Citation Nr: 18157209 Decision Date: 12/12/18 Archive Date: 12/11/18 DOCKET NO. 15-29 968 DATE: December 12, 2018 ORDER Service connection for diabetes mellitus is granted. Service connection for left leg above-knee amputation is granted. Service connection for end-stage kidney disease is granted. FINDINGS OF FACT 1. The conditions of the Veteran’s service involved duty or visitation in the Republic of Vietnam during the Vietnam era; hence, he is presumed to have been exposed to Agent Orange in active service. 2. The Veteran is diagnosed with diabetes mellitus, type II. 3. The Veteran’s diabetes mellitus likely increased or worsened the Veteran’s kidney disease and subsequent need for dialysis. 4. The Veteran’s diabetes mellitus likely increased or worsened the Veteran’s left foot ulcers, leading to infections and complications and subsequent above-knee amputation. CONCLUSIONS OF LAW 1. Diabetes mellitus is presumed to have been incurred in active service. 38 U.S.C. §§ 1110, 1112, 1116, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 2. Left above-knee amputation is proximately due to or the result of a service-connected disability. 38 U.S.C. §§ 1101, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2018). 3. End-stage kidney disease is proximately due to or the result of a service-connected disability. 38 U.S.C. §§ 1101, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Navy from September 1971 to June 1975. The Veteran testified at a December 6, 2018, hearing held before the undersigned via videoconference from the Reno, Nevada, Regional Office (RO). This decision is being rendered prior to the production of a transcript of that hearing; given the favorable outcome, the Veteran is not prejudiced. As the new and material evidence added to the file includes relevant service department records, the claims must be reconsidered, not reopened, under 38 C.F.R. § 3.156(c). Service Connection Service connection is awarded for disability that is the result of a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. 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); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability that are subject to lay observation. 38 U.S.C. § 1153(a) (2012); 38 C.F.R. § 3.303(a) (2017); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). Diabetes Mellitus It is well-established that the Veteran is diagnosed with diabetes mellitus, type II. The sole question is whether he was exposed to herbicides in Vietnam, thereby establishing the missing nexus element of his claim. He has consistently alleged that although his records do not reflect it, when the was assigned to the USS Haleakala, he transited through Vietnam, and was in fact aboard the USS Gompers for several weeks. Not only was he exposed to herbicides when landing at Danang airport in Vietnam to be bused to the Gompers, the ship was docked at the pier and is included in the list of ships for which exposure is presumed for crew members who report being ashore. His personnel records do not verify this information, but since the most recent denials he has submitted records from the Gompers showing that that it was present and sailed at a time matching gaps in his records he states were his travel time in April and May 1972. Further, he has introduced the credible reports of other service members who experienced similar travel events and transfers. The Board finds the Veteran’s statements to be credible and consistent with the circumstances, conditions, and hardships of service as a yeoman in the U.S. Navy. 38 C.F.R. § 3.303. The clarified timeline presented at the hearing was helpful. As exposure to herbicides in service is shown, and a diagnosis of type II diabetes is established, presumptive service connection is warranted. 38 C.F.R. §§ 3.307, 3.309. The Board notes that no evidence tending to rebut the presumption has been received. End-Stage Kidney Disease and Left Above the Knee Amputation A June 2014 VA examination report reflects that the etiology of the Veteran’s kidney disease is his history of poorly controlled diabetes mellitus and hypertension. VA records include a diagnosis of diabetic nephropathy. VA records also show that the Veteran received care for diabetic foot ulcers and other ongoing diabetes-related foot problems. In January 2013, he underwent an open amputation of his left foot, and eventually a left above-knee amputation. VA treatment records draw a clear connection between diabetes and the recurrent infections of the feet. The Board finds that the evidence warrants grants of secondary service connection. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Mary C. Suffoletta