Citation Nr: 18156102 Decision Date: 12/07/18 Archive Date: 12/07/18 DOCKET NO. 16-42 927 DATE: December 7, 2018 ORDER Service connection for diabetes mellitus, type II is granted. REMANDED Service connection for a heart condition, to include as due to herbicide exposure, is remanded. Service connection for left hand numbness, to include as due to herbicide exposure, is remanded. Service connection for bilateral peripheral neuropathy of the lower extremities, to include as due to herbicide exposure, is remanded. FINDINGS OF FACT 1. The evidence is at least in equipoise as to whether the Veteran was exposed to herbicide agents during his period of service in Thailand. 2. The Veteran’s currently diagnosed type II diabetes mellitus is presumed to be related his in-service exposure to herbicide agents. CONCLUSION OF LAW The criteria to establish service connection for type II diabetes mellitus are met. 38 U.S.C. §§ 1110, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.307(a)(6), 3.309(e). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the Air Force from June 1966 to February 1970. From March 7, 1968, to February 20, 1969, he served at the Udorn Royal Thai Air Force Base in Thailand (Udorn RTAFB). On October 25, 2018, he testified via Video Conference before the undersigned. 1. Exposure to herbicides The Veteran seeks service connection for, among other things, type II diabetes mellitus, on the basis that he developed this medical condition as a result of being exposed to herbicides while stationed in Thailand during the Vietnam Era. Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus, or link, between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Certain chronic diseases will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 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 diseases that are entitled to presumptive service connection based on herbicide exposure are listed in 38 C.F.R. § 3.309(e). Under 38 C.F.R. § 3.309(e), presumptive service connection based on Agent Orange exposure is available for type II diabetes mellitus. The Veteran claims herbicide exposure while serving in Thailand from March 7, 1968, to February 20, 1969. Special consideration of herbicide exposure on a facts-found or direct basis is to be extended to those veterans whose duties placed them on or near the perimeters of certain Thailand military bases. Applicable to this case, for herbicide exposure to be conceded on a facts-found or direct basis, the evidence must show that the Veteran served in the U.S. Air Force in Thailand during the Vietnam era at U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat or Don Muang Royal Thai Air Force Base; and that his service was performed near the air base perimeter as shown by evidence of daily work duties, performance evaluation reports, or other credible evidence. As set forth above, the Veteran served at the Udorn RTAFB from March 7, 1968, to February 20, 1969. The Veteran testified, and his records reflect, that he was an aircraft mechanic. However, the Veteran also testified that he regularly “pulled guard duty” at Udorn RTAFB around the perimeter and that he also had special duties he performed off base. Although the Veteran’s only documented duties were that of an aircraft maintenance specialist, his personnel file corroborates his assertion of leaving his base at least once when he was deployed as the ground crewman at a “Bare” forward operating base. A Bare base is one that has minimum essential facilities to house, sustain, and support operations to include, if required, a stabilized runway, taxiways, and aircraft parking areas. According to an evaluation note in the Veteran’s file, he was commended for the performance of his duties while at the Bare base, displaying an outstanding ability to maintain his aircraft under the most adverse conditions with little home base support. The Board finds that the Veteran’s statements that the he served along the perimeter and performed duties outside his normal base to be competent and credible evidence of such exposure; and that he was likely near and around the perimeter of the base. The evidence is at least in relative equipoise as to whether the Veteran was exposed to herbicide agents during active military service in Thailand. Based on the Veteran’s competent and credible lay statements regarding his responsibilities as undertaking guard duty around the perimeter and performing duties off-site from his base, reasonable doubt should be resolved in his favor. The Board notes that these findings are limited to the specific circumstances of this Veteran’s service. 2. Service connection for diabetes mellitus, type II The remaining inquiry is whether the Veteran currently has the claimed diabetes mellitus, type II. The clinical evidence of record demonstrates that the Veteran has been diagnosed with this disability. Resolving any doubt in the Veteran’s favor, his exposure to herbicide agents in Thailand during the Vietnam Era has been found. Accordingly, service connection for diabetes mellitus, type II is granted. REASONS FOR REMAND Service connection for (1) a heart condition, (2) left hand numbness and (3) bilateral peripheral neuropathy of the lower extremities. Exposure to herbicides in Thailand has been conceded. The Veteran has now been service-connected for type II diabetes mellitus. The questions arise as to whether the Veteran’s claimed heart condition, left hand numbness, and/or bilateral peripheral neuropathy of the lower extremities are related to the Veteran’s herbicide exposure in service or if these medical conditions developed secondary to the Veteran’s now service-connected diabetes mellitus. Medical guidance is needed for these claims to be appropriately adjudicated. In requesting that the RO schedule the Veteran for appropriate VA examinations, the Board observes that the claims file contains a medical opinion (not a medical examination report) pertaining to the Veteran’s heart condition; and whether a Grade I/IV systolic murmur noted in service was causally or etiologically related to service. Because that opinion did not address the causation theories of herbicide exposure or secondary service connection, the Veteran should be afforded a heart examination as well. Prior to scheduling this examination, the RO should attempt to locate medical records dated from approximately 2004 to 2006 to attempt to obtain information regarding the Veteran’s reported 2005 myocardial infarction. Therefore, the matters are REMANDED for the following actions: 1. Ask the Veteran to provide a list of any private or VA medical provider who has knowledge or medical records related to his 2005 myocardial infarction. If the Veteran provides information about private medical providers, request that he complete a VA Form 21-4142 and attempt to obtain these records. If medical treatment was undertaken by VA, conduct a search of the appropriate VA medical facility, requesting that a search be conducted for medical records pertaining to the Veteran during the time frame from 2004 to 2006. 2. Schedule the Veteran for an examination or examinations by an appropriate clinician to determine the nature and etiology of his heart condition, left hand numbness, and bilateral lower extremity peripheral neuropathy. The examiner must opine whether these conditions are at least as likely as not related to an in-service injury, event, or disease. The examiner should also be asked to provide a medical opinion as to whether it is at least as likely as not that the Veteran’s heart condition, left hand numbness and bilateral lower extremity peripheral neuropathy are related to in-service herbicide agent exposure. Lastly, the examiner should be asked to provide an opinion as to whether it is at least as likely as not the above-referenced conditions are either (1) proximately due to the Veteran’s service-connected diabetes mellitus, or (2) have been aggravated beyond their natural progression by his diabetes mellitus. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Talpins, Patricia