Citation Nr: 19127975 Decision Date: 04/10/19 Archive Date: 04/10/19 DOCKET NO. 17-51 246 DATE: April 10, 2019 ORDER Entitlement to service connection for diabetes mellitus, type II, to include as secondary to in service exposure to herbicides, is granted. REMANDED Entitlement to service connection for hypertension is remanded. Entitlement to service-connection for erectile dysfunction, to include as secondary to a service-connected disability, is remanded. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, the Veteran was exposed to herbicides during his active duty service in Thailand. 2. The Veteran was diagnosed with diabetes mellitus, type II. CONCLUSION OF LAW The criteria for service connection for diabetes mellitus, type II, to include as secondary to in service exposure to herbicides, are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309; M21-1, IV.ii.1.H.5.a-b. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran had active duty from August 1969 to August 1973, including a period of service at Udorn Royal Thai Airforce Base in Thailand. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). Veterans diagnosed with an enumerated disease who, during active service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed 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). For certain diseases with a relationship to herbicide agent exposure, such as diabetes mellitus, type II, and prostate cancer, a presumption of service connection arises if the disease manifests to a degree of 10 percent or more following service in areas with known exposure, including in or near the Korean DMZ at any time during the period from April 1, 1968 to August 31, 1971. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307 (a)(6)(iv), 3.309(e). Entitlement to service connection for diabetes mellitus, type 2, to include as secondary to in service exposure to herbicides The Board finds that service connection for diabetes mellitus, type II, is warranted. In support of this determination, the Board first notes that the Veteran contends that service connection for diabetes is warranted on a presumptive basis due to his exposure to herbicide agents while serving at the Udorn Air Base in Thailand. Although statutory and regulatory provisions do not establish a presumption of exposure to herbicide agents based on service in Thailand, a Compensation Service memorandum incorporated into the VA Adjudication Procedure Manual (VBA Manual M21-1) indicates that herbicides, including Agent Orange, were used at certain times and places at some military bases in Thailand during the Vietnam era. See VBA Manual M21-1, IV.ii.1.H.5.a. In order to acknowledge exposure to herbicide agents via service in Thailand, the evidence must show: (1) that an individual served at one of several Royal Thai Air Force Bases in the Air Force during the Vietnam era, and (2) that the individual's military occupational specialty (MOS) was that of a security policeman, a security patrol dog handler, a member of a security police squadron, or a position that otherwise required service near the air base perimeter as demonstrated by daily work duties, performance evaluation reports, or other credible evidence. If the answer to both inquiries is affirmative, then VA is to concede herbicide exposure in Thailand on a direct basis. See VBA Manual M21-1, IV.ii.1.H.5.b. [VA Manual M21-1 reflects the policy of the Veterans Benefit Administration (VBA), and not the policy of the VA Secretary, given that VBA and the Secretary are separate entities within VA and that M21 provisions do not go through the regular rulemaking procedures. Unlike a regulation, the VA Secretary has no say in what goes into the Manual.] The Veteran’s service records indicate, and VA has confirmed, that the Veteran served for a period of 62 days at the Udorn Royal Thai Air Force Base in Thailand beginning in December 1972. Pursuant to VBA Manual M21-1, IV.ii.1.H.5.b, Udorn qualifies as a Royal Thai Air Force Base for herbicide exposure purposes. Also, service in 1973 qualifies as Vietnam era service under 38 C.F.R. § 3.2(f). Lastly, although the Veteran’s MOS was not that of a security policeman, a security patrol dog handler, or a member of a security police squadron, he repeatedly contended in lay statements that his MOS duties in ground equipment maintenance required him to spend frequently time near the perimeter, and cross the perimeter of the air base to inspect and repair ground equipment such as generators and portable lights. See November 2011, October 2017 statements and May 2017 testimony. The Veteran’s personnel records and separation documents indicate that he worked as a ground equipment repairman. Combining the Veteran’s MOS with his lay reports of his in-service duties in Thailand and resolving all reasonable doubt in his favor, the Board finds that the Veteran’s duties required him to be near the perimeter of the Udorn Air Base such that herbicide exposure in service in Thailand must be acknowledged. See VBA Manual M21-1, IV.ii.1.H.5.b. In light of this acknowledgement, the Board finds that service connection for diabetes mellitus must be granted as (1) 38 C.F.R. § 3.309 (e) recognizes that diabetes mellitus is presumptively associated with herbicide exposure, and (2) the Veteran has a current diagnoses of diabetes mellitus type II. See September and October 2011 private treatment records. REASONS FOR REMAND Entitlement to service connection for hypertension The Veteran contends that his hypertension is related to his active service. The Board finds there is insufficient evidence upon which to adjudicate this claim. Although the Veteran has a current diagnosis of hypertension, this medical condition is not considered service-connected under the presumption for herbicide agent exposed Veterans outlined above. As such, a medical examination and opinion is necessary to determine the nature and etiology of the Veteran’s hypertension. Entitlement to service-connection for ED, to include as secondary to a service-connected disability The Veteran contends that he has ED as a result of his active service. While a private medical note of record suggests this condition may be related to his diabetes mellitus, there has been no formal medical determination concerning a diagnosis or etiology of this condition. Thus, the Board finds there is insufficient evidence to adjudicate this claim and it must be remanded for further development. These matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. Also, contact the Veteran to determine whether there are any additional relevant private treatment records and obtain any necessary authorizations for such records. 2. Then, accord the Veteran appropriate VA examination(s) to determine the nature and etiology of his hypertension and any ED he may have. The claims file, including a copy of this Remand, should be forwarded to the examiner(s) in conjunction with this(these) examination(s). All necessary studies and tests should be accomplished. Based on a review of the records and, the examinations, the examiner(s) should address the following: (a.) The examiner must opine whether it is at least as likely as not (50% probability or better) that the Veteran’s hypertension and ED were caused by any in-service injury, event, or disease, including in-service exposure to herbicides. (b.) The examiner must opine whether it is at least as likely as not (50% probability or better) that the Veteran’s hypertension and ED are, or have been during the appeal period, caused by or aggravated beyond their normal progression due to any service-connected condition, including the Veteran’s now service-connected diabetes mellitus, type II. A complete rationale for any opinion expressed must be provided. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M.E. Lee, Associate Counsel