Citation Nr: 18154788 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 16-39 318 DATE: November 30, 2018 ORDER Service connection for type II diabetes mellitus (DM) is denied. Service connection for cataracts is denied. Service connection for erectile dysfunction (ED) is denied. Service connection for peripheral neuropathy of the bilateral hands is denied. Service connection for peripheral neuropathy of the bilateral feet is denied. Service connection for hypertension is denied. FINDINGS OF FACT 1. The Veteran had active service from April 1969 to April 1973. 2. The Veteran served at the Udorn Royal Thai Air Force Base in Thailand from 1971 to mid-1973 in his military occupational specialty (MOS) as an aerospace ground equipment repairman; however, he did not serve in a security position or near the base perimeter and was not otherwise directly exposed to an herbicide agent during service. 3. DM was not shown in service, was not shown to a compensable degree within one year of service, and is not causally or etiologically related to service, to include as due to herbicide exposure. 4. A cataract disorder and ED were not shown in service, were not present to a compensable degree within one year of separation from active service, and were not caused or permanently worsened by a service-connected disability. 5. Peripheral neuropathies of the bilateral hands and feet are not shown. 6. Hypertension was not shown in service, was not continuous since service, was not shown to a compensable degree within one year of service, was not shown for many years after service, and is not causally or etiologically related to service; hypertension is not shown to have been caused by herbicide exposure. CONCLUSIONS OF LAW 1. DM was not incurred in or aggravated by service, nor is it due to in-service herbicide exposure. 38 U.S.C. § 1101, 1110, 1112, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.309, 3.310, 3.317 (2017). 2. A cataract disorder was not incurred in or aggravated by active service, nor is it proximately due to or aggravated by a service-connected disability. 38 U.S.C. §§ 1101, 1110, 1112, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.309, 3.310, 3.317 (2017). 3. ED was not incurred in or aggravated by active service, nor is it proximately due to or aggravated by a service-connected disability. 38 U.S.C. §§ 1101, 1110, 1112, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.309, 3.310, 3.317 (2017). 4. Peripheral neuropathy of the bilateral hands was not incurred in active service. 38 U.S.C. §§ 1101, 1110, 1112, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.309, 3.310, 3.317 (2017). 5. Peripheral neuropathy of the bilateral feet was not incurred in active service. 38 U.S.C. §§ 1101, 1110, 1112, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.309, 3.310, 3.317 (2017). 6. Hypertension was not incurred in service, may not be presumed to have been incurred in service, nor is it due to herbicide exposure. 38 U.S.C. §§ 1101, 1110, 1112, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.309 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Service connection may be granted on a presumptive basis for certain diseases listed in § 3.309, including type II diabetes mellitus, under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307. Service connection may also be granted on a presumptive basis for diseases associated with herbicide exposure under 38 C.F.R. § 3.309 for veterans who served in Thailand during the Vietnam War era where: (1) the veteran was in the Air Force, (2) the veteran served at the Royal Thai Air Force Bases of U-Tapao, Ubon, Nakhon, Phanom, Udorn, Takhli, Korat, or Don Muang, and (3) the veteran served as a security policeman, security patrol dog handler, or member of a security police squadron, or otherwise served near a base perimeter, as shown by the veteran’s MOS, daily work duties, performance evaluations, or other credible evidence. See VA Adjudication Procedure Manual (M21-1MR), Part IV, Subpart ii, Chapter I, Section H, Paragraph 5.a (2016). Notwithstanding the foregoing provisions regarding presumptive service connection for exposure to herbicide agents, a veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Type II Diabetes Mellitus As an initial matter, the Veteran has been diagnosed with diabetes mellitus. Specifically, in a July 2015 medical treatment note, the clinician diagnosed DM. Therefore, a current disorder has been shown and the first element of service connection has been met. A review of the record reveals that the Veteran served at the Udorn Air Force Base in Thailand from 1971 to mid-1973 and that his MOS was an aerospace ground equipment repairman. Accordingly, service during the Vietnam War era is established. In a December 2012 statement, the Veteran reported that while at Udorn Air Force Base, he worked in a shop that was on the perimeter of and outside of the base. He explained that he worked in a revetment where he repaired jammers and air compressors. He said that his shop had no sides and, as a result, he was fully exposed to the environment, including to the Agent Orange that was sprayed around the perimeter of the base. In a September 2018 statement, the Veteran elaborated on his Thailand service, noting that Agent Orange was used on the flight line to kill foliage and that, as a result, he was exposed to the chemical and suffered DM and heart trouble. VA has established a procedure for verifying exposure to herbicides in Thailand during the Vietnam era. See VBA Manual M21-1, IV.ii.1.H.5.b. Under the procedures outlined in the VBA Manual, if a veteran served at the Royal Thai Air Force Bases of U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korta, or Don Muang during the Vietnam era as a security policeman, security patrol dog handler, member of the security police squadron, or otherwise served near the air base perimeter, as shown by evidence of daily work duties, performance evaluations, or other credible evidence, then herbicide exposure will be conceded on a direct or facts-found basis. As noted above, the Veteran’s personnel record reflect service at Udorn Air Force Base during the Vietnam War era. Furthermore, the Board has considered his lay statements asserting exposure to herbicide agents during active service. However, the evidence does not show that he experienced in-service exposure to herbicide agents. Specifically, February and August 1972 performance reports describe his duties as inspecting, troubleshooting, and repairing aerospace ground equipment, as well as diagnosing malfunctions and performing repairs. The performance reports do not indicate that the Veteran was regularly near the perimeter of the Udorn Air Force Base as a result of his MOS. To the extent that the Veteran asserted that his duties regularly involved service at or near the perimeter of the base, such statements are inconsistent with, and outweighed by, additional evidence of record that does not otherwise document regular duties on or near the base perimeter. Accordingly, the evidence of record does not support the Veteran’s assertion of service connection based on in-service herbicide exposure. Notwithstanding the inapplicability of the herbicide exposure presumptive service connection regulations, the Board has considered the claim on a direct exposure basis. Combee v. Brown, 34 F.3d 1039, 1042-44 (Fed. Cir. 1994). As noted above, the Veteran is currently diagnosed with DM. A review of the service treatment records reveals that his endocrine, heart, and vascular systems were found to be clinically normal in his August 1972 separation examination. A sugar test of his urine was negative. As such, DM was not noted in his STRs. Therefore, there were no in-service complaints of, treatment for, or diagnoses related to DM. However, the evidence submitted by the Veteran has raised the argument that he has had DM since service that is a result of his in-service exposure to herbicide agents. Therefore, the question is whether there is a causal relationship between his current reported complains and service. Post-service records fail to establish a direct relationship between diabetes and in-service herbicide exposure. Specifically, July 2011 medical treatment notes indicated that the Veteran had been diagnosed with diabetes for 17 years and a November 2015 agent orange registry exam noted that he was diagnosed with diabetes at age 50, more than 25 years after his separation from service. Accordingly, the medical evidence does not support direct service connection based on exposure to herbicide agents. Cataracts and ED As an initial matter, a cataract disability and ED are not chronic diseases under 38 C.F.R. § 3.309(a); therefore, presumptive service connection is not for application. However, the Veteran has asserted that his cataracts and ED are caused or aggravated by his DM. Therefore, secondary service connection will be addressed. Further, direct service connection will be addressed. Turning first to direct service connection, the Veteran has been diagnosed with a bilateral cataract disorder and ED. Specifically, multiple July 2011 medical treatment notes diagnosed bilateral cortical cataracts and a March 2017 medical treatment note diagnosed ED. Therefore, current disorders have been shown and the first element of service connection has been met in each case. A review of the STRs shows that his eyes and genitourinary system were found to be clinically normal in his August 1972 separation examination. The STRs otherwise contain no in-service complaints of, treatment for, or diagnoses related to a cataract disability or ED. Therefore, a bilateral cataract disorder and ED were not noted in his STRs and the second element of direct service connection- in-service incurrence – has not been met in either case. Turning to secondary service connection, the Veteran has primarily maintained that his cataract disorder and ED are related to his DM. However, in order to establish service connection on a secondary basis, he must demonstrate evidence of a service-connected disability. As discussed above, he is not service connected for DM. Additionally, there is no indication from the record that his cataract disorder and ED were caused or aggravated by a service-connected disability. Therefore, the medical evidence does not support secondary service connection. Peripheral Neuropathies of the Hands and Feet For a disability to be service connected, it must be present at the time a claim for VA disability compensation is filed or during or contemporary to the pendency of the appeal. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). The record does not show that the Veteran has confirmed diagnoses of peripheral neuropathies of his bilateral hands and feet. To that end, an April 2014 Agent Orange peripheral neuropathy checklist did not identify diagnosed peripheral neuropathy. Similarly, a November 2015 Agent Orange registry examination diagnosed DM, but noted no transient acute and subacute peripheral neuropathy. Finally, a May 2017 medical treatment note diagnosed diabetes in the feet without neurological or circulatory complications, noting that a neurological examination was normal and finding no burning sensation in the feet. As noted, service connection may only be granted for a current disability. Brammer v. Derwinski, 3 Vet. App. 223 (1992). As there are no confirmed diagnoses related to peripheral neuropathies of the bilateral hands and feet at any time during the pendency of the appeal, there is no doubt to be resolved and service connection for peripheral neuropathies of the hands and feet is not warranted. Hypertension As an initial matter, the Veteran has not asserted that hypertension is secondary to a service-connected disability; therefore, service connection is not for application. However, as hypertension is a chronic disease under 38 C.F.R. § 3.309(a), service connection on the basis of continuity of symptomatology will be considered. Additionally, as the Veteran has argued that his hypertension is the result of in-service exposure to Agent Orange, presumptive service connection on the basis of herbicide exposure will be addressed. Further, direct service will be considered. Turning first to direct service connection, the Veteran has been diagnosed with hypertension. Specifically, a July 2015 treatment note diagnosed hypertension. Therefore, a current disorder has been shown and the first element of direct service connection has been met. A review of the STRs shows that the Veteran served in Thailand between late 1971 and mid-1973. However, his heart and vascular systems were clinically normal in his August 1972 separation examination. As such, hypertension was not noted in his STRs. Therefore, the second element of direct service connection – in-service incurrence – has not been met, and the medical evidence thus does not support the claim for service connection on a direct basis. Turning to the one-year presumption, hypertension did not manifest to a compensable degree within a year of separation from service. While a July 2015 medical treatment note diagnosed and noted a prior history of hypertension, it did not define the point at which hypertension began. Even assuming that he developed symptoms of hypertension as early as 2015, this is well outside the one-year presumption period. Therefore, the evidence does not support the claim based on the one-year legal presumption for certain chronic diseases such as hypertension. Next, the record does not establish continuity of symptomatology under 38 C.F.R. § 3.309(a). As noted above, the evidence shows that the Veteran’s symptoms were first diagnosed in 2015, more than 40 years after his separation from service. Therefore, hypertension was not shown until 2015, with documentation beginning the same year. In light of the above, the medical evidence is also against the claim for service connection based on continuity of symptomatology. With regard to presumptive service connection based on herbicide exposure, the Veteran has argued that his hypertension was the result of exposure to Agent Orange while serving in Thailand. However, service connection based on herbicide exposure is not, by regulation, warranted on a presumptive basis for hypertension. 38 C.F.R. § 3.309(e). Therefore, service connection for hypertension on the basis of presumed exposure to Agent Orange is denied. Notwithstanding the inapplicability of the Agent Orange presumptive service connection regulations, the Board has considered the claim on a direct exposure basis. Combee v. Brown, 34 F.3d 1039, 1042-44 (Fed. Cir. 1994). As noted above, there were no in-service complaints of, treatment for, or diagnoses related to hypertension. However, the evidence submitted by the Veteran has raised the argument that he has had hypertension since service that is a result of his in-service exposure to Agent Orange. Therefore, the question is whether there is a causal relationship between his current reported complaints and service. In support of the claim, a November 2015 clinician noted that exposure to Agent Orange was probable; however, the statement is assigned less probative value. While the clinician offered an opinion as to in-service exposure to Agent Orange, the clinician failed to opine as to whether hypertension was caused by in-service exposure to Agent Orange. Therefore, the November 2015 statement does not support a claim for service connection. Additional post-service records address the current state of the Veteran’s hypertension but fail to establish a relationship between hypertension and direct Agent Orange exposure. Moreover, as previously mentioned, the November 2015 clinician asserting probable Agent Orange exposure failed to opine as to the relationship between Agent Orange exposure and the Veteran’s current hypertension. Therefore, the November 2015 medical treatment note is insufficient to establish a nexus for service connection purposes. Accordingly, the medical evidence does not support direct service connection for hypertension based on herbicide exposure. The Board has considered multiple lay statements submitted by the Veteran regarding the etiology of the disabilities discussed above. He is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, he is not competent to offer an opinion as to the etiology of his current disorders due to the medical complexity of the matter involved. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456, 462. Such competent evidence has been provided by the medical personnel who have examined the Veteran during the current appeal and by service records obtained and associated with the claims file. Here, the Board attaches greater probative weight to the clinical findings than to his statements. In light of the above discussion, the preponderance of the evidence is against the claims for service connection and there is no doubt to be otherwise resolved. As such, the appeals are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Spigelman, Associate Counsel