACT Act, noting the Veteran's service in Guam and the presumptive association of CAD with herbicide exposure, as codified in 38 U.S.C. § 1116(d) and 38 C.F.R. § 3.309(e). For the short-term memory loss, diagnosed as mild cognitive impairment, the Veteran argued for direct service connection due to in-service onset and alternatively, secondary service connection to his already service-connected generalized anxiety disorder. The Board found the Veteran and his wife's testimony credible regarding the onset and continuation of symptoms, noting the Veteran's cognitive impairment was treated with medication related to his generalized anxiety disorder. Citing Amberman v. Shinseki, the Board found the mild cognitive impairment proximately due to the service-connected generalized anxiety disorder, granting service connection on a secondary basis. The Board's decision represents a complete grant of the benefits sought on appeal.

Rationale

PACT Act broadened covered service to include Guam; CAD presumptively associated with herbicide exposure; Veteran served in Guam during Vietnam Era

Full Decision Text

Citation Nr: A26039820
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 250528-549762
DATE: April 28, 2026

ORDER

Service connection for coronary artery disease (CAD) is granted pursuant to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act).

Service connection for short term memory loss, diagnosed as mild cognitive impairment, is granted.

FINDINGS OF FACT

1. The Veteran's CAD is presumed to have been incurred during service.

2. Affording the benefit of the doubt to the Veteran, the Veteran has a diagnosis of mild cognitive impairment proximately due to or the result of the Veteran's service-connected generalized anxiety disorder.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for CAD are met. 38 U.S.C. §§ 1110, 1116, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for service connection for short term memory loss have been met.  38 U.S.C. §§ 1110, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from January 1969 to October 1970 with five months and nine days of foreign service, to include service in Guam and Okinawa.

In the May 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. 

Therefore, the Board may only consider the evidence of record at the time of the May 2025 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. 

The Veteran and his wife presented sworn testimony at a hearing before the undersigned Veterans Law Judge in March 2026.  As the transcript of the proceeding reflects, at the hearing the Veteran waived the 90-day period following the appeal during which to submit additional evidence.  38 C.F.R. § 20.300(b).  As such, and because the Board is granting in full the benefits sought on appeal, the Board will proceed to adjudicate this matter.

Service Connection

To establish service connection for a claimed disorder, the following criteria must be met: (1) medical evidence of a current disability; (2) evidence of an in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and current disability. 38 C.F.R. § 3.303; see also, Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999).

Service connection may be granted for a disability resulting in a disease or injury that is incurred in or aggravated by active-duty military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may be established by credible lay evidence and medical evidence provided by the Veteran or otherwise. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.

Service connection may also be found on a secondary basis where the following criteria is met: (1) a current disability that is not already service-connected; (2) at least one service-connected disability; and, (3) evidence that the non-service-connected current disability is either proximately due to or as the result of a service-connected disability; or, aggravated beyond its natural progress by a service-connected disability. 38 C.F.R. § 3.310 (2018); see also, El-Amin v. Shinseki, 26 Vet. App
 medical evidence provided by the Veteran or otherwise. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.

Service connection may also be found on a secondary basis where the following criteria is met: (1) a current disability that is not already service-connected; (2) at least one service-connected disability; and, (3) evidence that the non-service-connected current disability is either proximately due to or as the result of a service-connected disability; or, aggravated beyond its natural progress by a service-connected disability. 38 C.F.R. § 3.310 (2018); see also, El-Amin v. Shinseki, 26 Vet. App. 136 (2013); Allen v. Brown, 7 Vet. App. 439 (1995).

1. Service connection for CAD.

The Veteran seeks service connection for a heart condition, which he contends is related to exposure to toxins while in service in Guam and Okinawa.  See Hearing Testimony, March 2026. 

As pertinent here, the PACT Act amended 38 U.S.C. § 1116 to add subsection (d), which broadens the term "covered service" to mean active military, naval, air, or space service "performed on Guam or American Samoa, or in the territorial waters thereof, during the period beginning on January 9, 1962, and ending on July 31, 1980."  See 38 U.S.C. § 1116(d)(5).  This PACT Act provision constitutes a liberalizing law.  See Spencer v. Brown, 4 Vet. App. 283, 287 (1993), aff'd, 17 F.3d 368 (Fed. Cir. 1994) (recognizing as a liberalizing law "a provision of law or regulation [that] creates a new basis for entitlement to benefits, as through liberalization of the requirements for entitlement to a benefit").  Thus, the Board will adjudicate the claims de novo and has phrased the appellate issues accordingly.

In the May 2025 rating decision on appeal, the AOJ made a favorable finding that private treatment records and VA examination dated September 4, 2024 shows a diagnosis of arteriosclerotic heart disease (coronary artery disease) to include acute, subacute, or old myocardial infarction with coronary artery bypass graft, hypertensive heart disease with congestive heart failure, atrial fibrillation and cardiomegaly.

Further, the record demonstrates that the Veteran served in Guam and has non-deployment related exposure.  This is corroborated by the Veteran and his wife's competent and credible testimony noting that the Veteran set foot in Guam in 1970.  See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge)

In this case, as discussed above, it is undisputed that the Veteran has current coronary artery disease.  Coronary artery disease is a disease that is presumptively associated with herbicide agent exposure.  38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e).  Under the PACT Act, the Veteran was presumptively exposed to herbicide agents during his Vietnam Era active service in Guam or its territorial waters.  In conclusion, the claim for service connection for CAD is granted on a presumptive basis.

2. Service connection for short term memory loss.

The Veteran contends that his diagnosed short term memory loss had its onset in service and has been recurrent since that time.  Alternatively, the Veteran asserts that his memory loss is secondary to his service-connected psychiatric disability, diagnosed as generalized anxiety disorder.  

The Board first notes that the Veteran is service connected for generalized anxiety disorder.  Furthermore, in a September 2025 rating decision, the Veteran's generalized anxiety disorder rating was increased, and it was recognized that the Veteran's psychiatric disability was manifested by impairment of short and long-term memory and mild memory loss.  

In Amberman v.  Shinseki, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has stated that service connection for multiple acquired psychiatric disorders is not necessarily precluded and noted that two psychiatric conditions "could have different symptoms and it could therefore be improper in some circumstances for the VA to treat these separately diagnosed conditions as producing only the same disability."  Amberman v. Shinseki, 570 F.3d 1377, 1380 (Fed. Cir. 2009).

At the March 2026 hearing, the Veteran's wife testified that she met the Veteran in November 1968 and married him in June 1969. 
 short and long-term memory and mild memory loss.  

In Amberman v.  Shinseki, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has stated that service connection for multiple acquired psychiatric disorders is not necessarily precluded and noted that two psychiatric conditions "could have different symptoms and it could therefore be improper in some circumstances for the VA to treat these separately diagnosed conditions as producing only the same disability."  Amberman v. Shinseki, 570 F.3d 1377, 1380 (Fed. Cir. 2009).

At the March 2026 hearing, the Veteran's wife testified that she met the Veteran in November 1968 and married him in June 1969.  She testified that he is a changed person after serving in the military.  She noted that the Veteran is being treated with medication for memory loss as part of his treatment for his service-connected generalized anxiety disorder.  

The Veteran and his wife are competent to report the onset and continuation of his disability symptoms, and the Board finds their testimony credible.  See Charles v. Principi, 16 Vet. App. 370, 374 (2002); see also Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

The Board notes that it may only consider the evidence of record at the time of the notification of the agency of original jurisdiction (AOJ) decisions 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).  During the March 2026 hearing, the Veteran, through his representative, incorporated evidence in the claims folder relevant to the claim, to include medical examination reports, that was discussed at the hearing, but was not within the evidentiary window.  Cash v. Collins, 166 F.4th 1046 (Fed. Cir. 2026).  

Specifically, the Veteran, incorporated by reference a September 2025 private medical record that reflects a diagnosis of mild cognitive impairment and listed also other trauma and stressor-related disorder and anxiety.  Cash.  The Medical record also noted that stress, trauma, depression, and anxiety symptoms, can significantly impact cognitive functioning and medication management as well as psychotherapy are considered the gold-standard therapeutically.  Therefore, psychiatric medication management is continually advised, as well as engagement in evidenced-based psychotherapy to address mood lability, adjustment difficulties to medical conditions, and cognitive changes.

In this case, the Veteran is service connected for generalized anxiety disorder, has a separate diagnosis of mild cognitive impairment as noted in the September 2025 private medical record, and is taking medication for his cognitive impairment that is related to his psychiatric disability.  Based on the available medical and lay evidence, the Board finds that the evidence shows that the Veteran's short term memory loss disability, diagnosed as mild cognitive impairment, is proximately due to his service-connected generalized anxiety disorder.  Accordingly, service connection is warranted.

During the March 2026 Board hearing, the Veteran indicated that awarding service connection for short term memory loss disability on a direct or secondary basis would satisfy his appeal.  See AB v. Brown, 6 Vet. App. 35, 38 (1993).  Therefore, the Board finds that this grant represents a complete grant of the benefit sought on appeal.

 

 

STEVEN D. REISS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Leigh, Sara

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.