Citation Nr: 21001198 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 16-06 749 DATE: January 7, 2021 ORDER Service connection for diabetes mellitus is granted. Service connection for peripheral neuropathy, right lower extremity is granted. Service connection for peripheral neuropathy, left lower extremity is granted. REMANDED The claim of entitlement to service connection for hypertension is remanded. The claim of entitlement to service connection for heart disease is remanded. The claim of entitlement to service connection for peripheral neuropathy, left upper extremity is remanded. The claim of entitlement to service connection for peripheral neuropathy, right upper extremity is remanded. The claim of entitlement to service connection for rheumatoid arthritis is remanded. FINDINGS OF FACT 1. The Veteran was exposed to herbicides on the perimeter of Korat AFB. 2. His diabetes is presumed to be related to his herbicide exposure. 3. His right and left lower extremity peripheral neuropathies are related to his diabetes. CONCLUSIONS OF LAW 1. The criteria are met for service connection for diabetes. 38 U.S.C. §§ 1110, 1116; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria are met for service connection for right and left lower extremity neuropathies. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served from November 1967 to November 1971. This appeal is from a January 2014 rating decision. In November 2019, the Board remanded this matter for additional development, which has been completed. Service Connection 1. Service connection for diabetes mellitus is granted. 2. Service connection for peripheral neuropathy, right lower extremity is granted. 3. Service connection for peripheral neuropathy, left lower extremity is granted. Service connection requires competent evidence showing: (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, 1167 (Fed. Cir. 2004). The Veteran asserts that his diabetes and peripheral neuropathy are related to his exposure to herbicides while serving at Korat AFB in Thailand. VA has determined that consideration should be given to claimants whose duties placed them on or near the perimeters of certain Thailand military bases, as it has been accepted that here was sporadic use of commercial herbicides within the fenced perimeters of several bases in Thailand, including Korat. In general, if the evidence shows that the Veteran’s duties or otherwise placed him near the base perimeter then exposure is conceded. The record shows his service met the above criteria while stationed at Korat. After review of the testimony of record and additional relevant evidence submitted, the Board finds the Veteran’s duty placed him near the base perimeter, and exposure to herbicides is conceded. Type 2 diabetes is listed among the conditions presumed to be service connected in veterans that have been exposed to certain herbicidal agents, including Agent Orange. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6)(iii), 3.309(e). Accordingly, service connection for diabetes is granted. VA has determined that early-onset peripheral neuropathy is also associated with herbicide exposure; however, it is not clear when the Veteran’s peripheral neuropathy of the bilateral lower extremities was diagnosed. See id. Service connection may also be granted on a secondary basis for disability that is related to a service-connected disability. 38 C.F.R. § 3.310. To prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and, (3) nexus evidence establishing a connection between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). Here, in a June 2012 disability benefits questionnaire completed by the Veteran’s treating physician, peripheral neuropathy is identified as being caused by the Veteran’s diabetes, which is service connected as of this decision. An August 2013 medical record also notes that the Veteran’s bilateral lower extremity peripheral neuropathy is most likely related to his diabetes. Accordingly, service connection for right and left lower extremity radiculopathy is granted. REASONS FOR REMAND 1. The claim of entitlement to service connection for hypertension is remanded. The Veteran asserts that his hypertension is related to herbicide exposure. Hypertension is not listed among the disabilities for which service connection is presumed related to such exposure. However, the National Academy of Sciences (NAS) has found “limited or suggestive” evidence of a relationship between herbicide exposure and development of hypertension. The examiner will be asked to consider and comment on that when providing the opinion. As service connection for diabetes has been granted, an opinion on a secondary relationship shall also be obtained. 2. The claim of entitlement to service connection for heart disease is remanded. It is unclear whether the Veteran has been diagnosed with an ischemic heart disability, which would be presumed to be related to his herbicide exposure during service. On remand, he shall be given a thorough examination. If his heart disease is not ischemic, an opinion shall be obtained as to whether it is related to service-connected diabetes. 3. The claim of entitlement to service connection for peripheral neuropathy, left upper extremity is remanded. 4. The claim of entitlement to service connection for peripheral neuropathy, right upper extremity is remanded. It is not clear whether the Veteran has been diagnosed with upper extremity peripheral neuropathy, and if so, whether it was of early onset or related to his diabetes. On remand, he shall be given a thorough examination. 5. The claim of entitlement to service connection for rheumatoid arthritis is remanded. The Veteran is seeking service connection for rheumatoid arthritis, which has not been related to service by any of his treatment providers. As he sees a number of private physicians, he shall be given an opportunity to update the record with any private treatment records. As he has been recently service connected for diabetes, an opinion should be obtained a to whether it causes or aggravated rheumatoid arthritis. The matters are REMANDED for the following action: 1. Ask the Veteran to provide authorization for the AOJ to obtain any private treatment records he wishes to be reviewed, or to provide copies himself. 2. Obtain updated VA treatment records. 3. After completion of directives 1 and 2, obtain a medical opinion as to whether it is as likely as not (50/50 probability or greater) that hypertension is related to service. The examiner is asked to review the record prior to rendering an opinion. The Veteran is presumed to have been exposed to herbicides. The National Academy of Sciences (NAS) has found “limited or suggestive” evidence of a relationship between exposure and development of hypertension. The examiner is asked to review the recent relevant literature, which should be discussed in the opinion. The Veteran is diagnosed with diabetes. The examiner is asked whether hypertension is caused or aggravated by diabetes. “Aggravated” means to have caused any increase in severity that is beyond the normal progression of the disability and it need not be permanent in nature. All opinions must be accompanied with explanation. It is up to the discretion of the examiner as to whether a physical examination is required to provide an opinion. If so, the examiner is asked to so notify the scheduling authority. 4. After completion of directives 1 and 2, schedule the Veteran for an appropriate examination for an opinion on whether the Veteran has ischemic heart disease. If he has non-ischemic heart disease, the examiner is asked whether it is as likely as not (50/50 probability or greater) that any diagnosis is caused or aggravated by diabetes. “Aggravated” means to have caused any increase in severity that is beyond the normal progression of the disability and it need not be permanent in nature. All opinions must be accompanied with explanation. 5. After completion of directive 1 and 2, schedule the Veteran for an appropriate examination for a report on whether the Veteran has right and/or left upper extremity peripheral neuropathy that is also as likely as not (50/50 probability or greater) related to his service. The examiner is asked to review the record prior to the examination and to provide diagnoses. If present, the examiner is asked to opine on whether it is as likely as not that it was of early-onset, or caused or aggravated by the Veteran’s diabetes. “Aggravated” means to have caused any increase in severity that is beyond the normal progression of the disability and it need not be permanent in nature. All opinions must be accompanied with explanation. 6. After completion of directives 1 and 2, forward the claims file to an appropriate examiner for a report on whether it is as likely as not (50/50 probability) that rheumatoid arthritis is caused or aggravated by diabetes, or any other service-connected disability. The examiner is asked to review the record and the recent relevant medical literature. All opinions must be accompanied with an explanation.   It is up to the discretion of the examiner as to whether a physical examination is required to provide an opinion. If so, the examiner is asked to so notify the scheduling authority. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Gibson 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.