Citation Nr: 18125434
Decision Date: 08/09/18	Archive Date: 08/09/18

DOCKET NO. 11-22 679
DATE:	August 9, 2018
ORDER
Entitlement to service connection for a respiratory disorder, including asbestosis, is denied.
Entitlement to service connection for diabetes mellitus, type II, to include as due to inservice herbicide exposure, is denied.
Entitlement to service connection for hypertension is denied.
Entitlement to service connection for ischemic heart disease (IHD), to include as due to inservice herbicide exposure, is denied.
Entitlement to service connection for a skin disorder, to include chloracne, to include as due to inservice herbicide exposure is denied.
Entitlement to service connection for peripheral artery disease (PAD), to include as due to inservice herbicide exposure, is denied.
Entitlement to service connection for peripheral neuropathy of the right upper extremity, to include as due to inservice herbicide exposure, is denied.
Entitlement to service connection for peripheral neuropathy of the right lower extremity, to include as due to inservice herbicide exposure, is denied.
Entitlement to service connection for peripheral neuropathy of the left lower extremity, to include as due to inservice herbicide exposure, is denied.
Entitlement to service connection for erectile dysfunction, to include as due to inservice herbicide exposure, is denied.
REMANDED
Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded.
Entitlement to an initial compensable rating for bilateral hearing loss is remanded.
FINDINGS OF FACT
1.  Although the Veteran was most likely exposed to asbestos during active service, he does not have a respiratory disorder, including asbestosis, which is related to his military service.  
2.  The Veteran was never on mainland Vietnam and although he served on the USS Perry in the coastal waters of Vietnam, he was not exposed to herbicides during service.  
3.  Diabetes mellitus, type II, first manifested many years after service and is unrelated to the Veteran’s military service.  
4.  Although the Veteran had several elevated blood pressure readings during service, hypertension first manifested many years after service and is unrelated to the Veteran’s military service.  
5.  IHD first manifested many years after service and is unrelated to the Veteran’s military service.  
6.  The Veteran is not shown to have chloracne and despite transitory skin reactions and infections during service, a chronic skin disorder first manifested many years after service and is unrelated to the Veteran’s military service.
7.  PAD first manifested many years after service and is unrelated to the Veteran’s military service.  
8.  Peripheral neuropathy of the right upper extremity first manifested many years after service and is unrelated to the Veteran’s military service.  
9.  Peripheral neuropathy of the right lower extremity first manifested many years after service and is unrelated to the Veteran’s military service.
10.  Peripheral neuropathy of the left lower extremity first manifested many years after service and is unrelated to the Veteran’s military service.
11.  Erectile dysfunction first manifested many years after service and is unrelated to the Veteran’s military service.  
12.  In September 2017, prior to the promulgation of a decision in the appeal, the Board received notification from the appellant that he was not appealing the issue of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities. 
CONCLUSIONS OF LAW
1.  The criteria for service connection for a respiratory disorder, including asbestosis, are not met.  38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2017).  
2.  The criteria for service connection for diabetes, to include as due to inservice herbicide exposure, are not met.  38 U.S.C. §§ 1110, 1131, 1116, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017).  
3.  The criteria for service connection for hypertension are not met.  38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017).  
4.  The criteria for service connection for IHD, to include as due to inservice herbicide exposure, are not met.  38 U.S.C. §§ 1110, 1131, 1116, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017).  
5.  The criteria for service connection for a skin disorder, to include chloracne, to include as due to inservice herbicide exposure, are not met.  38 U.S.C. §§ 1110, 1131, 1116, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017).  
6.  The criteria for service connection for PAD, to include as due to inservice herbicide exposure, are not met.  38 U.S.C. §§ 1110, 1131, 1116, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017).  
7.  The criteria for service connection for peripheral neuropathy of the right upper extremity, to include as due to inservice herbicide exposure, are not met.  38 U.S.C. §§ 1110, 1131, 1116, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017).  
8.  The criteria for service connection for peripheral neuropathy of the right lower extremity, to include as due to inservice herbicide exposure, are not met.  38 U.S.C. §§ 1110, 1131, 1116, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017).  
9.  The criteria for service connection for peripheral neuropathy of the left lower extremity, to include as due to inservice herbicide exposure, are not met.  38 U.S.C. §§ 1110, 1131, 1116, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017).  
10.  The criteria for service connection for erectile dysfunction, to include as due to inservice herbicide exposure, are not met.  38 U.S.C. §§ 1110, 1131, 1116, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017).  
11.  The criteria for withdrawal of an appeal by the appellant of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities have been met.  38 U.S.C. § 7105(b)(2), (d)(5) (201); 38 C.F.R. § 20.204 (2017).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran had active service in the U.S. Navy from June 1970 to May 1979.  His DD 215 reflects that his military occupational specialty was a marine mechanic and he had 1 year and 8 months of foreign or sea service.  His military decorations include the Vietnam Service Medal and the Combat Action Ribbon.  
This matter comes before the Board of Veterans’ Appeals (Board) from decisions of a Department of Veterans Affairs (VA) Regional Office (RO).  
The Veteran testified before a Decision Review Officer (DRO) at the RO in July 2017 and before the undersigned Veterans Law Judge (VLJ) at a December 2017 videoconference.  Transcripts of both hearings are of record. 
This appeal was processed using the Veteran's Benefits Management System (VBMS) and, in addition there is a Virtual VA paperless claims electronic file (now described as Legacy Content Manager Documents).  Accordingly, any future consideration of this appeal should take into consideration the existence of these electronic records.
In VA Form 9, dated September 15, 2017, and entered into VBMS on September 25, 2017, the Veteran stated that he was not appealing the claim for a TDIU rating.  Accordingly, the appeal as to that issue has been withdrawn and is no longer before the Board.  See 38 C.F.R. § 20.204.  
The Veterans Claims Assistance Act of 2000 (VCAA) imposes on VA an obligation to notify claimants of information or evidence needed for claim substantiation and a duty to assist claimants by making reasonable efforts to get the evidence needed.  See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107 (West 2002); 38 C.F.R. § 3.102, 3.156(a), 3.159, 3.326(a); see Pelegrini v. Principi, 18 Vet. App. 112, 120 (2004); Mayfield v. Nicholson, 20 Vet. App. 537 (2006) (Mayfield III), citing Mayfield II, 444 F.3d at 1333-34; and Quartuccio v. Principi, 16 Vet. App. 183, 187 (2002).  
The Veteran has reported what he feels are deficiencies as to the Board videoconference.  Otherwise, neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist.  See Scott v McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument); see also Bryant v. Shinseki, 23 Vet. App. 488 (2010) (duty to assist at hearings under 38 C.F.R. § 3.103(c)(2)).  
In VA Form 21-4138, Statement in Support of Claim, dated December 28, 2017, and entered into VBMS on January 4, 2018, the Veteran set forth his multiple concerns about the fairness of the December 2017 Board videoconference.  In part, he had expected the hearing to address only his claims for service connection for hypertension and diabetes.  Also, although he had suspected that there might be some collusion between his service representative and VA, he had been assured by his service representative that such was not the case.  He had been unsuccessful in obtaining supporting statements from two Marine guards that had prevailed in seeking VA benefits based on exposure to herbicides in drums which they guarded at Subic Bay but he believed that these were the same guards present when his work party had emptied drums on a pier at Subic Bay that contained herbicides.  He believed that his testimony had been incomplete because he was not allowed to present testimony as to the contents, i.e., herbicides, of drums he and others had cleaned on a pier at Subic Bay.  He was concerned that he had not received an impartial hearing.
38 C.F.R. § 3.103(c)(2) requires that a presiding Veterans Law Judge (VLJ) fully explain the issues and suggest the submission of evidence that may have been overlooked.  The videoconference focused on the elements necessary for claim substantiation and the appellant, via testimony, demonstrated actual knowledge of the elements necessary for claim substantiation.  
Addressing first the contention that he had expected to address only claims for service connection for hypertension and diabetes, it appears that he implicitly asserts that he was not given a full opportunity to present evidence as to other issues.  The Board finds this to be without merit.  First, the presiding VLJ specifically listed the issues which were for consideration at that hearing.  See page 2 of the transcript.  Neither the Veteran nor his representative objected to providing testimony as to issues other than those for service connection for hypertension and diabetes (which are the issues he alleges he was prepared to offer testimony).  Second, the forty-two pages of that transcript document the extensive and detailed testimony of the Veteran as to many issues on appeal.  For example, citation was made at the hearing to specific items of evidence with respect to the claim for service connection for a respiratory disorder due to asbestos exposure.  Third, he set forth testimony in great detail as to his PTSD stressors as well as circumstances of his inservice herbicide exposure (as will be set forth in greater detail below).  In fact, he even submitted a supporting statement from a service comrade as to such herbicide exposure.  Moreover, the transcript makes it clear that he also addressed his claim for an initial compensable rating for bilateral hearing loss and a claim for a TDIU rating (which he subsequently withdrew).  
Fairly read, the transcript of the Board’s videoconference gives no indication that the Veteran or his representative were not prepared to provide testimony, information, and argument as to all of the issues developed for appellant consideration (as listed at the beginning of the hearing) and no argument to the contrary was set forth at that hearing.  
As to the Veteran’s complaint of some unidentified collusion (apparently between his service representative and VA), he offers virtually nothing to support such a contention.  As to not being allowed to present testimony as to the drums (or barrels) on a pier at Subic Bay, Philippines, (which he alleges contained herbicides) the fact is that he did present testimony as to that very matter.  In fact, he presented a copy of a Board decision in another case in support of his argument.  
As fairly interpreted from the transcript and other documents of record, the Veteran’s contention in this regard is that there were two guards on the pier in Subic Bay when he and those in his work crew were emptying drums which contained herbicides and that at least one, if not both guards, eventually prevailed in claims for disability stemming from such herbicide exposure (including the person who was the claimant as to the Board decision which was offered into evidence).  At the hearing he presented extensive testimony as to his alleged herbicide exposure from cleaning drums on a pier at Subic Bay.  See generally pages 27 through 37.  Moreover, the Veteran present testimony as to what he believed was his ship board exposure on the USS Perry (DD 844).  See generally pages 21 through 26 of the transcript.  
Lastly, as to his comment that he had been unsuccessful in obtaining supporting statements from two Marine guards that had prevailed in seeking VA benefits based on exposure to herbicides in drums which they guarded at Subic Bay, this is a matter which is unrelated to the conduct of the videoconference.  Moreover, as he later made clear in other statements, he had contacted attorneys representing those guards in the hopes of obtaining supporting statements but had not received any cooperation.  However, this too is a matter unrelated to the conduct of the Board videoconference.  
In sum, the Board finds the allegation of a lack of impartiality or unfairness in the conduct of the Board videoconference to be completely without merit.  38 C.F.R. § 3.103(c)(2) requires that one presiding at a hearing fulfill two duties, i.e., (1) fully explain the issues and (2) suggest the submission of evidence that may have been overlooked.  Bryant v. Shinseki, 23 Vet. App. 488 (2010).  What is not required is the pre-adjudication of a claim; assess of credibility and probative value of evidence to determine the missing elements; mine the record for all latent issues; discuss what regulations are potentially applicable to all such issues, or explain all possible routes to benefits.  Leavey v. McDonald, No. 12-1883, slip op. at 9 (U.S. Vet. App. Nov. 14, 2014) (en banc) (citing Bryant, 23 Vet. App. at 493); 27 Vet. App. 135; withdrawn in Leavey v. McDonald, 27 Vet. App. 226 (2015) (because the Veteran had died prior to prior to the Court’s issuing its decision, and replaced it with Leavey v. McDonald, 27 Vet. App. 226 (2015)).  
In February 2018 the Veteran submitted a medical statement that he had a serious illness.  In March 2018 he and his representative moved to have his case advanced on the docket pursuant to 38 C.F.R. § 20.900(c) (2017).  38 U.S.C. § 7107(a)(2) (West 2014).  By separate letter that motion has been granted.  
The claims for service connection for an acquired psychiatric disorder, to include PTSD, and an initial compensable rating for bilateral hearing loss are addressed in the remand portion of this decision.
Background
Official records reflect that the Veteran served on the USS Perry (DD 844) which was in the official waters of the Republic of Vietnam from November 14, 1972 to November 28, 1972, and from December 3, 1972 to December 5, 1972; and December 19, 1972 to December 27, 1972, but the “record provides no conclusive proof of in-country service.” 
Service personnel records indicate that the Veteran served aboard the USS Perry from June 1971 to June 1973.  Also, a report covering the period from October 1972 to March 1973 reflects that the Veteran stood watch as an Engineering Officer of the Watch aboard the USS Perry.  Another entry reflects that he stood watches during “WestPac” deployment in 1972 in a combat zone.  
A December 27, 1972, notation reflects that the Veteran was authorized to wear the Combat Action Ribbon for action on November 15, 1972, off the northern coast of the Republic of Vietnam while conducting “NGFS” with the USS Perry in the Gulf of Tonkin.  
Additional information in the service personnel records shows that in 1972 the USS Perry joined the Seventh Fleet, reaching her station off the northern coast of South Vietnam on the 14th of November and for the next two weeks provided gunfire support for South Vietnamese forces.  Radar and oil pump casualties took her off the gun line until December 19th and she left Vietnam for the last time on December 26th on her way home.  The USS Perry was decommissioned in July 1973.  
Examination for enlistment in February 1970 revealed no abnormality.  The Veteran’s height was 69 ½ inches and he weighed 200 lbs.  His blood pressure was 139/70, and he denied having had elevated blood pressure.  
An examination for service in the nuclear field in June 1970 revealed no abnormality.  A urinalysis revealed that his sugar level was negative.  He weighed 195 lbs. and his blood pressure was 139/70.  In an adjunct medical history questionnaire the Veteran reported not having or having had skin diseases, tuberculosis, asthma, shortness of breath, pain or pressure in his chest, a chronic cough, palpitations or pounding heart, high or low blood pressure, sugar or albumin in his urine, recent gain or loss of weight, neuritis, frequent trouble sleeping, frequent or terrifying nightmares, depression or excessive worrying or nervous trouble of any sort.  
A January 1971 chest X-ray revealed some diffuse calcification which was not considered disqualifying.  A urinalysis revealed his sugar and albumin levels were negative.  In June 1971 his blood pressure was 132/92.  
The Veteran was hospitalized in July and August 1971 for a left elbow injury.  A urinalysis was normal.  A chest X-ray showed multiple calcified granulomas in the right and left lower lung fields.  After his arm was placed in a splint, he developed a rash and two days after that incision and drainage of the left olecranon bursa and left elbow was done.  A subsequent break-out appeared to be a drug allergy.  The relevant diagnoses were superficial cellulitis of the left elbow, and purulent olecranon bursitis, bacterial infection.  
An October 1971 Dental Health Questionnaire shows that did not have diabetes, major weight change, high blood pressure, tuberculosis, or heart disease.   In December 1971 the Veteran had swelling of the glans of his penis.  The impression was a bacterial infection with a hypersensitivity reaction, for which he was given Erythromycin because he was allergic to penicillin.  
Examination for re-enlistment, and service in the nuclear power field, in December 1972 revealed a fungal rash in the groin area.  A urinalysis revealed that his sugar level was negative.  A chest X-ray revealed a 0.7 cms. calcific density in the middle of the right middle lung field; three 0.2 cms. calcific densities in the right hilum.  It was recommended that he had a “PPD” test if not up to date.  His blood pressure was 130/90.  He weighed 216 lbs.  
Service treatment records (STRs) show that in conjunction with an application to service in a nuclear field the Veteran was afforded a psychiatric evaluation in December 1972 which found no mental abnormalities.  
The Veteran was hospitalized in July 1973 for an abdominal strain, at which time it was noted that he was slightly obese and his blood pressure was 126/70.  
In September 1973 it was noted that chest X-rays two months earlier had revealed no active disease of the parenchyma.  The heart was normal, and the impression was healed granulomatous disease of the lungs.   A urinalysis revealed that his sugar level was negative.  
In July 1974, when an old shoulder wound was treated, his blood pressure was 130/90.  In February 1975 he had an upper respiratory infection (URI).  In April 1975 he had tinea cruris.  In May 1975 he had another URI.  
On June 9, 1976 the Veteran injured his left elbow.  His blood pressure readings were 150/100 and 138/96.  Also in June 1976 he reported having been kicked in the groin and had pain localized to the right testicle.  About a week later he still complained of pain in the right testicle but had no hernia, varicocele or hydrocele.  
The February 1979 examination for service discharge found no abnormality.  A urinalysis revealed that his sugar level was negative and a chest X-ray was within normal limits but had revealed old granulomatous changes but no acute changes were identified.  His blood pressure was 112/60.  He was 69 inches in height and weighed 258 lbs.  It was reported that he was 78 lbs. overweight and had lost 38 lbs. since December 1978.  In an adjunct medical history questionnaire, the Veteran reported not having or having had asthma, shortness of breath, tuberculosis, pain or pressure in his chest, a chronic cough, heart trouble, high or low blood pressure, sugar or albumin in his urine, neuritis, frequent trouble sleeping, depression or excessive worrying or nervous trouble of any sort.  He reported having had a recent loss of weight.  
Information of record shows that the Veteran received VA education benefits as early as 1987.  
Submitted in support of his claims were private clinical records from 1994 to 2000.  These reflect that in 1993 the Veteran had elevated blood pressure levels and elevated blood sugar levels.  He weighed 309 lbs.  In March 1996 he weighed 303 lbs. and had type II diabetes.  In October 1996 it was reported that he had borderline hypertension, and type II diabetes.  The diagnoses included exogenous obesity.  In November 1996 he had hypertension and type II diabetes mellitus.  He weighed 300 lbs.  He also had hyperuricemia and gout.  In February 1997 it was reported that the Veteran had “syndrome X” and had hypertension, exogenous obesity, and type II diabetes mellitus for which he took insulin.  
Records from the Social Security Administration (SSA) include a private clinical record which shows that when seen in September 1993 a chest X-ray of the Veteran had revealed right lower lobe infiltrates compatible with pneumonia.  He was given a course of antibiotic therapy.  In October 1993 it was reported that he had had bilateral lower lobe infiltrates, particularly in the right lung.  The impression was that he was to be followed-up for bilateral lower lobe pneumonia.  An October 1996 private clinical records shows that the Veteran had had borderline hypertension.  His previous blood pressure reading had been 170/128, and currently it was 152/90.  His diabetes was not well controlled.  The impressions included border line hypertension.  Consideration was given to placing him on blood pressure medication.  The next month, November 1996, he raised the issue of having his stomach stapled in hopes of no longer having to take medication for diabetes and hypertension.  
SSA records include a March 1997 private clinical records which shows that the Veteran was seen for a check-up for obesity.  It was reported that “[a]pparently he was a helicopter pilot in Vietnam.  The helicopter was shot down.  He ended up with some cellulitis in his left elbow, some shrapnel wounds in his left knee” and was hospitalized in the Philippines for two months, during which he had some emotional problems and gained a lot of weight.  An August 1997 private clinical record states that the Veteran was reportedly given a psychiatric evaluation by VA in Cleveland to determine if he had PTSD.  It was reported that “[h]e had been a helicopter pilot in Vietnam and had been captured by the enemy and mistreated.”  A February 1999 private clinical record reflects that the Veteran was evaluated for diabetes and hypertension.  It was stated that “[t]his man was a Vietnam War vet and flew helicopters at a time when nobody wanted to do that.”  Private clinical records show that in March 2000 the Veteran had an abscess of the right cheek.  A December 2008 VA chest X-ray revealed numerous granulomatous calcifications in both hilar regions and in both lower lobes.  
SSA records show that the Veteran reported that he had last worked for Columbia Gas in March 2007 but thereafter had been self-employed, in home health, installing life aid equipment from 2008 to July 2013.  A report of a private consultation in November 2003, in preparation for Roux-en-Y-gastric bypass surgery, shows that the Veteran denied any history of coronary artery disease (CAD), myocardial infarction, congestive heart failure, deep venous thrombosis, pulmonary embolism, obstructive sleep apnea, asthma, chronic obstructive pulmonary disease (COPD) or depression.  The Veteran reported that a stress test was done because of risk factors of diabetes and hypertension and had been completely normal.  He had been obese for 17 years and had tried numerous weight reduction programs without success.  An electrocardiogram showed a normal sinus rhythm.  His pulmonary function test was within normal limits.  An electrocardiogram in April 2001 he shown mild left ventricular hypertrophy.  The Veteran reported that a stress test 2 or 3 years ago was done because of risk factors of diabetes and hypertension but he had not had shortness of breath, chest pain or palpitations at that testing and the test had been completely normal.  
Private clinical records show that in March 2006 the Veteran had bronchitis.  
VA outpatient treatment (VAOPT) records include a December 2008 record that the Veteran had been diabetic since 1986.  He had taken oral hypoglycemic medications for 12 years and when that ceased to be effective he was switched to insulin.  Later, he had “bariatric surgery” to help lose weight, close to 40 lbs.  He also had hypertension and gout.  He complained of tingling and numbness in both feet consistent with a finding of peripheral neuropathy.  He smoked a half a pack of cigarettes a day.  
A December 2008 VA letter thanked the Veteran for participation in VA’s Agent Orange Registry.  It was reported that the results of his visits, examinations, and laboratory tests revealed that he had type II diabetes mellitus and peripheral neuropathy.  In an attachment to that letter the Veteran reported that while the USS Perry was dry-docked in Subic Bay, Philippines, for repairs early 1973, he was assigned to a work party to run pumps to remove liquid from rusty drums labeled defoliant, into shipping containers.  He was not provided or used personal protective equipment.  While moving the drums into position for pumping, the liquid and vapors came into contact with his body. 
The Veteran also reported that while on the USS Perry off the coast of Vietnam for gunfire support and to pick up downed pilots, as a Machinists Mate he cleaned the heat exchangers on the solar shell evaporators and cleaned the main condenser.  All the heat exchangers had to be cleaned often due to the extremely warm temperature of the water and amount of debris being drawn into the heat exchangers.  The ship operated very close to coast of Vietnam and brackish waters allowing run off from Agent Orange to enter heat exchangers.  While cleaning heat exchangers, no ventilation was provided and he breathed vapors in a confined space.  
The Veteran stated that he had been assigned to ship's boarding and landing party and was assigned twice to use the ship’s launch to search for downed pilots.  On one occasion they had beached the launch on Vietnam soil to retrieve a parachute and look for a downed pilot.  
In the Veteran’s VA Form 21-526, Application for Compensation or Pension, received in July 2009, he reported that his diabetes mellitus, type II, and hypertension had begun in February 1986.  He reported having been exposed to herbicides in Vietnam and the Philippines and asbestos on board the USS Perry.  
VAOPT records include an October 2009 notation that the Veteran was informed that his obesity was contributing to his current health issues.  Also, the risks associated with hypertension were discussed, including the development of coronary artery disease (CAD).  He continued to smoke a pipe, twice daily.  
In a December 2010 Notice of Disagreement (NOD) the Veteran reported that while on the USS Perry, providing gunfire support for Army and Marine infantry, the ship was close enough to shore for him to breathe the same atmosphere as soldiers on the beach.  The water was not blue when the ship got as close as possible, within a couple hundred yards from beach, to provide gun fire support with 5-inch guns.  As member of the crew, he was awarded the Combat Action Ribbon from taking small arms fire from the beach.  Also, while on the USS Perry, he had cleaned parts of the water distillation plant which caused him to come in contact with water that was brackish and run off from shore that had been heated and condensed in a confined space without respiratory protection.  Also, (while at Subic Bay) he was assigned to a work party for 5 days to run and maintain pneumatic pumps to remove liquids from rusty drums, labeled defoliant, into shipping containers.  
In a letter received in February 2011 the Veteran reported that his diabetes started very shortly after being discharged from Navy.  On the USS Perry he was assigned to use the ship's launch to search downed pilot's parachute, and on one occasion “we beached the launch to retrieve the parachute.”  He could not find documentation of his having been assigned to the ships boarding and landing party.  A VA physician at Chillicothe, Ohio had confirmed that the Veteran’s condition was caused by Agent Orange.  
In March 2012 the Veteran underwent a psychological evaluation by Fairfield Psychological Evaluations and Assessments, LLC, to determine if he had PTSD.  On the USS Perry he worked on the sea water heat exchanges for the fresh water distillers, and the condensers had a lid that was clamped down with water in it and he feared that he would drown.  Also, he had witnessed others being killed, injured and wounded and while these, and other traumatic events, were occurring he believed that his life was threatened.  The particularly traumatic events were (a) being trapped in the main condenser on the USS Perry while cleaning it and water leaked in for approximately 15 minutes and believing he might drown, (b) firing of five-inch guns, and (c) the ship running aground.  
After psychological testing and a mental status examination, it was opined that there was sufficient evidence to support the diagnoses of: PTSD, dysthymia, generalized anxiety, a panic disorder and a sleep disorder.  It was reported that other diagnoses were diabetes with accompanying peripheral neuropathy of the right upper extremity and both lower extremities, erectile dysfunction, skin rashes as a result of herbicide exposure, and hypertension.  His GAF score was 35 and he was felt to be unemployable.  
VAOPT records include a review, by a cardiologist, of a CT scan which revealed mild cardiomegaly and coronary artery calcifications with evidence of prior granulomatous disease.  There was no significant perfusion reversibility to suggest ischemia.  
A service comrade, A. M., reported in VA Form 21-4138, Statement in Support of Claim, in May 2017 that when deployed to Vietnam on the USS Perry he and the Veteran were assigned to the forward engine room.  The Veteran had also been assigned to the ship’s boarding crew.  Although no other ships were ever boarded, the USS Perry’s launch was used to search for downed pilots on at least 3 occasions.  On one such occasion, the crew of the launch spotted a parachute close to shore which they tried to recover.  According to the crew of the launch, the launch was beached due to a big wave.  The rudder of the launch was damaged when the launch was washed on shore.  Mr. A. M. reported that he had not seen the launch on the beach but the account by the crew of the launch and the bent rudder led him to believe that the launch had been beached.  
A service comrade, A. M., reported in VA Form 21-4138, Statement in Support of Claim, in June 2017 that the USS Perry was docked at Subic Bay, Philippines for generator repair when a working party of 12 engineering crew members was mustered, including the Veteran, to pump out rusty drums on the ammo pier.  Most of the drums were rusty but some had distinctive orange bands, and some had what appeared to be yellow bands.  There were complaints of bad odor which upset their stomachs and caused nausea.  Another servicemember (not the Veteran) said that the working party tried to empty the drums using an electric centrifugal pump, but the pump did not have enough suction to empty the drums.  A.M. was in charge of supplying the ship with fresh water and was using a water truck to haul water to the ship.  The servicemember (not the Veteran) flagged A. M. down and explained that he needed a pneumatic pump from ship to finish the job.  A.M. gave him a ride back to ship and transported the pump back to ammo pier.  A.M. saw the drums and the work party, which included the Veteran, working to empty the drums.  A.M. could see liquid on the concrete surrounding the drums and the odor was very bad. 
In a July 2017 statement the Veteran’s niece reported that he had raised her since he was discharged from the Navy.  He had suffered from “being a diabetic, having depression and anger issues his whole life.”  
Of record is an e-mail dated July 9, 2017 from the Veteran to his service representative.  It states that in attempting to find shipmates for supporting statements he: 
got a phone call from [redacted], who lives in Pittsburg, Pa. [redacted] was on the USS Perry during our Vietnam cruise.  [redacted] said he was approved for his agent orange claim in Pittsburg approximately 3 years ago.  [redacted] said he took his DD214 into the Pittsburg Pa. office, they searched ships logs and found he qualified for agent orange while we were on the gun line supporting Army troops on hill 108, the Vietcong made a surprise attack on Army troops on hill 108 and did not have artillery or air support, the USS Perry was given orders to move close to shore and provide gun support so that the Vietcong could not over run their base.  According to [redacted], our actions saved the base and a lot of Army troops.  He did not have to go to hearing or use the appeal process.  Our ship did take enemy fire while providing support.
A July 2017 VAOPT record shows that the Veteran was treated for actinic keratoses and squamous cell carcinoma.  He had had “blu-light” therapy.  The assessment was a history of nonmelanoma skin cancer.  
On VA general medical examination on June 18, 2013, the Veteran’s claim file and electronic VA treatment records were reviewed.  It was reported that the Veteran had diabetes mellitus, type II, and that he estimated the onset to have been in 1981.  He had gout, and he estimated the onset to have been in about 1988.  
With respect to a claimed respiratory disorder, including claimed inservice asbestos exposure, the examiner reported that the STRs showed that on reenlistment examination dated December 8, 1972, the Veteran was noted to have calcifications in the right middle lung field and right hilum.  No specific respiratory complaints were noted in service.  He had served as a machinist's mate, therefore, his exposure to asbestos during service was "probable."  There was no diagnosis of asbestosis, or any other chronic lung diagnosis.  Pulmonary function tests (PFTs) ordered in 2003 listed diagnoses of obesity and symptom of dyspnea.  The PFTs were normal.  Chest X-rays in 1972 and 2008 showed calcifications, but no plaques.  This was not consistent with a diagnosis of asbestosis.  The calcifications were noted in the 1972 entrance examination, and no other work-up was felt necessary.  The Veteran consistently reported no respiratory problems in his service medical histories, including on 1979 discharge examination.  Therefore, he did not have a respiratory condition which was least as likely as not (50 percent or greater probability) incurred in or caused by his service.  Also, the examiner stated that she found no evidence that the Veteran was unemployable based on the current examination findings.  He was not restricted from sedentary employment.  
It was also reported that the Veteran had never been diagnosed as having a respiratory disorder.  The Veteran reported having some intermittent shortness of breath going back many years.  He did not recall any particular diagnosis being made.  He did not recall having a lot of respiratory symptoms while in the Navy, but afterwards, when he was exerting himself, he would cough or wheeze occasionally.  He had not been prescribed any medication or inhaler for his symptoms.  PFTs in 2003 were normal.  The 1972 service entrance examination found calcifications on chest X-rays, but he was asymptomatic and continued to be so until his 1979 discharge examination.  He had a smoking history but stated he was no longer smoking.  Private clinical records in the claim files showed no chronic lung diagnoses.  VA chest X-rays in 2008 had revealed numerous granulomatous calcifications in both hilar regions and in both lower lobes of the lungs, and his heart was not enlarged.  The results of PFT in November 2003 were reported.  
On VA psychiatric examination on June 20, 2013 the Veteran’s claim file was reviewed and the diagnoses were claustrophobia and a depressive disorder, not otherwise specified (NOS) but the examiner found that the Veteran did not meet the criteria for a diagnosis of PTSD.  The Veteran's fear of enclosed places and anxiety appear to be related to claustrophobia.  Regarding his sleeping difficulties, it was difficult to determine how much was related to his depression (he still had dreams at night about his wife) and the claustrophobia (his negative dreams about being in an enclosed space).  
Upon interviewing the Veteran, the examiner observed that the Veteran reported having temper flashes sometimes.  He had been married from 1981 until 2006, when his first wife suddenly died from a brain aneurysm.  He said that she was "probably the best friend I ever had."  He reported that he could not have children “after Vietnam", apparently indicating that he was infertile, and he blamed his infertility on Agent Orange.  During service, he was stationed aboard this USS Perry when it was deployed to Vietnam between 1972 in 1973.  He left the military because he was frustrated as he was having difficulty making weight standards, he had to attend morning physical training and felt that it was very inconvenient for him and embarrassing given his rank.  From 1979 until 1981 he says that he "didn't do nothing."  He said that he did not have to work because he was able to collect unemployment and live off some savings.  In 1981 he began working for [redacted], after his wife died in 2006 he "lost my whole life."  He was offered early retirement from work.  Since 2007 to the current he has worked part-time (15-30 hours per week) for a local home health company, installing life alert and medication dispensers.  He had has never participated in formal mental health treatment, he had never been prescribed psychiatric medication.  
The Veteran was interviewed with regards to any fear of hostile military or terrorist activity.  As to one event which the Veteran considered to be a stressor, he stated that while on board the USS Perry the ship was docked for repairs Subic Bay, he was working on cleaning out sediment from the ship.  Apparently, the upper part of his body was down the hole, and several of his friends then lifted his feet and legs dropping him into the confined area he was cleaning out.  He said that they then shut the lid trapping him in a small space.  He stated that he passed out because he was so anxious and as a result he was unsure how long he was in this area.  He was very mad when he was let out.   
The examiner stated that this did meet Criterion A (i.e., as to whether it was adequate to support the diagnosis of PTSD) but it was not related to a fear of hostile military or terrorist activity because the event occurred while the ship was in dock. 
The examiner further stated that the Veteran did not meet the full criteria for PTSD as to Criterion E and Criterion F.  The examiner reported that in regards to a diagnosis of PTSD, based on today's evaluation, the Veteran did not appear to meet the full diagnostic criteria.  Specifically, Criterion C, because although he reported trying to avoid situations where he felt he might be trapped or other small spaces and he did report avoiding talking about this trauma.  He did not display an inability to recall important aspects of the trauma (other than the time he says he was unconscious), he did not display markedly diminished interest in participation in significant activities, he did not display a detachment or estrangement from others (he had a group of friends he interacts with regularly, he enjoyed interacting with his elderly neighbors), he did not have a restricted range of affect nor did he have a foreshortened sense of future.  In addition, Criterion F did not appear to be met, his symptoms did not appear to have caused clinically significant distress or impairment in social, occupational or other important areas of functioning.  
The Veteran did appear to meet the diagnostic criteria for simple phobia, claustrophobia and depressive disorder NOS.  The claustrophobia seemed more likely than not be related to the reported incident of being trapped in a small area on his ship.  The depressive disorder appeared to be more related to his wife's sudden and unexpected death.  
As regard employability, from a purely psychological point of view, the Veteran was employable.  He remained capable of completing complex tasks in environments where he would not be required to work in small, enclosed spaces.  
In August 2013 an article dated July 21, 2013 entitled “US Returning to Subic Bay” from an unidentified source was submitted.  It states that US Naval ships underwent maintenance.  Near a former Naval runway were weapons bunkers that had been used to store nuclear weapons and other ordinances.  One of the former bunkers had been converted into a restaurant.  Just inside the door of that restaurant was “an orange steel drum marked ‘Agent Orange’ that is used to hold the menus.”  This was a reminder of the massive toxic legacy the US left in Subic Bay.  
Of record is a September 2013 PTSD Disability Benefits Questionnaire, apparently from a private psychologist.  It listed that Veteran’s diagnoses as (a) chronic PTSD, (2) Major Depressive Disorder, recurrent, severe without psychotic features, and (3) Generalized Anxiety Disorder.  Other medical diagnoses included diabetes, hypertension, tinnitus, and “breathing issues.”  The Veteran’s symptoms of PTSD were distressing memories, nightmares, cognitive and behavioral avoidance patterns, and being easily startled, and hypervigilant.  Symptoms of a major depressive disorder were depressed mood, anhedonia, irritability, and fatigue.  There was a significant overlap of symptomatology but the trauma symptoms, i.e., PTSD, were considered to be primary.  The records reviewed were an attorney’s contact summary and excerpts of rating decisions. 
It was reported that the Veteran was offered an early retirement from Columbia Gas because of his attitude.  The Veteran believed that he was unable to work due to vocational and physical issues.  He had never received psychiatric treatment.  It was reported that the Veteran met all of the criteria for a diagnosis of PTSD.  However, no actual stressors upon which a diagnosis of PTSD was made were recited in the report of this examination.  
On the other hand, in an adjunct report from that private psychologist, it was reported that the Veteran had undergone assessment in August 2013.  The private psychologist reported that the Veteran was considered to be a “Blue Water” veteran.  While aboard the USS Perry off the coast of Vietnam his ship was often close to the shore providing naval gunfire support.  He recalled taking small arms fire from small boats.  He also recalled one of his peers using a 50 caliber gun and "blowing a boat out of the water."  He recalled seeing a lot of blood and "that was my first experience seeing someone dead.”   He recalled hearing a woman's voice, and the shooting stopped.  He also recalled a situation where his peers locked him into a main engine reduction gear.  He stated, "they left me in there for twenty to thirty minutes, and I went nuts."  He recalled yelling and screaming to get out and started feeling helpless and terrified as "the oil could have drowned me."  
Also, while at Subic Bay the Veteran was placed on a working party and moved and cleaned square metal containers "marked hazardous and defoliant."  He reported that many of the containers were rusted and leaking "a dark oily liquid that. smelled like chlorine."  He recalled seeing blue and orange stripes on the barrels.  He was not provided protective gear, arid the liquid made his skin tingle and burn.  He recalled having blisters on his arm and was treated at sick bay.  After the contact with this chemical, he believed he started struggling with erectile dysfunction, weight gain, fatigue, and difficulty staying alert.  Later, aboard the USS Tripp (DE-1075) he believed he was exposed to asbestos insulation.  
The Veteran believed he began experiencing symptoms consistent with PTSD, generalized anxiety, and depression after being locked up in the reduction gear.  He first noticed that he began questioning his own judgment and became distrustful of peers and more vigilant, and became claustrophobic.  His current symptoms of PTSD manifested as distressing memories of being locked up, and his recurrent nightmares of drowning, suffocation, or being in the reduction gear.  He believed that coming into contact with chemicals during military service had prevented him from being a father.  
After a mental status examination and psychological testing the diagnoses were (a) chronic PTSD, (2) major depressive disorder, recurrent, severe without psychotic features, and (3) generalized anxiety disorder.  His symptoms of generalized anxiety and depression were considered secondary to his trauma symptoms.  
A November 2013 VAOPT record for screening for a colonoscopy shows that the Veteran had a squamous cell carcinoma removed from his left earlobe in 2013.  
In a May 2014 Agent Orange (AO) Peripheral Neuropathy (PN) Review Checklist, signed by a physician, it was reported that there was no objective or lay evidence in the claims folder that suggest that PN manifested itself during military service, within one year of last exposure and/or prior to May 8, 1976.  It was noted that the Veteran conceded that he was not in-country in Vietnam and records showed that he was stationed in the official waters of Vietnam only.
SSA records include a private clinical record of April 2006 which shows that the Veteran sustained a fracture rib when a motor bike flipped over.  A March 2007 VAOPT record shows that the Veteran presented to the VA Cambridge Clinic for the first time “wanting the benefits that he is entitled to.”  He had recently had surgery for a ventral hernia that was due to bariatric surgery about 4 years ago.  He continued to smoke cigars.  On physical examination there was trace edema of both lower extremities.  He had a history of hypertension.  Another March 2007 VAOPT record shows that on PTSD screening he responded in the negative as to whether he had ever had any experience that was so frightening, horrible, or upsetting that in the last month he had had nightmares about it or thought about it when he did not want to.  He responded in the negative as to whether he was constantly on guard, watchful or easily startled.  He responded in the negative as to whether he felt numb detached from others, activities or his surroundings.  As to whether a stressful event he experienced was related to his military service, the response was negative.  The PTSD screening was negative.  In March 2008 the Veteran was advised to quit smoking.  A December 2008 VAOPT record shows that the Veteran was seen for Agent Orange Registry evaluation.  He had been a diabetic since 1986.  He had been on oral hypoglycemic medications for 12 years, until switched to insulin.  Later on, he had bariatric surgery that help him lose close to 40 lbs.  Also, he took medication for hypertension and gouty arthritis.  He complained of tingling and numbness of his feet, consistent with a finding of peripheral neuropathy.  He smoked ½ pack of cigarettes daily.  He had been sterilized and, as a result, had no children.  He had been in the Navy and was in Vietnam in 1971.  It was also reported that he had been involved in cleaning up spilled Agent Orange chemicals as well which he believed exposed him to herbicides during his service.  On physical examination there was scarring from prior bariatric surgery.  His chest was emphysematous.  He had impaired sensation in both feet.  
SSA records also include a November 2009 VAOPT record shows that a tobacco screening reflects that the Veteran indicated he was a life-time non-user of tobacco; however, that same clinical record indicates that he was no longer using tobacco, having quit 7 years ago.  A December 2010 VAOPT record shows that his 10-year risk for coronary artery disease, using the Framingham study guidelines was 13 %.  VAOPT records show that in July 2010 the Veteran wanted to lose another 25 lbs. of weight and wanted to cut down on his blood pressure medication after losing that weight.  He was advised that a 10% reduction in body weight would improve his health risks.  He had had past bariatric surgery.  Also, strategies to stop smoking were discussed.  A pathology study of excision of a lesion of the left earlobe in August 2013 revealed squamous cell carcinoma.  
At a July 2017 DRO hearing the Veteran testified that he had no heart problems prior to his military service.  He had served on the U.S.S. Perry which had gone to Vietnam for six months.  His duties as a machinist’s mate involved engineering as to water distillation, air-conditioning, and refrigeration.  He had been assigned to the ship’s boarding and landing party, having been trained to board and search other vessels, and he was to ensure functioning of the motor of a launch boat.  While off the coast of Vietnam, the launch had been sent out three times.  A statement from a service comrade states that the Veteran was sent out on the launch three times to search for downed pilots.  On one of the occasions when his launch was sent out it ran aground on a sandbar.  They had been given strict orders never to go ashore and, so, those on the launch jumped in the water, waist-high, and pushed the launch towards open water.  However, he could not narrow down the time frame as to when this event occurred to within a two-month window.  He had unsuccessfully attempted to obtain the ships logs.  Also, from talking with the ship’s quartermaster, he did not believe that the incident of the launch being stuck on a sandbar would have been recorded in the deck logs.  
The Veteran also testified that he had been awarded the Combat Action Ribbon because his ship had taken small arms fire from the Vietnam shore while his ship was providing naval gunfire support.  His ship was close enough to the Vietnam shore to see trucks and tanks on the beach without binoculars.  He had seen the artillery guns on his ship blow up a truck on the beach.  It was stated that an inservice performance evaluation confirmed that the Veteran had stood engineering officer of the watch in a combat zone.  The Veteran confirmed that his sister-in-law submitted a statement to the effect that directly after service discharge he began suffering from diabetes, aggression, and anger issues.  
The Veteran testified that during service he had been put on a weight program in which he had to watch his calories, run a mile-and-a-half to two miles daily, and move back onto the base for monitoring.  The Veteran’s service representative argued that the Veteran had developed diabetes during service which had gone undiagnosed, and he also now had ischemic heart problems.  As to herbicide exposure, he testified that his shipboard work included maintaining the distillation plant which included cleaning the filters, even when his ship was close to shore.  Because of the age of his ship, a World War II era ship, the distillation plant had leaks.  
Also as to herbicide exposure, a statement from a service comrade confirmed that his ship docked at Subic Bay in the Philippines for repairs, sometime in 1971, 1972 or 1973.  At that time the Veteran was part of a working party moving drums on a dock.  Some of the drums had orange bands and some had yellow bands, and they have a very bad odor which caused nausea.  Some of the work involved transferring or pumping the contents of some drums into other drums.  At that time, he had not worn any safety equipment.  Only two members of this work party, other than the Veteran, were still alive.  He had spoken with the wife of the seaman that had been the supervisor of the work party and found out that the supervisor had died “very young of the same stuff I’ve got.”  
The Veteran further testified that he had a “Veteran’s Benefits Handbook” and had been getting them for six years but “[t]hey’d stopped them, because they called me and told me I wasn’t a true Vietnam Vet.”  Also, in about 1985 “they said, ‘No, you’re Navy.  You don’t get nothing. No’.”  Between that time and 2007 he became sick and had gone to a VA clinic and a VA physician, Dr. Williamson [phonetic spelling] had reviewed the medical records which the Veteran had brought and told the Veteran that he had been a diabetic before he was discharged from service.”  That physician had told him that the first thing that Agent Orange did was disturb a person’s metabolism which was why he had been unable to lose weight during service.  He had then been sent to another VA physician, Dr. Raman in Chillicothe.  It was at about this time that he started getting “them handbooks.”  Shortly after that, i.e., about two years ago, both of these physicians had been let go.  
The Veteran submitted a “Veterans Health Benefits Handbook” at the DRO hearing and this shows that in Chapter 2 “Eligibility” it was stated that VA records showed that eligibility for VA health benefits was based on unique eligibility factors, as listed, and included “10 percent service-connected” and “determined to be a Vietnam-era herbicide-exposed Veteran.”  
In a September 2017 letter the Veteran stated that during his last 2 years in the Navy he gained 132 lbs. and was made to participate in a Navy weight loss program requiring physical conditioning leading to exhaustion and creating financial and marital problems.  He was not allowed to re-enlist due to his weight problems and he had difficulty accepting this.  In November 1979 he attempted to hang himself.  Also in that month his ankles and legs became swollen and a physician in Newcomerstown, Ohio, told him that he was diabetic and needed to lose weight quickly.  He was prescribed medication and was physically active, according to his physician’s instructions, but after a couple of months he stopped taking the medication and as long as he stayed active his sugar levels remained borderline.  He enrolled in the VA health care system in 2008.  He began getting a Veterans Health Handbook each year and listed under eligibilities was a statement that he was a Vietnam era herbicide-exposed veteran, which led him to believe that he was eligible for Agent Orange illnesses.  He asked his VA physician about Agent Orange documentation and was told that his severe weight gain in his last two years in the Navy was due to diabetes, which was probably caused by Agent Orange.   Thus, he believed that he was diabetic before being discharged from the Navy.  
Submitted in September 2017 was a handwritten letter from L.S., a former sheriff, stating that he knew the Veteran to have been diabetic and depressed in the late 1970s.  
In a VA Form 9 in September 2017 the Veteran reported that as to a combat stressor, on November 15, 1972, he was standing on port side of ship watching gun fire support for troops when the ship was attacked by fire from beach.  The bullets ricocheted off the ship just behind him, and he hit the deck but was not hurt.  He had been very scared because the bullets came as a complete surprise.  The ship went to general quarters and everyone was told to take cover, as he made his way to ships hatch, just as he got there someone closed the hatch for general quarters, and he had had to run to opposite side of ship for cover.  He had never been so scared in his life.  
Also in that VA Form 9 in September 2017 the Veteran reported that while on the USS Perry’s deployment to Vietnam the heat and having to take salt water showers caused his skin to become dry and peel.  
In another VA Form 9 in September 2017 the Veteran reported that he believed that he had erectile dysfunction and was sterile.  He believed that this was due to either inservice exposure to herbicides or to having been kicked in the groin during service, for which he was seen in sick bay, following which his testicles and penis swelled to twice normal size and he vomited for 2 to 3 hours
In a September 2017 statement J. V. H., a retired Naval Captain, reported that he had been the commanding officer of the USS Perry during the deployment to the Seventh Fleet in 1972 – 1973.  He recalled that while in Subic Bay a work party to which the Veteran was assigned was to empty and dispose of drums on a pier at “NAS Cubi Point.”  
At the December 2017 Board videoconference the Veteran testified that he had been a machinist’s mate on an old World War II built destroyer for a little over a year.  It had asbestos as insulation and lagging on the ships pipes.  He had even helped to remove some of the asbestos, having seen the asbestos particle floating in the air.  At that time he had not used a respirator for protection.  He had never been given a formal diagnosis of asbestosis.  He now had wheezing.  
The Veteran’s service representative stated that the Veteran’s last pulmonary function testing and examination for asbestosis was in 2003 and requested that the Veteran be afforded a more recent examination for pulmonary function testing and to check for asbestosis.  The presiding VLJ noted that asbestosis was determined based on X-ray studies, and the service representative, while acknowledging that VA took X-rays in 2003, request new chest X-ray studies to see if there were signs of asbestosis.  
The service representative stated that VA chest X-rays in 2008 did not reveal plaques but did find calcifications, just as inservice X-rays in 1972 had revealed calcifications.  The Veteran testified that when he had the chest X-rays in 1972 a physician had inquired whether the Veteran had ever been exposed to asbestos and informed the Veteran that he (the physician) was concerned about it and that the Veteran should “keep an eye on it.”  
As to PTSD, the Veteran testified that his ship had received a Combat Action Ribbon because it had taken small arms fire from shore in Vietnam, in response to artillery fire from his ship.  He had been standing on the side of the ship and heard someone yell “incoming” and he hit the deck because of a short burst of small arms fire.  This had “scared me some.”  The Veteran also testified that he had been scared when aboard a launch on the coast of Vietnam, even though they had never been fired at during the 2 or 3 times when he was in the launch.  
On another occasion, while onboard ship he had been in a water tank, cleaning out that tank, when someone put the lid back on the water tank and started filling the water tank which had become about ¼ full before someone heard him knocking on the water tank wall and let him out.  During this episode he had been in a panic, and still had nightmares about it.  The Veteran testified that he now had depression and anxiety.  The service representative stated that the Veteran’s depression and anxiety stemmed from his having been discharged from military service due to his being unable to control his weight.  
The Veteran testified that shortly after his military service, in 1979, he had tried to hang himself, and that for a large part of his postservice career he had not had medical insurance and he had not been guided to a VA health center until about 2007.  In about 2010 he had started going to a VA health clinic.  Two psychiatrists had told him that he had PTSD or that he had mental issues.  At the Board videoconference it was acknowledged that a September 2013 Disability Benefits Questionnaire (DBQ) reflected diagnoses of PTSD and a generalized anxiety disorder.  
At the Board videoconference a copy of decision by the Board in an unrelated case was submitted which reflects that herbicide exposure was conceded in that case in which a claimant alleged inservice exposure while guarding barrels of Agent Orange at Subic Bay in the Philippines.  The Veteran testified that at Subic Bay he had been on 3 or 4 work parties which were involved in pumping out 55 to 60 barrels, some of which had yellow rings on them and some had orange stripes.  He testified that he had tried to obtain a statement from his then commanding officer that he had come into contact with herbicides but the commanding officer declined because, while acknowledging that the Veteran was on a work party, he could not state that he knew that Agent Orange was there.  The Veteran then testified that these drums leaked a lot.  
The Veteran submitted a statement from “Arnie Moyet” who served with the Veteran on the USS Perry from 1972 to 1973 and that ship docked at Subic Bay and a working party, including the Veteran, had to pump out rusty drums on an ammo pier.  The drums had had distinctive orange bands and some appeared to have yellow bands, and a bad order had caused nausea.  
As to the Board decision in an unrelated case which was submitted and reflected that herbicide exposure was conceded in that case in which a claimant alleged inservice exposure while guarding barrels of Agent Orange at Subic Bay in the Philippines, the service representative argued that the Veteran was there at that same time and emptying the barrels.  Page 37.  
Also, while off the coast of Vietnam his ship had been within 1,000 to 5,000 yards of the Vietnam coast, and debris from the coast as well as herbicides came into contact with the ship.  As to a respiratory disorder, the Veteran testified that during his military service he had been a smoker.  
Then Veteran testified that he had been forced to retire in 2007 because he kept losing the ability to drive and, basically, he would fall asleep.  He had tried for 3 or 4 years thereafter to do menial jobs, even putting in home healthcare systems.  His problem in this regard did not stem solely from diabetes but from “[e]verything as a whole.”  He had started working for Columbia Gas repairing meters for 5 or 6 years.  
Of record is a February 19, 2018 VAOPT, entered into VBMS on February 21, 2018, which states that the Veteran had long-standing diabetes mellitus, type 2.  “As documented, diabetes mellitus type 2 has been associated with exposure to Agent Orange.  He had related having signs and symptoms of diabetes soon after his service aboard ship on the shore of Vietnam during the Vietnam War.  His illness requires continuous monitoring, dietary changes, and multiple medications in order to prevent potential deadly complications of the disease.”  He also had “ischemic heart disease as documented by past left heart catherization showing multi-vessel coronary artery disease.”  
In a March 2018 statement, A. M., a service comrade, stated that the Veteran, after his Board videoconference, had called and asked if he could remember anything further about the work party on the pier at Subic Bay.  Based on his records, A. M., stated that in about mid-December 1972 the USS Perry docked at Subic Bay for repairs of the generator and distillation plant.  While A. M. was engaged in another matter, a work party went to an ammo pier to help empty drums.  A. M. had helped load a pump from the USS Perry to help empty the drums and unload the pump and hoses at the pier.  He had seen the drums that the work party was trying to empty.  Most of the drums were gray with orange stripes, and some had a yellow stripe.  All of the drums were very rusty, and some were already leaking.  There was liquid on the concrete which had a very foul smell.  He and another servicemember (not the Veteran) had walked through the liquid to get the pump and hoses in position.  Some of the work party were complaining that it made them sick to their stomach.  A. M. had seen the Veteran moving the drums into a position to pump them out.  
A May 2018 VA thoracic CT scan, conducted due to asbestos exposure and an abnormality chest X-ray, when compared to a December 2018 VA chest X-ray, revealed evidence of old granulomatous disease.  There were several sub-centimeter nonspecific nodules which were not definitely calcified.  These were also likely granulomatous but a follow-up chest CT in 6 months to document stability was recommended.  It also revealed mild pericardial fluid versus thickening.
Service Connection
Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131.  Service connection requires that there be (1) medical evidence of a current disability, (2) medical or lay evidence of in-service incurrence or aggravation of an injury, and (3) medical evidence of a nexus between the claimed in-service injury and the present disability.  Dalton v. Nicholson, 21 Vet. App. 23, 36 (2007).  
Service connection may be granted for any disease diagnosed after discharge, when the evidence establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d) (2017).  However, not every manifestation of joint pain or any cough, during service will permit service connection for arthritis or pulmonary diseases first shown as a clear-cut clinical entity at some later date.  38 C.F.R. § 3.303(b).  
A showing of an in-service chronic disease requires evidence of (1) a sufficient combination of manifestations for disease identification, and (2) sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “chronic.  A showing of continuity of symptoms is not required when disease identity is established but is required when in-service chronicity is not adequately supported or when an inservice diagnosis of chronicity may be legitimately questioned.  38 C.F.R. § 3.303(b).  Certain chronic conditions, e.g., a psychosis, diabetes mellitus, essential hypertension, cardiovascular disease, and organic diseases of the nervous system, will be presumed to have been incurred in service if manifested to a compensable degree within 1 year after service.  38 U.S.C. §§ 1101, 1112, 1113 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017).  
However, pleural plaques are not listed as such a chronic condition under 38 C.F.R. § 3.309(a) (2017).  See Walker v. Shinseki, 708 F.3d 1331, 1338-39 (Fed. Cir. 2013) (demonstrating a continuity of symptomatology since service or within the presumptive period after service only applies to the chronic diseases listed under 38 C.F.R. § 3.309(a)).  
Service connection will be granted on a secondary basis for disability that is proximately due to or the result of, or permanently aggravated by, an already service-connected condition.  38 C.F.R. § 3.310(a) and (b).  This requires (1) evidence of a current disability; (2) a service-connected disability; and (3) evidence establishing a nexus between the service-connected disability and the claimed disability.  Wallin v. West, 11 Vet. App. 509, 512 (1998).  
Lay evidence, when credible, is competent to establish the presence of continuity of symptomatology for a claimed disability during and since separation from military service, subject to the limitation that the claimed disability is a 'chronic' disease as defined at 38 C.F.R. § 3.309(a)).  See Barr v. Nicholson, 21 Vet. App. 303, 307 (2007).  
38 U.S.C. § 1154(a) requires consideration of all pertinent medical and lay evidence.  This requires assessing competence, credibility, and probative (relative) weight of evidence.  “[T]here is no categorical requirement of ‘competent medical evidence … [when] the determinative issue involves either medical etiology or a medical diagnosis’.”  Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); see also 38 C.F.R. § 3.307(b) (a determinative factual basis can be shown by medical or competent lay evidence); 38 C.F.R. § 3.159(a)(1), (2) (defining competent medical and lay evidence); 38 C.F.R. § 3.307(b) (as to chronicity and continuity of symptoms lay evidence should describe material and relevant facts observed and not merely conclusions based upon opinion).
Lay evidence may, in some circumstances, establish a medical diagnosis, causation or etiology, i.e., when a layperson (1) is competent to identify the medical condition, (2) is reporting a contemporaneous medical diagnosis, or (3) describes symptoms at the time which supports a later diagnosis by a medical professional.  Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009) (overruling broad holdings in Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) and Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (2007) that competent medical evidence is required when the determinative issue is either medical etiology or medical diagnosis); see also King v. Shinseki, 700 F.3d 1399 Fed. Cir. 2012); 2012 WL 6029502 (C.A. Fed.) (confirming that Davidson, Id., overruled the broad holdings in Buchanan, Id., and Jandreau, Id.).  
Mere conclusory or generalized lay statements that a service event or illness caused a current disability are insufficient.  Waters v. Shinseki, 601 F.3d 1274, 1278 (2010).  Although a lay person is competent in certain situations to provide a diagnosis of a simple condition, a lay person is not competent to provide evidence as to more complex medical questions.  See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007).  Once lay evidence is determined to be competent, the Board must determine whether such evidence is also credible.  See Layno v. Brown, 6 Vet. App. 465 (1994).  
The credibility of lay evidence may not be refuted solely by the absence of corroborating medical evidence, but it is a factor.  Buchanan, 451 F.3d at 1336.  VA may rely on an absence of an entry in a record as evidence that the event did not occur, but only if the matter is of the kind that ordinarily would have been recorded.  Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011); see also Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000) (“[E]vidence of a prolonged period without medical complaint can be considered”).  
Other credibility factors are the lapse of time in recollecting events attested to, prior conflicting statements as opposed to consistency with other statements and evidence, internal consistency, facial plausibility, bias, interest, the length of time between alleged incurrence of disability and the earliest or first corroborating medical or lay evidence thereof, and statements given during treatment (which are usually given greater probative weight, particularly if close in time to the onset thereof).  Caluza v. Brown, 7 Vet. App. 498, 511 (1995).  
Reasonable doubt will be favorably resolved and it exists when there is an approximate balance of positive and negative evidence.  It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  If the Board determines that the preponderance of the evidence is against the claim, it has necessarily found that the evidence is not in approximate balance, and the benefit of the doubt rule is not applicable.  Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed.Cir. 2001).
Entitlement to service connection for a respiratory disorder, including asbestosis
As to asbestos-related diseases, the Board notes there are no laws or regulations specifically dealing with asbestos and service connection.  However, the VA Adjudication Procedure Manual, M21-1 (M21-1), and opinions of the United States Court of Appeals for Veterans Claims (Court) and General Counsel provide guidance in adjudicating these claims.
In 1988, VA issued a circular on asbestos-related diseases that provided guidelines for considering asbestos compensation claims.  See Department of Veterans Benefits, Veterans’ Administration, DVB Circular 21-88-8, Asbestos-Related Diseases (May 11, 1988).  The information and instructions contained in the DVB Circular since have been included in VA Adjudication Procedure Manual, M21-1, part VI, paragraph 7.21 (October 3, 1997).  VA must adjudicate the veteran’s claim for service connection for a lung disorder, as a residual of exposure to asbestos, under these guidelines.  See Ennis v. Brown, 4 Vet. App. 523, 527 (1993); McGinty v. Brown, 4 Vet. App. 428, 432 (1993).  
As to the M21-1, it provides that, when considering these types of claims, VA must determine whether military records demonstrate evidence of asbestos exposure in service (see M21-1, Part III, par. 5.13(b) (October 3, 1997); M21-1, Part VI, par. 7.21(d)(1) (October 3, 1997)); determine whether there was pre-service and/or post-service evidence of occupational or other asbestos exposure (Id.); and thereafter determine if there was a relationship between asbestos exposure and the currently claimed disease, keeping in mind the latency and exposure information found at M21-1, Part III, par. 5.13(a) (see M21-1, Part VI, par. 7.21(d)(1) (October 3, 1997)).  
In this regard, the M21-1 provides the following non-exclusive list of asbestos related diseases/abnormalities:  asbestosis, interstitial pulmonary fibrosis, effusions and fibrosis, pleural plaques, mesotheliomas of pleura and peritoneum, lung cancer, bronchial cancer, cancer of the larynx, cancer of the pharynx, cancer of the urogenital system (except the prostate), and cancers of the gastrointestinal tract.  See M21-1, Part VI, par. 7.21(a)(1) & (2).
The M21-1 also provides the following non-exclusive list of occupations that have higher incidents of asbestos exposure:  mining, milling, work in shipyards, insulation work, demolition of old buildings, carpentry and construction, manufacture and servicing of friction products such as clutch facings and brake linings, and manufacture and installation of roofing and flooring materials, asbestos cement sheet and pipe products, and military equipment.  See M21-1, Part VI, par. 7.21(b)(1).  In addition, the M21-1 notes that, during World War II, several million-people employed in U.S. shipyards and U.S. Navy personnel were exposed to asbestos.  See M21-1, Part VI, par. 7.21(b)(2).
Next, the Board notes that the M21-1 provides the following medical guidance:  in order for an appellant to have a clinical diagnosis of asbestosis the record must show a history of exposure and radiographic evidence of parenchymal lung disease (see M21-1, Part VI, par. 7.21(c)); the latent period for asbestosis varies from 10 to 45 or more years between first exposure and development of disease (see M21-1, Part VI, par. 7.21(b)(2)); and exposure to asbestos may cause disease later on even when the exposure was brief (as little as a month or two) or indirect (bystander disease) (Id.).
M21-1 does not create a presumption of in-service exposure to asbestos for claimants that worked in one of the occupations that the M21-1 listed as having higher incidents of asbestos exposure.  See Dyment v. West, 13 Vet. App. 141, 145 (1999); see also Ennis v. Brown, 4 Vet. App. 438, vacated at 4 Vet. App. 523, new decision issued at 4 Vet. App. 523 (1993); McGinty v. Brown, 4 Vet. App. 428 (1993); Ashford v. Brown, 10 Vet. App. 120 (1997).  Thus, in claims of service connection for disability due to asbestos exposure, the appellant must first establish that the disease that caused or contributed to his disability was caused by events in service or an injury or disease incurred therein.  Cuevas v. Principi, 3 Vet. App. 542, 548 (1992).  
As to the General Counsel, in VAOPGCPREC 04-2000 (April 13, 2000), it was held as follows:  M21-1, Part VI, par. 7.21(a), (b), & (c) are not substantive in nature, but nonetheless need to be discussed by the Board in all decisions; the first three sentences of M21-1, Part VI, par. 7.21(d)(1) are substantive in nature and the development criteria it lays out must be followed by the agency of original jurisdiction; and M21-1, Part VI, par. 7.21 does not create a presumption of medical nexus between a current asbestos related disease and military service.
Here it is undisputed that the Veteran had a high probability of exposure to asbestos.  It is also undisputed that he now has some over-inflation of the lungs.  While the over-inflation of his lungs may be due to his past long history of smoking, it is not contended or shown that such over-inflation is due to his past asbestos exposure.  
In accordance with the M21-1 to have a clinical diagnosis of asbestosis the record must show a history of exposure, which the Veteran in this case has, but also radiographic evidence of parenchymal lung disease, which in this case the Veteran does not have. 
The STRs show that inservice chest X-rays revealed calcific densities and calcified granulomas but a 1973 specifically found no active disease of the parenchyma.  Although he had two URIs in 1975 there is no clinical evidence of a chronic respiratory disorder during service or at service discharge when he denied having asthma, shortness of breath, pain or pressure in his chest, or even a chronic cough.  
After service the Veteran had episodes of pneumonia, following which there was radiological evidence of pulmonary infiltrates, and bronchitis.  
Significantly, the June 2013 VA examination specifically found that there had never been a diagnosis of asbestosis or, in fact, any chronic lung disease.  The examiner pointed out that X-rays had not found plagues and that the radiological absence of plaques was not consistent with a disease of asbestosis.  The examiner’s opinion was that it was less likely as not that the Veteran had a respiratory disorder as a result of military service.  
The Board has considered the request at the Board videoconference that the Veteran be afforded a current respiratory examination to determine if there were now signs of asbestosis.  However, inasmuch as the June 2013 VA examination, including X-rays, found no radiological evidence of asbestosis, even if a more recent examination did find such evidence it would only indicate that the Veteran was exposed to asbestos since his last VA examination and this would not be probative evidence in favor of his claim.  
For the foregoing reasons and bases, the Board finds that the preponderance of the evidence is against the claim for service connection for a respiratory disorder, including asbestosis.
Herbicide Exposure
VA regulations provide that a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the Vietnam era, namely from February 28, 1961, to May 7, 1975, 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 that service. 38 C.F.R. § 3.307(a)(6)(iii).  If a veteran was exposed to an herbicide agent (to include Agent Orange) during active service, certain diseases shall be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied.  This list of diseases includes type 2 diabetes (also known as type II diabetes mellitus or adult-onset diabetes); early on-set peripheral neuropathy; chloracne or other acneform disease consistent with chloracne; and ischemic heart disease (IHD), which includes atherosclerotic cardiovascular disease and coronary artery disease (CAD) and Prinzmetal’s angina but does not include hypertension or peripheral manifestations of arteriosclerosis, e.g., peripheral vascular disease; 
Notwithstanding the presumptive provisions, service connection for claimed residuals of exposure to herbicides also may be established by showing that a disorder resulting in disability is, in fact, causally linked to the exposure.  See Brock v. Brown, 10 Vet. App. 155, 162-64 (1997); Combee v. Brown, 34 F.3d 1039, 1044 (Fed. Cir.), citing 38 U.S.C. §§ 1113 and 1116, and 38 C.F.R. § 3.303.
There are two theories by which a presumption of herbicide exposure may apply and they are (1) presence in Vietnam or brown waters of Vietnam, or (2) actual exposure, even if in blue waters off the coast of Vietnam, or exposure elsewhere, which in this case is alleged to have been from cleaning drums, which had contained herbicides, at a pier at Subic Bay, Philippines.  
As to the first theory, this requires no evidence of actual exposure to herbicides.  Specifically, a veteran who "served in the Republic of Vietnam" between January 6, 1962, and May 7, 1975, is presumed service connected for certain conditions likely caused by exposure to herbicides, including diabetes, even if he cannot prove he was ever actually exposed.  38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e).  
But VA limits this presumption to veterans who served on or visited the Vietnam landmass or its inland waterways, and does not apply it to veterans who served exclusively offshore in ocean-going ships, i.e., in the "blue water Navy."  See Haas v. Peake, 525 F.3d 1168, 1197 (Fed. Cir. 2008) (upholding VA's statutory interpretation excluding the "blue water Navy" from presumptive herbicide exposure).  The term "blue water Navy" refers to open water naval vessels that sailed off the coast of Vietnam, as opposed to the term "brown water Navy," which refers to ships that sailed within the inland waterways of Vietnam.  Taina v. Shinseki, No. 13-0875, slip op. footnote 1 at 3 (U.S. Vet. App. May 27, 2014) (nonprecedential memorandum decision).  
"[A] May 2011 Institute of Medicine (IOM) report concluded that although there were several plausible ways by which blue water Navy veterans could have been exposed to herbicides, "there was not enough information on the concentrations of Agent Orange in the Vietnamese environment to determine whether blue water Navy veterans were or were not exposed to Agent Orange via ingestion, dermal contact, or inhalation of potable water."  See BLUE WATER NAVY VIETNAM VETERANS AND AGENT ORANGE EXPOSURE, INSTITUTE OF MEDICINE (May 20, 2011)"; generally see also Taina v. Shinseki, No. 13-0875, slip op. at 3 (U.S. Vet. App. May 27, 2014) (nonprecedential memorandum decision). 
Here, the Veteran admits that his ship never docked in Vietnam, including at any deep water port.  While there is some evidence that the Veteran set foot in Vietnam, having gone in a launch to a South Vietnamese beach to search for parachutes or down pilots, the evidence overall and including the Veteran’s more recent admissions, establish that he never set foot on the Vietnam landmass.  Under these circumstances, it is not error to determine that the Veteran is not entitled to the presumption of herbicide exposure under the first theory.  Taina v. Shinseki, No. 13-0875, slip op. at 3 and 4 (U.S. Vet. App. May 27, 2014) (nonprecedential memorandum decision).  
As to the second theory, the Veteran asserts that he was exposed to herbicides by drinking and bathing in contaminated water, and cleaning barrels in Subic Bay, Philippines, that contained herbicides, thus entitled to service connection based on the herbicide presumption as a result of actual herbicide exposure.  See generally Taina v. Shinseki, No. 13-0875, slip op. at 2 (U.S. Vet. App. May 27, 2014) (nonprecedential memorandum decision). 
In addressing the second theory, i.e., actual herbicide exposure, the Board must not only address the appellant's competence and credibility to observe the symptoms of his diabetes and to address its etiology but must also address the credibility or competence of the appellant’s lay evidence or testimony that he was exposed to Agent Orange while in the waters just off the coast of Vietnam and while cleaning barrels in Subic Bay, Philippines which contained herbicides; which, if accepted, might lead to an award of service connection.  Taina v. Shinseki, No. 13-0875, slip op. at 3 and 4 (U.S. Vet. App. May 27, 2014) (nonprecedential memorandum decision).  
"[A] May 2011 Institute of Medicine (IOM) report concluded that although there were several plausible ways by which blue water Navy veterans could have been exposed to herbicides, "there was not enough information on the concentrations of Agent Orange in the Vietnamese environment to determine whether blue water Navy veterans were or were not exposed to Agent Orange via ingestion, dermal contact, or inhalation of potable water."  See BLUE WATER NAVY VIETNAM VETERANS AND AGENT ORANGE EXPOSURE, INSTITUTE OF MEDICINE (May 20, 2011)"; generally see also Taina v. Shinseki, No. 13-0875, slip op. at 3 (U.S. Vet. App. May 27, 2014) (nonprecedential memorandum decision). 
However, the Veteran is simply not competent to attest that water from inland Vietnam flowed out to sea and remained within water used on the USS Perry for cleaning clothes, drinking, food preparation, and bathing.  The Veteran's argument is similar to the argument raised in Haas v. Peake, 525 F.3d 1168 (Fed. Cir. 2008), in which the veteran argued that service members serving offshore could have been exposed to Agent Orange through several mechanisms, such as "runoff" carrying toxic chemicals into the sea, "spray drift" transporting toxins via the wind, and the shipboard consumption of drinking water produced by evaporative distillation; the veteran cited an Australian study for support.  The study conducted by the Australian Department of Veterans Affairs suggested that Vietnam Veterans of the Royal Australian Navy may have been exposed to herbicide compounds by drinking water distilled on board their vessels.  The findings of the study were considered by VA in creating a rule against presumptive exposure to deep water vessels.  Although the Federal Circuit passed no judgment on the validity of studies such as the Australian study, it did highlight VA's rulemaking with respect to this Australian study: “VA scientists and experts have noted many problems with the study that caution against reliance on the study to change our long-held position regarding veterans who served off shore. First, as the authors of the Australian study themselves noted, there was substantial uncertainty in their assumptions regarding the concentration of dioxin that may have been present in estuarine waters during the Vietnam War . . . . Second, even with the concentrating effect found in the Australian study, the levels of exposure estimated in this study are not at all comparable to the exposures experienced by veterans who served on land where herbicides were applied . . . . Third, it is not clear that U.S. ships used distilled drinking water drawn from or near estuarine sources or, if they did, whether the distillation process was similar to that used by the Australian Navy.”  Haas v. Peake, 525 F.3d 1168, 1194 (quoting 73 Fed. Reg. 20,566, 20,568 (Apr. 16, 2008)).
Accordingly, even after consideration of the doctrine of the favorable resolution of doubt, the Board must conclude that there is no competent and credible evidence that the Veteran was exposed to herbicides while the USS Perry was in the coastal waters of Vietnam.  
As to possible herbicide exposure from cleaning drums on a pier in Subic Bay, the Board notes that the Veteran has submitted into the record a copy of Board decision in another case which awarded benefits for a claim based on exposure of a guard to herbicides while stationed at Subic Bay.  
38 C.F.R. § 20.1303 provides that “[a]lthough the Board strives for consistency in issuing its decisions, previously issued Board decisions will be considered binding only with regard to the specific case decided.  Prior decisions in other appeals may be considered in a case to the extent that they reasonably relate to the case, but each case presented to the Board will be decided on the basis of the individual facts of the case in light of applicable procedure and substantive law.”  
In this regard, the Veteran asserts that the appellant that prevailed in the Board decision he submitted in support of his claim is a guard that was present when the USS Perry was at Subic Bay and he was part of a work party that had to clean drums on a pier, which he alleges contained herbicides.  In this regard the Veteran had indicated that the USS Perry was at Subic Bay after being off the coast of Vietnam.  A statement from a service comrade is similarly vague to when the USS Perry docked at Subic Bay being in a time frame from 1971 to 1973.  However, the USS Perry was in the Vietnam coastal waters in 1972 and the copy of the Board decision submitted by the Veteran shows that the guard in that case was at Subic Bay from February to August 1971, and also shows that, contrary to the Veteran’s statements, that if there was a spill from the drums it was cleaned by personnel wearing hazardous material uniforms.  
The Board does not doubt that the Veteran engaged in some form of work in a pier in Subic Bay but that given the many years after the events in question, finds that the testimony of the Veteran and the supporting statements of service comrades are simply not sufficient to find that he was exposed to herbicides at Subic Bay.  Indeed, a letter from a superior officer specifically refrained from stating that the drums on the pier at Subic Bay contained herbicides.  The logic of that was that it would be simple speculation to assert that the drums contained herbicides.  This Board concurs with this and notes that even if the contents of such drums did cause a foul smell this has little probative value in establishing that such drums contained herbicides.  In sum, other than the Veteran’s mere speculation, there is no corroborating evidence that the drums which were cleaned on a pier in Subic Bay in 1972 had been used to transport, and had contained, herbicides.  
For the foregoing reasons, the Veteran’s inservice exposure to herbicides has not been established.  
Lastly, the Veteran essentially asserts that VA has already conceded that he was exposed to herbicides during service because he had been sent Veterans Health Benefits Handbooks acknowledging such herbicide exposure.  However, such information furnished to the Veteran was not part of any adjudication of a claim for VA benefits.  From the record, it appears that this information was provided to the Veteran merely as part of his enrollment in the VA Agent Orange Registry and appears to have simply assumed that he was exposed to herbicides during service, based on information he provided.  
Accordingly, the Veteran is not entitled to presumptive service connection for a disability based upon inservice herbicide exposure.
Entitlement to service connection for diabetes
It is alleged that the Veteran had diabetes during his active service, based on a VA Dr. purportedly having said that his inservice obesity was due to metabolic disturbance from diabetes.  Moreover, while there is no categorical rule that medical evidence is required when the determinative issue is either medical etiology or a medical nexus, and lay evidence can be competent and sufficient to establish a diagnosis where (1) the layperson is competent to identify the medical condition, or (2) is reporting a contemporaneous medical diagnosis, or (3) describes symptoms that support a later diagnosis by a medical professional, this does not mean that in adjudicating a claim that a layperson’s statements of what he or she was told by medical personnel must be blindly accepted as true.  See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).  While the holding in Washington v. Nicholson, 19 Vet. App. 362, 368 (2005) that “the connection between what a physician said and the layman's account of what he purportedly said, filtered as it [is] through a layman's sensibilities, is simply too attenuated and inherently unreliable to constitute ‘medical’ evidence” is no longer binding in light of the holding in Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) and Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007), the reasoning in Washington, Id. at 368, is persuasive particularly in circumstances in which the layperson is reciting matters of a complex medical nature which was told to him or her many years ago.  See also Smith v. Derwinski, 2 Vet. App. 137, 140 (1992) (VA “is not required to accept every bald assertion [] as to service connection or aggravation of a disability.”).   
This statement by the Veteran finds no corroborative support anywhere else in the record.  Thus, the Board finds that the Veteran’s lay statements in this regard are without probative value.  
The Veteran has submitted conflicting lay evidence as to the onset of his diabetes.  He had reported that he had diabetes immediately after his military service, and a recent 2017 statement from a former sheriff is to the effect that he had diabetes in the late 1970s, which would be a point in time during military service or within a year thereafter.  However, in his 2009 VA Form 21-526, in which he claimed service connection for diabetes he reported that the onset of diabetes, and even hypertension, was in 1986.  
Rather, the evidence overall is quite clear that he first developed diabetes mellitus a number of years after his military service and the Veteran’s lay statements as to the putative opinion of a VA physician regarding the inservice onset of diabetes, i.e., as causing his inservice obesity, is simply lacking in such probative value as to outweigh the greater preponderance of the evidence which is to the contrary.
Entitlement to service connection for hypertension
Initially, the Board notes that hypertension is not a disability for which presumptive service connection is warranted on the basis of inservice herbicide exposure.  See Note 2 to 38 C.F.R. § 3.309(e).  For VA purposes, hypertension means that the diastolic pressure is predominantly 90 or greater, and isolated systolic hypertension means that the systolic pressure is predominantly 160 or greater with a diastolic pressure of less than 90.  See 38 C.F.R. § 4.104, Diagnostic Code 7101.  
The Veteran had two borderline diastolic readings of 90 during service and two elevated readings, of 92 in June 1971 and 96 in June 1976.  All of his systolic readings were within normal limits.  However, almost three years after his last elevate diastolic reading, of 96, in June 1976 his blood pressure readings, both systolic and diastolic, were within normal limits at this February 1979 discharge examination.  
Again, the Board notes that in his 2009 VA Form 21-526, in which he claimed service connection for diabetes and hypertension he reported that the onset of both diabetes and hypertension had been in 1986, more than half a decade after he was discharged from active service.  The contemporaneous clinical records demonstrate that as late as 1996 his blood pressure was considered to be only borderline.  There is no persuasive evidence which otherwise demonstrates that the Veteran’s elevated diastolic readings during service were anything but acute and transitory or that hypertension otherwise had its onset during his active service or within one year after his discharge from military service.  
Lastly, although it is not specifically contended that the Veteran’s hypertension is due to his claimed diabetes, because service connection is not warranted for diabetes mellitus, type II, service connection for hypertension may not be granted as either being caused by the diabetes or aggravated by the diabetes.  
Accordingly, the preponderance of the evidence is against the claim for service connection for hypertension.
Entitlement to service connection for IHD
Because it is found that the Veteran was not exposed to herbicides during military service, service connection is not warranted for any form of IHD on the basis of such putative exposure.  It is not otherwise shown or contended that the Veteran developed IHD, or any form of heart disease, either during his active service or that any IHD, or any form of heart disease, manifested within one year after his discharge from military service.  In fact, the clinical evidence is clear that the Veteran was first found to have any form of heart many years after his military service.  Accordingly, the preponderance of the evidence is against the claim for service connection for IHD.
Entitlement to service connection for a skin disorder
Because it is found that the Veteran was not exposed to herbicides during military service, service connection is not warranted for any form of skin disease on the basis of such putative exposure.  Moreover, only chloracne is a skin disease which is presumptively due to herbicide exposure and there is no clinical evidence that the Veteran has ever had chloracne.  
During service in 1971 the Veteran had a skin reaction due to a drug allergy and later that year he was found to be allergic to penicillin.  In 1972 and 1975 he had tinea cruris, a fungal infection of the groin area.  However, the examination for discharge from service in February 1979 negative for a skin disorder, including any chronic residuals of a drug reaction or tinea cruris.  
After military service, the Veteran was treated in March 2000 for an abscess of right cheek; a pathology study of tissue excised from a lesion of the left earlobe in August 2013 revealed squamous cell carcinoma; and a VAOPT record reflects treatment in July 2017 for actinic keratoses and squamous cell carcinoma, and noted a history of nonmelanoma skin cancer.  
The only evidence which would serve as a nexus, i.e., to connect the postservice right cheek abscess, squamous cell carcinoma, and actinic keratoses to military service is the report in March 2012 of a private psychological assessment which diagnosed, in part, skin rashes due to herbicide exposure.  However, as noted, because it is found that the Veteran was not exposed to herbicides during service there is no basis for granting service connection for these skin disorders on the basis of being due to inservice herbicide exposure.  The evidence does not other demonstrate that the Veteran has any chronic skin disability which is of service origin.
Entitlement to service connection for PAD
Because it is found that the Veteran was not exposed to herbicides during military service, service connection is not warranted for PAD on the basis of such putative exposure.  No other basis for granting service connection is asserted on appeal.  The service records are negative for PAD and the earliest evidence of PAD is many years after the Veteran’s discharge from active service.  There is no clinical evidence which links the claimed PAD to the Veteran’s military service.  Accordingly, the preponderance of the evidence is against the claim for service connection for PAD.   
Entitlement to service connection for peripheral neuropathy of the right upper extremity
Because it is found that the Veteran was not exposed to herbicides during military service, service connection is not warranted for any peripheral neuropathy of the right upper extremity on the basis of such putative exposure.  No other basis for granting service connection is asserted on appeal.  The service records are negative for peripheral neuropathy of the right upper extremity and the earliest evidence thereof is many years after the Veteran’s discharge from active service.  There is no clinical evidence which links the claimed peripheral neuropathy of the right upper extremity to the Veteran’s military service.  Thus, the preponderance of the evidence is against the claim for service connection for peripheral neuropathy of the right upper extremity.
Entitlement to service connection for peripheral neuropathy of the right lower extremity
Because it is found that the Veteran was not exposed to herbicides during military service, service connection is not warranted for any peripheral neuropathy of the right lower extremity on the basis of such putative exposure.  
The service records are negative for peripheral neuropathy of the right lower extremity and the earliest evidence thereof is many years after the Veteran’s discharge from active service.  There is no clinical evidence which links the claimed peripheral neuropathy of the right lower extremity to the Veteran’s military service.  So, the preponderance of the evidence is against the claim for service connection for peripheral neuropathy of the right lower extremity.
Entitlement to service connection for peripheral neurpathy of the left lower extremity
Because it is found that the Veteran was not exposed to herbicides during military service, service connection is not warranted for any peripheral neuropathy of the left lower extremity on the basis of such putative exposure.  
The service records are negative for peripheral neuropathy of the left lower extremity and the earliest evidence thereof is many years after the Veteran’s discharge from active service.  There is no clinical evidence which links the claimed peripheral neuropathy of the left lower extremity to the Veteran’s military service.  As such, the preponderance of the evidence is against the claim for service connection for peripheral neuropathy of the left lower extremity.
Entitlement to Service Connection For Erectile Dysfunction
Because it is found that the Veteran was not exposed to herbicides during military service, service connection is not warranted for any erectile dysfunction on the basis of such putative exposure.  

While it is known that diabetes mellitus may cause erectile dysfunction, the Veteran also asserts that he has erectile dysfunction due to inservice trauma to the groin, i.e., have been kicked in the testicles.  While the evidence does establish that he sustained such an injury, it is not until many years after he developed diabetes mellitus that he first asserted that he had erectile dysfunction.  Although he is competent to attest to having erectile dysfunction, the Board finds that the Veteran is not competent as a layperson to render such an opinion because the question of causation of erectile dysfunction as a result of trauma involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship.  As such, this issue may not be competently addressed by lay evidence, and the Veteran's own opinion is nonprobative evidence.  See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). 
Thus, the preponderance of the evidence is against the claim for service connection for service connection for erectile dysfunction.  
Entitlement to TDIU
The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed.  38 U.S.C. § 7105 (2012).  An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision.  38 C.F.R. § 20.204 ().  Withdrawal may be made by the appellant or by his or her authorized representative.  38 C.F.R. § 20.204.  In the present case, the appellant has withdrawn the appeal as to the issue of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities and, hence, there remain no allegations of errors of fact or law for appellate consideration.  Accordingly, the Board does not have jurisdiction to review the appeal as to this issue and the appeal as to that issue is dismissed.
REASONS FOR REMAND
Entitlement to service connection for an acquired psychiatric disorder, to include PTSD is remanded.  
The Board is aware that some of the evidence of record is either conflicting or confusing as to the circumstances of any participation by the Veteran in combat.  As to this, he was awarded the Combat Action Ribbon because his ship, the USS Perry, came under small arms fire while along the Vietnamese coast.  
In this regard, first, despite some evidence that he putatively (but by the Veteran’s admission did not) stepped foot on Vietnamese soil, the evidence does demonstrate that he was on a launch which, for only a little while, was stuck on a sand bar along the Vietnamese coast.  During that time the Veteran did not come under fire, but he reports having feared that he (and the others in the launch) would come under fire while wading in the water to free the launch.  
Second, there is evidence consistent with the circumstances of the Veteran’s service that the USS Perry came under small arms fire while the Veteran was aboard that ship and he has reported that at that time he feared for his life.  He has also reported having seen trucks on the shore being blown up and people on small boats being shot.  
However, there is virtually no corroboration of histories recorded by private clinicians of the Veteran’s having been a helicopter pilot or having been captured by the enemy.  Thus, any such history must be disregarded. 
The Veteran was afforded a VA psychiatric examination in June 2013 (as reported above).  However, the only stressor which that psychiatric examiner address was the Veteran’s report of having been trapped by fellow crew members in a confined space while onboard ship and fearing that at that time he would drown.  The June 2013 VA psychiatric examiner opined that this did not fall within the scope of fear of hostile military or terrorist activity.  
The June 2013 VA psychiatric examiner did not address the other reported stressors, which are consistent with the Veteran’s military service, as summarized above.  Thus, a VA psychiatric examination is needed for a professional medical opinion as to whether the circumstances, as described above, gave rise to PTSD as a result of a fear of hostile military or terrorist activity.  
Entitlement to an initial compensable rating for bilateral hearing loss is remanded.
On VA audiology examination of June 17, 2013 the Veteran’s claim file was reviewed.  Audiometric testing revealed the following puretone thresholds, in decibels:
Hertz →
Decibels ↓	1,000	2,000	3,000	4,000	Discrimination Ability
Right	20	35	55	50	94%
Left	20	35	60	50	90%

Discrimination ability was determined by using the Maryland CNC test.  Both puretone audiometric and discrimination testing were valid for rating purposes.  The diagnosis was a bilateral sensorineural hearing loss.  The Veteran reported difficulty hearing conversation, especially in background noise, and also reported difficulty tolerating his bothersome tinnitus.  
At the December 2017 Board videoconference the Veteran testified that he had had a “second follow-up audio exam in Cambridge” and the audiologist he told him that the findings were the same as the first VA audiology examination and that he was “on the borderline.”  The Veteran stated that he now used lip reading.  The second audiologist had told the Veteran that he could ask VA for a new examination because the “findings are borderline.”  It was requested that the Veteran be afforded a new VA audiology rating examination.  Pages 4 and 5 of that transcript.  
In this regard, there is no record on file of a second VA audiology evaluation.  Thus, the Veteran should be contacted and requested to provide as much information as possible as to the date and location of his reported “second follow-up audio exam in Cambridge.”  Then, the appropriate steps should be taken to obtain the results of any such audiology examination and associate the same with the Veteran’s electronic records.  
Also, in light of the fact that the most recent audiology evaluation of record took place more than five years ago and Veteran’s testimony, he should be afforded an -up-to-date VA audiology rating examination.
The matters are REMANDED for the following action:
1.	Afford the Veteran a VA psychiatric examination for the purpose of determining whether he now has PTSD and, if so, whether it is due to or the result of a fear of hostile military or terrorist activity.  

The examiner may consider the events as described above to have been within the scope of the Veteran’s expected participation in activities in a combat area.  Specifically, (a) being aboard the USS Perry when it came under small arms fire while along the Vietnamese coast; (b) having seen trucks on the shore being blown up and people on small boats being shot; and (c) being on a launch which was stuck on a sand bar along the Vietnamese coast when he feared they would come under fire.  
The examination report should reflect review of pertinent material in the claims folder.  The examiner must carefully review the evidence of record, the Veteran's statements, and the clinical evidence, and conduct a thorough examination.  The Veteran's statements may serve to support any medical determination to the extent the statements may be reasonably made by a layperson.  For example, the Veteran, as a layperson may address what her personally observed or experienced, including current or past symptoms, and what a physician previously told him.  The examiner must not accept lay statements beyond the ambit of lay knowledge or comprehension, such as a statement by the Veteran that he currently suffers from a medical illness which has not been diagnosed by appropriate medical personnel.  The examiner may accept that a physician told him these things, for purposes of establishing etiology or a diagnosis, but not accept the Veteran's personal knowledge of such matters.  The examiner should also address whether any statements or evidence are contradicted or reasonably questioned based on other evidence of record.  
If the diagnosis of PTSD is deemed appropriate, the examiners should comment upon the link between the current symptomatology and one or more of the inservice stressors found to be established by the RO and state whether it was sufficient to cause PTSD.  The examination report should include the complete rationale for all opinions expressed.  

2.	Contact the Veteran and request that he provide as much detailed information as possible as to the date and location of his reported “second follow-up [VA] audio exam in Cambridge.”  Then, the appropriate steps should be taken to obtain the results of any such audiology examination and associate the same with the Veteran’s electronic records.  

3.	Schedule the Veteran for a VA audiological examination to determine the current level of severity of his service-connected bilateral hearing loss.  The Veteran’s electronic medical records should be made available to and be reviewed by the examiner, if needed.  Any tests or studies deemed necessary should be conducted, to specifically include audiometric testing, and the results should be reported in detail.  The examiner should also fully describe the functional effects caused by the Veteran's hearing disability on his daily life.  See Martinak v. Nicholson, 21 Vet. App. 447 (2007).  

 

If the auditory thresholds from the current examination differ significantly from the results of other tests, the VA examiner should explain the reason why there is a difference, if possible.


 
DEBORAH W. SINGLETON
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Department of Veterans Affairs