Citation Nr: 18119359 Decision Date: 07/18/18 Archive Date: 07/18/18 DOCKET NO. 15-12 886 DATE: July 18, 2018 ORDER Entitlement to service connection for a heart disorder, to include ischemic heart disease (IHD) and coronary artery disease (CAD), as secondary to herbicide exposure, is granted. Entitlement to service connection for diabetes mellitus, as secondary to herbicide exposure, is granted. REMANDED Entitlement to service connection for left lower extremity peripheral neuropathy is remanded. Entitlement to service connection for right lower extremity peripheral neuropathy is remanded. FINDINGS OF FACT 1. The Veteran was exposed to herbicides while serving in Thailand during the Vietnam era. 2. The Veteran's IHD, CAD, and diabetes are presumed to be related to his exposure to herbicide agents during his active military service in Thailand. CONCLUSIONS OF LAW 1. The criteria for service connection for a heart disorder, diagnosed as IHD and CAD, have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. 2. The criteria for service connection for diabetes have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 1131; 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from August 1969 to August 1973. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee, which denied the Veteran’s claims. The Veteran testified before the undersigned Veterans Law Judge in June 2018. A transcript is included in the claims file. Service Connection The Veteran asserts service connection is warranted for a heart disorder and diabetes as due to herbicide exposure in Thailand. A service-connected disability is one that was incurred in or aggravated during active service, or may be presumed to have been incurred during service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Certain diseases, including IHD, CAD, and diabetes mellitus, associated with exposure to herbicide agents, will be presumed to have been incurred in service even though there is no evidence of that disease during the period of service at issue. 38 U.S.C. § 1116(a) (2012); 38 C.F.R. §§ 3.307(a)(6), 3.309(e) (2017). The Veteran has claimed he was exposed to herbicides while stationed in Thailand. VA procedures for verifying exposure to herbicides in Thailand during the Vietnam Era are detailed in the VA Adjudication Manual, M21-1MR, Part IV, Subpart ii, Chapter 2, Section C ("M21-1MR"). VA has determined that there was significant use of herbicides on the fenced-in perimeters of military bases in Thailand intended to eliminate vegetation and ground cover for base security purposes as evidenced in a declassified Vietnam era Department of Defense document titled "Project CHECO Southeast Asia Report: Base Defense in Thailand" (Project CHECO Report). Special consideration of herbicide exposure on a facts-found or direct basis should be extended to those Veterans whose duties placed them on or near the perimeters of Thailand military bases. This allows for presumptive service connection of the diseases associated with herbicide exposure. The majority of troops in Thailand during the Vietnam Era were stationed at the Royal Thai Air Force Bases of U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat, and Don Muang. If a veteran served on one of these air bases as a security policeman, security patrol dog handler, member of a security police squadron, or otherwise served near the air base perimeter, as shown by MOS (military occupational specialty), performance evaluations, or other credible evidence, then herbicide exposure should be acknowledged on a facts-found or direct basis. However, this applies only during the Vietnam Era, from February 28, 1961, to May 7, 1975. See M21-1MR, Part IV, Subpart ii, Chapter 1, Section H.5.b. In this case, the Veteran served in Thailand during the Vietnam Era. The Veteran asserts that he was exposed to herbicides during service and that his heart disorder, diagnosed as IHD and CAD, and diabetes should be presumed connected to service. Private treatment records include diagnoses of IHD, CAD, and diabetes. The Veteran's service personnel records reflect that he served in Thailand during the Vietnam Era. During his service in Thailand, he was stationed at Ubon Royal Thai Air Force Base and his military operation specialty (MOS) was aircraft maintenance specialist. Considering the evidence of record, to include the Veteran’s testimony before the undersigned, the Board finds that herbicide exposure is conceded. Based on this finding of exposure to herbicides, the Veteran's IHD, CAD, and diabetes mellitus are presumed to be service connected. Accordingly, the claims of service connection for a heart disorder, diagnosed as IHD and CAD, and diabetes mellitus are granted. REASONS FOR REMAND The Veteran asserts service connection for right and left leg peripheral neuropathy is warranted due to now service-connected diabetes mellitus. However, it is unclear whether the Veteran has a current diagnosis of peripheral neuropathy. The Board finds a remand is necessary. The matters are REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any lower extremity peripheral neuropathy. The examiner must opine whether such disability is at least as likely as not related to the Veteran’s service.   The examiner should also provide an opinion whether any diagnosed peripheral neuropathy of the lower extremities is at least as likely as not (1) proximately due to service-connected disability, or (2) aggravated beyond its natural progression by service-connected diabetes. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. M. Donahue Boushehri, Counsel