Citation Nr: 18155229 Decision Date: 12/03/18 Archive Date: 12/03/18 DOCKET NO. 17-42 125 DATE: December 3, 2018 ORDER Service connection for ischemic heart disease is granted. Service connection for diabetes mellitus, type II, is granted. REMANDED Service connection for hypertension is remanded. FINDINGS OF FACT 1. The weight of the evidence shows that, on a facts-found basis, the Veteran was exposed to herbicide agents while serving at the Royal Thai Air Force Base in Udorn, Thailand. 2. The Veteran is diagnosed with ischemic heart disease which has manifested to a degree of 10 percent or more, and there is no evidence to rebut the presumption that the disease was related to his herbicide exposure during active service. 3. The Veteran is diagnosed with diabetes mellitus, type II, which has manifested to a degree of 10 percent or more, and there is no evidence to rebut the presumption that the disease was related to his herbicide exposure during active service. CONCLUSIONS OF LAW 1. The criteria for service connection for ischemic heart disease have been met. 38 U.S.C. §§ 101, 1110, 1112, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for service connection for diabetes mellitus, type II, have been met. 38 U.S.C. §§ 101, 1110, 1112, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from November 1971 to February 1992. Service Connection Service connection may be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred or aggravated in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). In general, service connection requires competent and credible evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The Veteran is seeking entitlement to service connection for ischemic heart disease and diabetes mellitus, type II, which the Veteran contends are due to exposure to herbicide agents while stationed at Udorn Royal Thai Air Force Base from August 1974 to August 1975. The Board concludes that the Veteran has a current diagnosis of coronary artery disease, status post myocardial infarction, and diabetes mellitus that is related to in-service herbicide exposure. 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). VA regulations provide that if a veteran was exposed to an herbicide agent during active military, naval, or air service, the following diseases shall be service connected if the requirements of 38 C.F.R. § 3.307 (a) are met, even if there is no record of such disease during service: AL amyloidosis, chloracne or other acneform disease consistent with chloracne; type 2 diabetes (also known as Type II diabetes mellitus); Hodgkin’s disease; chronic lymphocytic leukemia (CLL); multiple myeloma; Non-Hodgkin’s lymphoma; acute and subacute peripheral neuropathy; porphyria cutanea tarda; prostate cancer; respiratory cancers (cancer of the lung, bronchus, larynx or trachea); soft tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma), chronic B-cell leukemias, Parkinson’s disease, and ischemic heart disease. 38 C.F.R. § 3.309 (e). A veteran, who during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during service. 39 U.S.C. § 1116 (f); 38 C.F.R. § 3.307 (a)(6)(iii). The Board notes that there is no evidence that the Veteran ever served in the Republic of Vietnam; however, he has contended that he was exposed to herbicides while stationed at Udorn Royal Thai Air Force Base in Thailand from August 1974 to August 1975, from living and working near the perimeter of the base where herbicides were sprayed. A VA Memorandum regarding herbicide use in Thailand during the Vietnam Era was placed in the Veteran’s claims folder. The memorandum notes that according to the Department of Defense, there are no records of tactical herbicide storage or use at military bases in Thailand, except for limited testing at Pranburi Military Reservation from April 2 through September 8, 1964. However, the memorandum also noted that there was use of non-tactical (commercial) herbicides within fenced perimeters, and VA guidance for the development of claims based on herbicide exposure in Thailand notes that there is some evidence that the herbicides used on the Thailand base perimeters may have been either tactical herbicides procured from Vietnam, or a commercial variant of much greater strength and with characteristics of tactical herbicides. If a veteran’s military occupational specialty included contact with base perimeters, there was a greater likelihood of exposure. The military occupational specialties cited in this regard included security police, especially dog handlers. Accordingly, if a United States Air Force veteran served near an air base perimeter in Thailand from February 1961 to May 1975, as shown by military occupational specialty, performance evaluations, or other credible evidence, then herbicide exposure should be acknowledged. In this case, the Veteran has credibly testified that both the compound where he worked as a supplier of aircraft parts and his barracks were near the perimeter of Udorn Air Force Base, where service personnel records confirm that he was stationed from August 1974 to July 1975 and worked as a NORS Controller. Accordingly, resolving any doubt in the Veteran’s favor, the Board finds that there is sufficient evidence to conclude that the Veteran was frequently in physical contact with the perimeter, or that he was in sufficiently close and unprotected proximity to it. See generally Haas v. Peake, 525 F.3d 1168 (Fed. Cir. 2008). As such, the Board finds that exposure to herbicide agents during duty at Udorn, Thailand has been established. Additionally, private medical records confirm that the Veteran has a current diagnosis of coronary artery disease, a type of ischemic heart disease, and diabetes mellitus. Because both diabetes mellitus and ischemic heart disease are conditions for which service connection can be granted on a presumptive basis when exposure to herbicides is established, entitlement to service connection for diabetes mellitus and ischemic heart disease are granted. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. REASONS FOR REMAND The Veteran is also seeking entitlement to service connection for hypertension, which he contends is due to herbicide exposure. While private medical records confirm that the Veteran has a current diagnosis of hypertension and the Board has determined that the in-service herbicide exposure should be conceded, hypertension is not currently one of the enumerated medical conditions for which service connection can be granted on a presumptive basis. However, that does not preclude the Veteran from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039, 1041-42 (Fed. Cir. 1994). The National Academies of Sciences, Engineering and Medicine (NAS) recently concluded that there is sufficient epidemiologic evidence to conclude that there is a “positive association” between hypertension and herbicide exposure. Accordingly, the Board finds that a remand is required to obtain a medical opinion addressing whether it is at least as likely as not the Veteran's current hypertension is related to his in-service herbicide exposure. The matter is REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his hypertension. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including in-service herbicide agent exposure. 2. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. D. Anderson, Counsel