Citation Nr: 20021576 Decision Date: 03/26/20 Archive Date: 03/26/20 DOCKET NO. 15-36 300 DATE: March 26, 2020 ORDER Entitlement to service connection for diabetes mellitus type II (diabetes), to include as due to in-service exposure to an herbicide agent, is granted. REMANDED Entitlement to service connection for coronary artery disease, claimed as ischemic heart disease, to include as due to in-service exposure to an herbicide agent, is remanded. Entitlement to service connection for hydronephrosis, claimed as kidney condition, to include as secondary to service-connected diabetes mellitus type II, is remanded. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, he was exposed to an herbicide agent during his active military service. 2. The Veteran has a current diagnosis of diabetes which requires restricted diet and oral hypoglycemic medication. CONCLUSION OF LAW The criteria for service connection for diabetes as a result of in-service exposure to an herbicide agent have been met. 38 U.S.C. §§ 1110, 1116, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the Air Force from November 1969 to September 1973. Service Connection 1. Entitlement to service connection for diabetes mellitus type II, to include as due to in-service exposure to an herbicide agent, The Veteran asserts that his currently diagnosed diabetes was caused by in-service exposure to an herbicide agent. If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases are presumed to be service-connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met, even though there is no record of the disease during service, provided that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied. 38 U.S.C. § 1116(a); 38 C.F.R. § 3.309(e). The term “herbicide agent” is defined as a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962 and ending on May 7, 1975, specifically: 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram. 38 C.F.R. § 3.307(a)(6)(i) (2017). VA procedures for verifying exposure to herbicides in Thailand during the Vietnam Era are detailed in the VA Adjudication Manual, M21-1MR, Part IV, Subpart ii, Chapter 2, Section C (M21-1MR). VA has determined that there was significant use of herbicides on the fenced-in perimeters of military bases in Thailand intended to eliminate vegetation and ground cover for base security purposes as evidenced in “Project CHECO Southeast Asia Report: Base Defense in Thailand.” Special consideration of herbicide exposure on a facts-found or direct basis should be extended to those veterans whose duties placed them on or near the perimeters of Thailand military bases. This allows for presumptive service connection of the diseases associated with herbicide exposure. See 38 C.F.R. § 3.307 (e). The majority of troops in Thailand during the Vietnam Era were stationed at the Royal Thai Air Force Bases (RTAFB) of U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat, and Don Muang. If a veteran served on one of these air bases as a security policeman, security patrol dog handler, member of a security police squadron, or otherwise served near the air base perimeter, as shown by MOS (military occupational specialty), performance evaluations, or other credible evidence, then herbicide exposure should be acknowledged on a facts-found or direct basis. However, this applies only during the Vietnam Era, from February 28, 1961, to May 7, 1975. See M21-1MR, Part IV, Subpart ii, Chapter 2, Section C.10(q). The Veteran’s military personnel records include temporary orders assigning him to Ubon RTAFB in July 1972 as well as a performance review for this work there between July 1972 and October 1972. The Veteran was assigned to the 408th Munitions Maintenance Squadron in the Load/Reload section and did not work as a security policeman, security patrol dog handler, or a member of a security police squadron. However, the Veteran has stated that he was assigned to a duty station past the end of the runway, near the perimeter of the base. He stated that the jungle near his duty station was cleared back after a sapper attack. He also stated that he often had to cross over the space between the inner and outer perimeter. Two buddy statements provided in October 2016 confirm the Veteran’s statements about his duty station being next to the perimeter of Ubon RTAFB. The Board finds that the Veteran’s statements, confirmed in part by his orders and performance review and in part by the two October 2016 buddy statements, are sufficiently credible evidence that he served near the perimeter of Ubon RTAFB from July 1972 to October 1972. The Board therefore acknowledges on a facts-found basis that the Veteran was at least as likely as not exposed to an herbicide agent during his active military service. The Veteran’s August 2013 VA examination shows a current diagnosis of diabetes treated with an oral hypoglycemic and restricted diet. Diabetes is listed as a disease associated with exposure to herbicide agents. 38 C.F.R. § 3.309(e). A compensable rating for service-connected diabetes is granted if the condition is controlled by restricted diet. 38 C.F.R. § 4.119, Diagnostic Code 7913. As VA has not contested this diagnosis or treatment, the presence of a current disability, manifested to a compensable degree, is shown. Because the Veteran was exposed to an herbicide agent while on active duty and has been diagnosed with a compensable manifestation of diabetes, a condition listed in 38 C.F.R. § 3.309(e), the Board must grant service-connection for diabetes on a presumptive basis. REASONS FOR REMAND 1. Entitlement to service connection for coronary artery disease, claimed as ischemic heart disease, to include as due to in-service exposure to an herbicide agent, is remanded. The Veteran’s in-service exposure to an herbicide agent has been conceded, as discussed in the service connection section above. However, the record contains no post-service treatment records and only a partially completed disability benefits questionaire from September 2013. This does not provide enough information to determine whether the Veteran’s coronary artery disease has manifested to a compensable degree. A remand is required to obtain relevant treatment records and provide an adequate examination to determine the severity of the Veteran’s condition. 2. Entitlement to service connection for hydronephrosis, claimed as kidney condition, to include as secondary to service-connected diabetes mellitus type II, is remanded. The Board cannot make a fully-informed decision on the issue of service connection for hydronephrosis, claimed as a kidney condition, because no VA examiner has opined whether this condition is related to his active service or whether it was caused or aggravated by a service-connected disability. A remand is required to obtain relevant treatment records and provide an adequate examination to determine the etiology and severity of the Veteran’s hydronephrosis. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from September 1973 to the Present. 2. Ask the Veteran to complete a VA Form 21-4142 for any private treatment providers for his kidneys and coronary artery disease. Make two requests for the authorized records from any source for which the Veteran provides authorization, unless it is clear after the first request that a second request would be futile. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature, etiology, and severity of any ischemic heart disease, to include coronary artery disease. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. The examiner must opine whether it at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. In addition to the opinions required above, the examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any kidney condition, to include hydronephrosis. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. The examiner must also opine whether any diagnosed condition is at least as likely as not (1) proximately due to or (2) aggravated beyond its natural progression by service-connected diabetes. 5. Readjudicate the Veteran’s claims. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Zimmerman 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.