Citation Nr: 20023047 Decision Date: 04/02/20 Archive Date: 04/02/20 DOCKET NO. 18-02 859 DATE: April 2, 2020 ORDER Entitlement to service connection for ischemic heart disease to include coronary artery bypass graft (CABG) is granted. Entitlement to service connection for diabetes mellitus is granted. REMANDED Entitlement to service connection for strain and arthritis, right shoulder is remanded. Entitlement to service connection for strain and arthritis, left shoulder is remanded. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, his ischemic heart disease is as at least as likely as not related to herbicide agent exposure in Thailand. 2. Resolving reasonable doubt in the Veteran’s favor, his diabetes mellitus is as at least as likely as not related to herbicide agent exposure in Thailand. CONCLUSIONS OF LAW 1. The criteria for service connection for ischemic heart disease to include coronary artery bypass graft (CABG) are met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(e) (2019). 2. The criteria for service connection for diabetes mellitus are met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309(e) (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1971 to October 1995. This matter came before the Board of Veterans Appeals (Board) on appeal from July 2014, September 2015 and September 2017 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veteran’s Law Judge during a March 2020 hearing. The Board notes that the rating decisions on appeal also adjudicated the issues of increased ratings for bilateral hearing loss disability, cervical spine and tinnitus disabilities and service connection for bilateral arm, right hip, right thigh and left knee disabilities. However, when the Veteran filed his August 2014, September 2016, and August 2018 Notices of Disagreement, he limited his appeals to the issues of service connection for ischemic heart disease, diabetes mellitus and his bilateral shoulder disabilities. The issues of increased ratings for bilateral hearing loss disability, cervical spine and tinnitus disabilities and service connection for bilateral arm, right hip, right thigh and left knee disabilities are therefore not before the Board. Service Connection Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability). See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); 38 C.F.R. § 3.303(a). In addition, if a Veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases, including ischemic heart disease and diabetes mellitus, shall be presumptively 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 further that the rebuttable presumption provisions of 38 C.F.R. § 3.307 (d) are also satisfied. 38 C.F.R. § 3.309 (e). 1. Entitlement to service connection for ischemic heart disease to include coronary artery bypass graft (CABG) The Veteran contends that his ischemic heart disease is due to in-service herbicide agent exposure that occurred while he was stationed in Thailand. The Board concludes that service connection is warranted. November 2015 VA treatment records document a diagnosis of coronary artery disease and myocardial ischemia. The records contain stress test results showing dyspnea at 7.4 METs. The Board therefore finds that the Veteran has a current disability of coronary artery disease that manifested to at least 10 percent. 38 C.F.R. § 4.104, Diagnostic Code 7005. As the Veteran is claiming service connection on a presumptive basis, resolution of this appeal turns on whether the Veteran had qualifying exposure to herbicides during service. He has not claimed, nor do his military personnel records reflect, any service in the Republic of Vietnam. Therefore, the presumption of herbicide exposure for such service is inapplicable. See 38 C.F.R. § 3.307 (a)(6)(iii). That notwithstanding, the Veteran has documented service in Thailand during the Vietnam Era, showing that he served at Korat Royal Thai Air Force Base as an AC-130 aircraft mechanic. Claims involving alleged exposure at such an installation are to be analyzed under the appropriate administrative guidelines given the absence of pertinent statutory and regulatory provisions. See Ennis v. Brown, 4 Vet. App. 523 (1993); McGinty v. Brown, 4 Vet. App. 428 (1993). According to these guidelines, exposure will be conceded for certain veterans whose duties placed them on or near the perimeters of Thailand military bases during the Vietnam era. Such veterans include those who were stationed at the Royal Thai Air bases including Korat, and who served in a position or MOS that required duty on the base perimeter, such as security police or dog handler, etc. While records show that the Veteran served at Korat Royal Thai Air Base, he does not have the requisite MOS to concede herbicide exposure based on these provisions. Nevertheless, at the March 2020 Board hearing, the Veteran reported that he worked every day on the flight line as a mechanic, at the extreme south end of the ramp, which was close to the perimeter, and that he regularly walked from the flight line to the perimeter. The Veteran has also submitted photographs showing the layout of Korat air force base and the location of the AC-130 flight line. At the hearing, he also reported that he would regularly participate in target practice at the perimeter fence and that he was within inches of the fence at those times. The Board notes that the Veteran is competent to report details of his regular duties during service. Moreover, the undersigned has had the opportunity to observe the Veteran and finds him to be credible. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff’d per curiam, 78 F.3d 604 (Fed. Cir. 1996). A December 2017 Formal Finding memorandum indicates that VA lacked the information the U.S. Army and Joint Services Records Research Center (JSRRC) required to verify herbicide exposure in Korat AB, Thailand. The report states that, while the Veteran had submitted information regarding his service at Korat, there was insufficient information to submit a JSRRC request. In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether instead, a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit-of-the doubt is afforded to the claimant. 38 C.F.R. § 3.102. Here, the Board finds that evidence is in relative equipoise, and will afford the Veteran the benefit-of-the doubt. The evidence shows that the Veteran served in the U.S. Air Force during the Vietnam Era at Korat Royal Thai Air Force Base. He has submitted credible, competent lay testimony indicating service near the perimeter, to include his regular work on the flight line, walking near the perimeter and target practice within inches of the perimeter fence. The December 2017 Formal Finding memorandum indicates that attempts to confirm the Veteran’s proximity to the perimeter were inconclusive. Therefore, the Board finds that the evidence is in relative equipoise. Accordingly, the Board gives the benefit of the doubt to the Veteran, and herbicide agent exposure is conceded. As the Veteran has a current disability of ischemic heart disease that has manifested to at least 10 percent and herbicide agent exposure has been established, service connection is warranted. 38 C.F.R. §§ 3.307, 3.309(e). 2. Entitlement to service connection for diabetes mellitus The Veteran contends that his diabetes mellitus is due to herbicide agent exposure. Exposure to herbicide agents while stationed in Thailand during the Vietnam Era has been conceded above. The Board concludes that service connection is warranted. VA treatment records document a diagnosis of diabetes mellitus and a prescription for metformin, an oral hypoglycemic. The Board therefore finds that the Veteran has a current disability of diabetes mellitus that has manifested to at least 10 percent. 38 C.F.R. § 4.120, Diagnostic Code 7913. As the Veteran has a current disability of diabetes mellitus that has manifested to at least 10 percent and herbicide agent exposure has been established, service connection is warranted. 38 C.F.R. §§ 3.307, 3.309(e). REASONS FOR REMAND 1. Entitlement to service connection for strain and arthritis, right shoulder is remanded. 2. Entitlement to service connection for strain and arthritis, left shoulder is remanded. A September 2017 VA examination found that the Veteran’s bilateral shoulder disabilities were not likely due to his service-connected cervical spine disability. As a rationale, the examiner stated that the shoulder disabilities were more likely due to natural aging and a history of physical work. The Board finds, however, that the opinion is inadequate as its rationale is conclusory in nature and does not indicate any reason that aging/physical labor is a more likely cause than the service-connected cervical spine disability. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The opinion is also inadequate as the examiner did not address the issue of aggravation by the service-connected disability. See El-Amin v. Shinseki, 26 Vet. App. 136, 140–41 (2013); Allen v. Brown, 7 Vet. App. 439 (1995). Remand for a new examination is therefore required. The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate VA examination, to determine the etiology of any current bilateral shoulder disability. The examiner should review the file and provide a complete rationale for all opinions expressed. For any current bilateral shoulder disability found to be diagnosed, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such disability is related to the Veteran’s active service, to include whether it was caused or aggravated by the Veteran’s service-connected cervical spine disability. In providing the opinion, the examiner should consider and discuss any lay statements of record, to include the Veteran’s statements regarding the onset and persistence of his symptoms. 2. If upon completion of the above action the appeal remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Arnold, 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.