Ischemic heart disease decisions — 2012

The Veteran's claim for service connection for an acquired psychiatric disorder, including PTSD, was denied. The evidence does not support a finding that the Veteran currently has such a condition.,Ischemic heart disease is presumed to have been incurred as a result of exposure to herbicides during military service.

The Veteran's appeal is being remanded for additional development, including obtaining medical opinions regarding the nature and etiology of his heart disorder. The case will be reviewed by the RO on the basis of this additional evidence.

The Board found no current diagnosis of a heart disorder and denied the claim for service connection.

The Veteran's depressive disorder is found to be secondary to his service-connected coronary artery disease and hypertension. The Veteran's service-connected residuals of shell fragment wounds to the right leg are not productive of complete paralysis of the internal popliteal tibial nerve; nor does it represent an exceptional disability picture. A separate disability rating of 10 percent, but no higher, is warranted for deep scars in the posterior popliteal fossa area of the right leg that cover an area in excess of 6 inches but not 12 inches. The Veteran's service-connected residuals of shell fragment wounds to the left leg are not productive of a severe muscle injury; nor does it represent an exceptional disability picture. A separate disability rating of 10 percent, but no higher, is warranted for deep scars on the posterior aspect of the left calf and knee areas that cover an area in excess of 6 inches but not 12 inches. The Veteran's service-connected coronary artery disease, status post three stents, is not productive of congestive heart failure, workload of greater than 3 METs but no great than 5 METs that results in dyspnea, fatigue, angina, dizziness, or syncope, or, left ventricular dysfunction with an ejection fraction of 30 to 50 percent; nor does it represent an exceptional disability picture. The Veteran's service-connected hypertension is consistent with diastolic pressure predominately 100 or more, requires continuous medication, and does not represent an exceptional disability picture.

The Veteran's hypertension was incurred during service and is related to his military service.,The Veteran's heart disorder, including congestive heart failure and cardiomyopathy, is likely secondary to his service-connected hypertension. The residuals of cerebrovascular accidents are also related to the Veteran's service-connected hypertension.

The Board has determined that additional development is needed to properly adjudicate the Veteran's claim for service connection of a heart disability, including obtaining relevant Social Security Administration records and VA treatment records. The Veteran will be provided an opportunity for a VA examination to determine if his current heart murmur is related to his active military service.

The Veteran's cause of death is listed as COPD, with CAD and hypertension as significant contributing conditions. The Board finds that the Veteran served in Vietnam during a period when herbicide exposure was presumed, and thus service connection for his coronary artery disease (CAD) is granted.

The Veteran's appeal is being remanded for additional development, including obtaining medical records and providing the Veteran with VA examinations to assess his PTSD, heart disability, hypertension, sleep apnea, and left wrist condition.

The Board has determined that a VA medical opinion is needed to determine whether the Veteran had ischemic heart disease and if this condition caused or contributed to his death. The case will be remanded for further development.

The Veteran's claim for service connection for coronary artery disease was granted in a February 2012 rating decision.

The Veteran's appeal is being remanded for further development, including obtaining medical opinions regarding the etiology of his claimed conditions and any residuals from cellulitis. Service connection will be considered based on the merits of the claims.

The Veteran's hypertension and coronary artery disease were not incurred during active military service, and the Board found no evidence of a direct connection to service.

The Board found no evidence of a chronic condition in service or within one year following separation, and the examiner's opinion was that hypertension did not exist prior to service. The Veteran's valvular heart disease is considered direct service connection as there is no indication it was incurred during service.

The Veteran's coronary artery disease, status post myocardial infarction has been rated at 30 percent since the date of claim. The disability is manifested by evidence of cardiac dilation on electrocardiogram and a workload of greater than 5 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope.

The Board finds that the Veteran's service-connected PTSD caused or contributed to his fatal coronary artery disease, and thus grants service connection for the cause of the Veteran's death. The Board also finds that the Veteran's service-connected PTSD caused or contributed to his coronary artery disease, and thus grants service connection for coronary artery disease as due to service-connected PTSD, for accrued benefits purposes.

The VA determined that the Veteran does not have a current diagnosis of coronary artery disease or a prior myocardial infarction, and thus denied service connection for this condition.

The Board found that the Veteran's death was not caused by his service-connected conditions and denied both service connection for cause of death due to service-connected disabilities and under 38 U.S.C.A. § 1151.

The Board has granted service connection for heart disability and hypertension, finding that these conditions are secondary to the Veteran's service-connected diabetes mellitus. The claims of service connection for venous stasis of the bilateral lower extremities, peripheral neuropathy of the upper and lower extremities, and a heart disability have been denied.

The Board finds that further development is required to address the Veteran's claims for service connection, including VA examinations and additional medical records. The case is being remanded to comply with these requirements.

The Veteran's service-connected PTSD with traumatic encephalopathy, atherosclerotic heart disease, and dementia are considered contributory causes of his death from cardiopulmonary arrest.