14-05 084
14-05 084
| Board of Vet. App. | Nov 1, 2017Background
- Veteran served on active duty in the U.S. Army from Oct 1966 to Oct 1968, including service in the Republic of Vietnam (conceded herbicide exposure).
- Veteran appealed denial of service connection for hypertension and a heart disability (including ischemic heart disease); initial RO decision dated January 2010; hearing held Sept 2016.
- VA obtained examinations in Dec 2009 and Jan 2014, but examiners did not address whether hypertension was aggravated by the Veteran’s service‑connected diabetes mellitus or whether hypertension was directly related to herbicide exposure.
- Medical records and opinions conflict about whether the Veteran has ischemic heart disease; July 2015 VA treatment note referenced atherosclerosis of the abdominal aorta.
- Board remanded the claims for additional development: obtain outstanding VA records, schedule a new VA exam to address etiology and aggravation questions (specific 50% probability questions), and then readjudicate with supplemental SOC if denials remain.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Service connection for hypertension (directly or secondary to diabetes; herbicide exposure) | Hypertension is related to conceded herbicide exposure and/or aggravated by service‑connected diabetes | Prior VA exams did not establish service connection; hypertension not presumptively linked to herbicide exposure | Remanded for a new exam/opinion addressing (1) aggravation by service‑connected disabilities (including diabetes) and (2) etiological link to herbicide exposure (50% probability standard) |
| Service connection for heart disability (including ischemic heart disease; herbicide exposure; secondary to diabetes) | Heart disease (including ischemic heart disease) is related to herbicide exposure and/or secondary to diabetes | Record has inconsistent diagnoses; prior opinions inadequate to establish etiology or ischemic heart disease | Remanded for a new exam to diagnose current heart conditions (addressing ischemic heart disease, abdominal aorta atherosclerosis) and to opine on service connection, herbicide relation, and aggravation by diabetes (50% probability standard) |
Key Cases Cited
- Barr v. Nicholson, 21 Vet. App. 303 (VA must ensure examinations it provides are adequate)
- D'Aries v. Peake, 22 Vet. App. 97 (medical opinion adequate when based on prior history and describes disability in sufficient detail)
- Bowling v. Principi, 15 Vet. App. 1 (inadequate examination reports must be returned)
- Nieves‑Rodriguez v. Peake, 22 Vet. App. 295 (opinion must contain a reasoned medical explanation connecting conclusions and supporting data)
- Stefl v. Nicholson, 21 Vet. App. 120 (Board may not rely on its own lay judgment when exam lacks adequate rationale)
- Colvin v. Derwinski, 1 Vet. App. 171 (Board forbidden from relying on its own medical judgment)
- Kutscherousky v. West, 12 Vet. App. 369 (appellant may submit additional evidence after remand)