200518-85372, 200518-85372

Background

Veteran served on active duty from Sept. 1967 to Sept. 4, 1970 and is presumed exposed to herbicide agents due to service in Vietnam.
Veteran filed an initial claim for service connection in Nov. 2019; RO issued a March 2020 rating decision and the Veteran elected Direct Review before the Board of Veterans' Appeals.
Service treatment and separation exam (June 22, 1970) show no diagnoses or complaints for heart disease, skin cancer, diabetes, or psychiatric conditions.
Post-service records show diagnoses of atrial fibrillation, hypertension, basal cell carcinoma and several benign skin conditions; no diagnosis of ischemic heart disease, diabetes mellitus, or a mental disorder of record.
A VA mental disorders examination (Dec. 2019) found no current mental disorder; other evidence (labs/notes) showed no diabetes in 2019.
The Board denied service connection for mental disorder, diabetes, skin disorder, and heart disorder (preponderance of evidence against nexus) and remanded hypertension for a VA exam due to NAS 2018 guidance implicating a possible Agent Orange–hypertension association and VA’s duty to assist.

Issues

Issue	Veteran's Argument	Secretary/VA Argument	Held
Service connection for mental disorder (PTSD/general)	Veteran contends mental disorder is related to service/experiences and onset post-service	No in-service or post-service competent medical diagnosis or nexus; VA exam found no mental disorder; lay etiology not competent	Denied — no current diagnosis or nexus
Service connection for diabetes mellitus	Veteran claims diabetes is related to service/herbicide exposure	No diagnosis of diabetes in record; not shown in service; no nexus opinion	Denied — no current disability or nexus
Service connection for skin disorder(s) (including basal cell carcinoma)	Veteran links skin conditions to service/herbicide exposure	Separation exam normal; skin cancers/conditions not listed as herbicide-presumptive; no nexus opinion	Denied — no in-service evidence or nexus; basal cell carcinoma not presumptive
Service connection for heart disorder (atrial fibrillation)	Veteran attributes heart problems to service/herbicide exposure or service events	Atrial fibrillation onset documented Aug. 2019; not an herbicide-presumptive ischemic heart disease; no in-service evidence or nexus opinion	Denied — no in-service disease, not presumptive, no nexus
Service connection for hypertension	Veteran contends hypertension related to service/herbicide exposure	VA acknowledges possible association per NAS 2018 update and internal guidance; no exam/opinion obtained	Remanded — VA to obtain medical exam/opinion on etiology of hypertension

Key Cases Cited

Clemons v. Shinseki, 23 Vet. App. 1 (Vet. App. 2009) (lay claimant not competent to provide complex medical diagnoses)
Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (limits continuity-of-symptomatology theory to conditions listed as chronic)
Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (scope of lay evidence and competence for medical matters)
Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009) (examples where nexus may be obvious to layperson)
Barr v. Shinseki, 21 Vet. App. 303 (Vet. App. 2007) (competence of lay evidence for observable conditions)
Woehlaert v. Nicholson, 21 Vet. App. 456 (Vet. App. 2007) (limits on lay diagnosis for complex conditions)
McLendon v. Nicholson, 20 Vet. App. 79 (Vet. App. 2006) (duty to obtain VA examination when necessary to decide claim)
Gilbert v. Derwinski, 1 Vet. App. 49 (Vet. App. 1990) (benefit-of-the-doubt/standard for preponderance of evidence)
Healey v. McDonough, 33 Vet. App. 312 (Vet. App. 2021) (VA treatment of NAS Agent Orange updates and procedural implications)
Euzebio v. McDonough, 989 F.3d 1305 (Fed. Cir. 2021) (judicial consideration of VA’s use of NAS findings)
King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012) (limits on probative weight of lay statements about medical etiology)