Citation Nr: 18149368 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 16-38 054 DATE: November 9, 2018 ORDER Entitlement to service connection for diabetes mellitus type II is denied. Entitlement to service connection for peripheral neuropathy of the lower extremities, to include as secondary to diabetes mellitus type II, is denied. Entitlement to service connection for Posttraumatic Stress Disorder (PTSD) is denied. FINDINGS OF FACT 1. The Veteran does not have a current diagnosis of diabetes mellitus type II and has not had a diagnosis at any time during the pendency of the appeal. 2. The Veteran's peripheral neuropathy was not present in service or for many years thereafter, and is not otherwise etiologically related to service. 3. The evidence does not show that the Veteran has a diagnosis of PTSD in accordance with VA regulation that is causally related to any event of his active service. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for diabetes mellitus type II have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2017). 2. The criteria for entitlement to service connection for peripheral neuropathy of lower extremities have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2017). 3. The criteria for Entitlement to service connection for PTSD have not been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. §§ 3.303, 3.304 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1971 to January 1975. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Service Connection Service connection is awarded for disability that is the result of a disease or injury in active service. 38 U.S.C. § 1110. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004), citing Hansen v. Principi, 16 Vet. App. 110, 111 (2002); see also Caluza v. Brown, 7 Vet. App. 498 (1995). A Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962 and ending on May 7, 1975, is presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.307(a)(6)(iii). “Service in the Republic of Vietnam” includes military service in the waters offshore and military service in other locations if the conditions of the military service involved duty or visitation in Vietnam. 38 C.F.R. § 3.307(a)(6)(iii); see Haas v. Peake, 525 F.3d 1168 (Fed. Cir. 2008), cert. denied, 129 S. Ct. 1002 (2009) (holding that service in Vietnam means that the veteran actually set foot within the land borders of Vietnam). Certain diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam (Vietnam) during the Vietnam era will be considered to have been incurred in service. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6). The presumption of service connection requires exposure to an herbicidal agent and manifestation of the disease to a degree of 10 percent or more within the time period specified for each disease. 38 C.F.R. § 3.307(a)(6)(ii). A Veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. See Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (2009); see also Walker v. Shinseki, 708 F.3d 1331, 1334 (Fed. Cir. 2013). In making its ultimate determination, the Board must give a veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. See Fagan, 573 F.3d at 1287 (quoting 38 U.S.C. § 5107 (b)). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). A lay witness is competent to testify as to the occurrence of an in-service injury or incident where such issue is factual in nature. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). In some cases, lay evidence will also be competent and credible on the issues of diagnosis and etiology. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Specifically, lay evidence may be competent and sufficient to establish a diagnosis where (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau, 492 F.3d at 1377; see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). 1. Diabetes Mellitus Type II The Veteran contends that he incurred diabetes mellitus type II as a result of service in Vietnam. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, or disease. The Board concludes that the Veteran does not have a current diagnosis of diabetes mellitus type II and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The July 2016 VA examiner evaluated the Veteran and determined that he did not have a diagnosis of diabetes mellitus type II. Further, despite being treated at VA facilities from August 2011 to April 2016, VA treatment records do not contain a diagnosis of diabetes mellitus type II. A note attached to the Veteran's July 2016 VA examination states that a hemoglobin A1c level of 5.7 to 6.4 places an individual in the pre-diabetes category. A level above 6.4 is indicative of an individual having diabetes. The Veteran's measurements on this test were 5.7, placing the Veteran in the pre-diabetes category. Further, the Veteran denied having diabetes during primary care visits in both February 2013 and March 2013. In September 2013 the Veteran was diagnosed with peripheral neuropathy. It is not until March 2014 that the Veteran self identifies as having diabetes. While the Veteran believes he has a current diagnosis of diabetes mellitus type II, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. 2. Peripheral Neuropathy The Veteran contends that his peripheral neuropathy of the lower extremities is due to diabetes. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or was aggravated beyond its natural progress by service-connected disability. As discussed above, the Board has denied entitlement to service connection for diabetes mellitus type II. As the Veteran is not currently service-connected for diabetes mellitus type II, secondary service connection for peripheral neuropathy may not be established as a matter of law. See 38 C.F.R. § 3.310(a). Service connection may also be granted on a direct basis, but the preponderance of the evidence is also against finding that the Veteran’s peripheral neuropathy is related to an in-service injury or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). The Veteran did not report any symptoms of peripheral neuropathy in service or for many years thereafter. The first report of peripheral neuropathy symptoms is in February 2013, nearly 40 years after separation from service. No probative evidence links the disability to service. Accordingly, the claim for service connection for peripheral neuropathy must be denied. 3. PTSD The Veteran contends that he incurred PTSD as a result of traumatic events in service. Specifically, the Veteran contends that when he was on temporary duty assignment to Bien Hoa, Vietnam, that the base was under repeated attack. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of PTSD, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the in-service stressor occurred. 38 C.F.R. § 3.304(f). In this case, the evidence does not establish an in-service stressor that could warrant a diagnosis of PTSD under 38 C.F.R. § 4.125(a), as is required for service connection. The March 2014 VA examiner opined that the Veteran’s PTSD is at least as likely as not related to an in-service injury, event, or disease; however, the opinion is not probative because the preponderance of the evidence weighs against finding that the Veteran’s stressors occurred. Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993). The Veteran has claimed two different stressors. First, that his base was frequently bombarded while stationed in Vietnam. Second, the stress of handling munitions caused his PTSD. The Veteran served overseas during the Vietnam Era, however, he was stationed at Clark AFB in the Philippines. The Veteran claims that members of his unit were routinely sent to Vietnam and Thailand in support of ongoing missions. It is during one of these temporary duty assignments that the Veteran claims his base came under attack. The official history of the 405th Fighter Wing, of which the Veteran's unit was a part, states that six crews of maintenance personnel were sent to Da Nang AB and to Royal Thai Air Force Base (RTAFB) Udorn on temporary duty. However, the Veteran’s personnel record does not reflect any temporary duty assignments in Vietnam or Thailand. Further, the Veteran claims that he served at Bien Hoa while on temporary assignment to Vietnam. There is no evidence that members of the 405th Fighter Wing served at Bien Hoa. The examiner based her conclusion that the Veteran had service in Vietnam because he was awarded the Vietnam Service Medal. However, this award was also given to members of the armed services who served in Thailand, Laos, or Cambodia in support of operations in Vietnam. In addition to stating that he served at Bien Hoa, the Veteran stated that he had a temporary duty assignment at RTAFB Udorn. As the official history of the 405th Fighter Wing states that members of the Veteran's unit served at RTAFB Udorn, any service of the Veteran in Thailand would entitle him to this medal. In regard to the Veteran's other alleged stressor, no competent medical professional has linked the Veteran's PTSD to the stress of handling large quantities of explosive ordinance. As there was no in-service indication of symptoms of any psychiatric disorder, no in-service notation of PTSD, and there has been no probative evidence of a stressor to warrant a PTSD diagnosis, there is no basis upon which service connection for PTSD can be granted. To the extent that the Veteran may believe he has PTSD and that it is related to stressful circumstances during his active service, as a layperson, he is not competent to provide an opinion concerning this matter requiring medical expertise. Accordingly, the claim for service connection for PTSD must be denied. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Uller, Associate Counsel