Citation Nr: 20004166 Decision Date: 01/16/20 Archive Date: 01/16/20 DOCKET NO. 18-24 771 DATE: January 16, 2020 ORDER The application to reopen the previously denied claim of entitlement to service connection for diabetes mellitus is granted. The application to reopen the previously denied claim of entitlement to service connection for an acquired psychiatric disorder is granted. The application to reopen the previously denied claim of entitlement to service connection for hypertension is granted. The application to reopen the previously denied claim of entitlement to service connection for polyneuropathy is granted. The application to reopen the previously denied claim of entitlement to service connection for erectile dysfunction is granted. Service connection for type 2 diabetes mellitus is granted. Service connection for other specified trauma and stressor related disorder is granted. Service connection for hypertension is granted. Service connection for polyneuropathy is granted. Service connection for erectile dysfunction is granted. Service connection for diabetic retinopathy is granted. VETERAN’S CONTENTIONS The Veteran contends that he currently has diabetes mellitus as a result of in-service exposure to herbicide agents in Thailand as well as during several brief visits to Vietnam. Additionally, the Veteran contends that he currently has diagnoses of hypertension, polyneuropathy, erectile dysfunction, and retinopathy as a result of his diabetes mellitus. Lastly, the Veteran states that he has a current psychiatric disorder as a result of his service in Southeast Asia during the Vietnam era. FINDINGS OF FACT 1. The Veteran served on active duty from July 1966 to June 1968 in the United States Army. The Veteran’s service personnel records (SPRs) indicate that he was assigned to the Joint United States Military Advisory Group Thailand (JUSMAGTHAI) at Don Muang Airport, Bangkok, Thailand. The Veteran’s SPRs provide that he served in Thailand from January 1967 to June 1968. The Veteran was granted a top-secret security clearance for his service in Thailand. 2. In a March 2003 rating decision, a Department of Veterans Affairs (VA) Regional Office (RO) denied entitlement to service connection for diabetes mellitus, erectile dysfunction, hypertension, polyneuropathy, depression with anxiety, and posttraumatic stress disorder (PTSD). These issues were most recently denied again in a June 2013 rating decision. Evidence received since the June 2013 decision relates to previously unestablished facts. 3. In a May 2001 report, non-VA psychologist Dr. Amos diagnosed the Veteran with dysthymic disorder, rule-out major depression, and rule-out PTSD. Thereafter, in an October 2001 treatment record, Dr. Amos noted that the Veteran shared trauma stories from his service-period in the Vietnam era. The Veteran reportedly wondered whether his feelings of emotional numbness may have been caused by his military duties. 4. In September 2002, the Veteran reported for an evaluation by Dr. Dunn of Greater Rochester Neurological Associates. Dr. Dunn noted that the Veteran had been diabetic for about 12 years and that the Veteran had reported tingling in his feet. Dr. Dunn stated that results of an examination and electrodiagnostic studies indicated that the Veteran had mild distal sensorimotor polyneuropathy. Dr. Dunn opined that this disability was presumably diabetic. Dr. Dunn conducted a follow-up evaluation in September 2005, which again confirmed the presence of neuropathy, diabetic in nature. 5. In December 2002, the Veteran reported for a VA examination regarding a multitude of disabilities. After evaluating the Veteran, the examiner diagnosed the Veteran with type 2 diabetes mellitus. Additionally, the examiner provided diagnoses of hypertension, impotence, and peripheral neuropathy, all of which the examiner stated were more likely than not related to diabetes. 6. In December 2003, the Veteran received correspondence from Dr. Langelotti, an Agent Orange Registry Physician with the Rochester, New York VA Outpatient Clinic. Dr. Langelotti indicated that, following an examination, the Veteran had the following medical conditions: type 2 diabetes mellitus, hypertension, depression and anxiety, impotence, insomnia, and peripheral neuropathy. 7. In June 2012, VA received copies of a passport which was issued to the Veteran during his service period. The Veteran’s passport demonstrated that the Veteran travelled to Macau, Thailand, Taipei, and Hong Kong while in service. 8. In a June 2014 treatment record, non-VA provider Dr. Sorge indicated that the Veteran continued to experience multiple medical problems, including: type 2 adult-onset diabetes mellitus; hypertension, erectile dysfunction, peripheral polyneuropathy related to diabetes, acute situational adjustment reaction with an element of depression and dysthymic disorder, and PTSD. 9. As recorded in a July 2014 treatment record, private provider Dr. Valle noted the Veteran’s hypertension was associated with his diabetes mellitus, which at that time was uncontrolled. 10. Similar to the issue of hypertension, February 2015 and December 2016 treatment records from private optometrist Dr. Fine indicated that the Veteran experienced diabetic retinopathy. Dr. Fine noted that the retinopathy required only monitoring and not active treatment. 11. An August 2015 VA treatment record documented that the Veteran continued to experience erectile dysfunction and was prescribed sildenafil citrate. 12. During the course of the Veteran’s appeal, he was provided a VA PTSD examination in March 2017. After examining the Veteran and reviewing an electronic copy of the Veteran’s claims file, the examiner provided diagnoses of unspecified depressive disorder and other specified trauma and stressor related disorder. The examiner remarked that while the Veteran displayed many mild symptoms associated with PTSD, he did not fully meet the diagnostic criteria for this disorder. The examiner also stated that although the Veteran had previously been properly diagnosed with depression, the Veteran was currently non-symptomatic. Lastly, the examiner opined that the Veteran’s other specified trauma and stressor related disorder appeared to be service-connected and had resulted from his military experience. 13. The Veteran has continued to experience type 2 diabetes mellitus, hypertension, neuropathy, and erectile dysfunction during the course of the appeal period. See VA Treatment Records dated July 2001 through May 2018, received by VA on June 2018. 14. In November 2019, the Veteran and his spouse testified at a Board of Veterans’ Appeals (Board) hearing. During the hearing, the Veteran testified that, when he first went overseas, he traveled to Bangkok, Thailand. The Veteran then stated that, in performing his duties as an accountant associated with covert, top-secret operations, he repeatedly worked at 3 different Thai air bases: U-Tapao, Udorn, and Don Muang. The Veteran then explained that his duties brought him in close proximity to the perimeters of each air base. Specifically, he stated that his duties required him to account for and track the flow of military equipment, which was frequently stored outdoors near the perimeters of the bases. Additionally, the Veteran stated that he noticed that the grass near the bases’ perimeters was a different color. Lastly, the Veteran recalled a specific incident where he developed a rash after playing football on a field located adjacent to one of the base’s perimeter fencing. 15. The Veteran’s service treatment records (STRs) indicate that the Veteran did indeed develop a pruritic rash on his legs in November 1967, a period where he was serving in Thailand. Additionally, the Veteran’s November 2019 hearing testimony is consistent with other statements associated with the claims file that describe his duties and travels in Thailand. See, e.g., September 2016 Correspondence. CONCLUSIONS OF LAW 1. The June 2013 rating decision is final; new and material evidence has been received to reopen the claim of entitlement to service connection for diabetes mellitus. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.104, 3.156, 20.1103. 2. The June 2013 rating decision is final; new and material evidence has been received to reopen the claim of entitlement to service connection for an acquired psychiatric disorder. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.104, 3.156, 20.1103. 3. The June 2013 rating decision is final; new and material evidence has been received to reopen the claim of entitlement to service connection for hypertension. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.104, 3.156, 20.1103. 4. The June 2013 rating decision is final; new and material evidence has been received to reopen the claim of entitlement to service connection for polyneuropathy. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.104, 3.156, 20.1103. 5. The June 2013 rating decision is final; new and material evidence has been received to reopen the claim of entitlement to service connection for erectile dysfunction. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.104, 3.156, 20.1103. 6. The criteria for service connection for type 2 diabetes mellitus are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 7. The criteria for service connection for other specified trauma and stressor related disorder are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for hypertension are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 9. The criteria for service connection for polyneuropathy are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 10. The criteria for service connection for erectile dysfunction are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. 11. The criteria for service connection for diabetic retinopathy are met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS These matters come before the Board of Veterans’ Appeals (Board) on appeal from a December 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). As indicated above in the Findings of Fact section, the Veteran and his spouse testified at a Board hearing in November 2019. A transcript of the hearing is of record. Service Connection As an initial matter, the Board notes that the Veteran previously filed a claim seeking entitlement to service connection for diabetes mellitus, an acquired psychiatric disorder, hypertension, polyneuropathy, and erectile dysfunction that was denied in a March 2003 rating decision. The Veteran was notified of that denial in April 2003 and, as the Veteran neither appealed nor submitted additional evidence within one year of the decision, it became final. See 38 C.F.R. § 20.1103. Since April 2003, the Veteran has sought service connection for these issues on several occasions and they were most recently denied in June 2013. Pursuant to 38 C.F.R. § 3.156, a claimant may reopen a finally-adjudicated claim by submitting new and material evidence. The Board finds that such evidence has been received and it reopens the applications for the previously denied issues of service connection for diabetes mellitus, an acquired psychiatric disorder, hypertension, polyneuropathy, and erectile dysfunction. Turning to the merits of these reopened issues, the Board first concludes that service connection for type 2 diabetes mellitus is warranted. In support of this determination, the Board states that, generally, establishing service connection requires competent evidence of: (1) a current disability; (2) an in-service precipitating disease, injury, or event; and (3) a causal relationship, i.e., a nexus, between the current disability and the in-service event. Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). In addition, 38 C.F.R. § 3.309(e) recognizes that diabetes mellitus is associated with in-service herbicide exposure and is a condition that is entitled to service connection presumptively. In the instant case, as recounted above in the Findings of Fact section, the Veteran has a current diagnosis of type 2 diabetes mellitus. As such, he may be entitled to service connection presumptively per 38 C.F.R. § 3.309(e) if the evidence demonstrates he was exposed to herbicide agents in service. Although the Veteran has provided lay testimony as well as copies of a prior passport, his SPRs do not contain documentation of service in Vietnam. However, per information provided by the Department of Defense, VA recognizes that herbicide agents, including Agent Orange, were used at certain times and places at some military bases in Thailand during the Vietnam era. After reviewing the evidence of record, the Board concludes that in-service herbicide exposure must be acknowledged in the instant case based upon the Veteran’s Thailand service under current VA policy. Specifically, (1) the Veteran has documented service at Don Muang Royal Thai Air Force Base during a period which qualifies as Vietnam era service under 38 C.F.R. § 3.2(f); (2) Don Muang Royal Thai Air Force Base qualifies as an identified air base where herbicide agents were used in Thailand; and (3) the Veteran’s testimony combined with his occupational duties in service indicate that he routinely served near and crossed over the perimeter of the base. Therefore, as the Board has acknowledged in-service exposure to herbicides via the Veteran’s Thailand service, service connection for diabetes mellitus must be granted presumptively as set forth in 38 C.F.R. §§ 3.307(a)(6) and 3.309(e). Having granted service connection for type 2 diabetes mellitus, the Board now finds that service connection for hypertension, polyneuropathy, erectile dysfunction, and retinopathy as secondary to diabetes is also warranted. Specifically, as discussed in the Findings of Fact section, the Veteran’s claims file repeatedly contains documentation by medical professionals that each of these conditions was related to the Veteran’s diabetes. As such, these conditions must be granted on secondary bases. See 38 C.F.R. § 3.310(a). Lastly, the Board also concludes that service connection for other specified trauma and stressor related disorder is warranted in the instant case. Specifically, as recounted in the Findings of Fact section, the evidence of record currently demonstrates that: (1) the Veteran has a current diagnosis of other specified trauma and stressor related disorder; (2) the Veteran’s SPRs and prior passport document that he served in Southeast Asia while assigned to the JUSMAGTHAI; and (3) a VA examiner in March 2017 positively linked the development of other specified trauma and stressor related disorder to the Veteran’s military experiences. The Board finds the March 2017 VA examiner’s opinion to be adequate for adjudicative purposes. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). As all requirements for service connection have been satisfied, the Board grants the Veteran’s claim regarding other specified trauma and stressor related disorder on a direct basis. See 38 C.F.R. § 3.303(a). S.C. KREMBS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N.S. Pettine, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.