Citation Nr: 21061319 Decision Date: 10/01/21 Archive Date: 10/01/21 DOCKET NO. 20-27 071 DATE: October 1, 2021 ORDER Service connection for diabetes mellitus type II, including as due to herbicide and/or jet fuel exposure, is denied. Service connection for neuropathy of the left upper extremity, including as due to herbicide exposure and/or jet fuel exposure and due to diabetes mellitus type II, is denied. Service connection for neuropathy of the right upper extremity, including as due to herbicide exposure and/or jet fuel exposure and due to diabetes mellitus type II, is denied. Service connection for neuropathy of the left lower extremity, including as due to herbicide exposure and/or jet fuel exposure and due to diabetes mellitus type II, is denied. Service connection for neuropathy of the right lower extremity, including as due to herbicide exposure and/or jet fuel exposure and due to diabetes mellitus type II, is denied. FINDINGS OF FACT 1. The Veteran was not exposed to herbicide agents during service, and herbicide exposure during service is not presumed. 2. There was no endocrine system injury or disease of the endocrine system or chronic symptoms of diabetes mellitus during service; diabetes mellitus did not manifest to a compensable degree within one year of service; symptoms of diabetes mellitus have not been continuous since service separation; and diabetes mellitus is not causally or etiologically related to active service. 3. There was no arm or relevant neurologic injury during service; chronic symptoms of upper extremity neuropathy were not manifested during service; symptoms of upper extremity neuropathy were continuous since service separation; upper extremity neuropathy did not manifest to a compensable degree in the year following service separation; and the current upper extremity neuropathy was manifested many years after service and is not causally or etiologically related to service. 4. There was no leg or relevant neurologic injury during service; chronic symptoms of lower extremity neuropathy were not manifested during service; symptoms of lower extremity neuropathy were continuous since service separation; lower extremity neuropathy did not manifest to a compensable degree in the year following service separation; and the current lower extremity neuropathy was manifested many years after service and is not causally or etiologically related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes mellitus type II, including as due to herbicide and/or jet fuel exposure, are not met. 38 U.S.C. §§ 1110, 1112, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309. 2. The criteria for service connection for neuropathy of the left upper extremity, including as due to herbicide exposure and/or jet fuel exposure and due to diabetes mellitus type II, are not met. 38 U.S.C. §§ 1110, 1112, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 3. The criteria for service connection for neuropathy of the right upper extremity, including as due to herbicide exposure and/or jet fuel exposure and due to diabetes mellitus type II, are not met. 38 U.S.C. §§ 1110, 1112, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 4. The criteria for service connection for neuropathy of the left lower extremity, including as due to herbicide exposure and/or jet fuel exposure and due to diabetes mellitus type II, are not met. 38 U.S.C. §§ 1110, 1112, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. 5. The criteria for service connection for neuropathy of the right lower extremity, including as due to herbicide exposure and/or jet fuel exposure and due to diabetes mellitus type II, are not met. 38 U.S.C. §§ 1110, 1112, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from December 1965 to December 1969. This matter is on appeal from a July 2016 rating decision. In March 2021, the Board granted service connection for tinnitus and remanded the current issues on appeal for verification of herbicide exposure while stationed at Eglin AFB, Social Security Administration (SSA) records, and VA examinations with medical opinions on whether the diabetes mellitus type II and peripheral neuropathies were incurred in or related to service and whether the peripheral neuropathies were caused or aggravated by the diabetes mellitus type II. In March 2021, SSA records obtained and attempts to verify herbicide exposure were made. In June 2021, VA examinations were provided, and adequate medical opinions were obtained. For these reasons, the Board finds that there was compliance with the prior remand directives. The Board finds that the duties to notify and assist have been satisfied. Neither the Veteran nor the evidence has raised any specific contentions regarding the duties to notify or assist. While the case was in remand status, service connection was established for bilateral hearing loss, so that issue is no longer before the Board. See July 2021 Decision Review Officer (DRO) decision. Service Connection Legal Authority Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be established on a direct basis when there is competent, credible evidence of: (1) a current disability; (2) a disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. 38 C.F.R. § 3.303(a), (d). Service connection may be established on a presumptive basis for chronic diseases listed under 38 C.F.R. § 3.309(a) if chronic symptoms of the disease were shown in service; the disease was manifested to a compensable degree with a presumptive period, usually one year after service separation; or continuous symptoms of the disease were manifested since service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.33(b), 3.307, 3.309(a); see also Walker v. Shinseki, 708 F. 3d 1131 (Fed. Cir. 2013). Because the current diagnoses of diabetes mellitus type II and bilateral and upper extremity neuropathies (as organic diseases of the nervous system) are listed as chronic diseases under 38 C.F.R. § 3.303(b), the presumptive service connection provisions are applicable. To establish presumptive service connection for a disease associated with exposure to certain herbicide agents, the evidence must show the following: (1) that the veteran served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 (or was otherwise exposed to an herbicide agent during active service); (2) that he currently suffers from a disease associated with exposure to certain herbicide agents listed under 38 C.F.R. § 3.309(e); and (3) that the current disease process manifested to a degree of 10 percent or more within the specified time period prescribed in section 3.307(a)(6)(ii). 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). If a veteran was exposed to an herbicide agent during active military, naval, or air service, the certain diseases shall be service connected, if the requirements of 38 C.F.R. § 3.307(a) are met, even if there is no record of such disease during service. The list of diseases associated with exposure to certain herbicide agents includes diabetes mellitus type II and early onset peripheral neuropathy. See 38 C.F.R. § 3.309(e). Service connection may be established on a secondary basis for a disability which was either: (1) caused by, or (2) aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Compensation based on secondary aggravation will be awarded only for the degree of disability over and above the degree of disability prior to aggravation. Allen v. Brown, 7 Vet. App. 439 (1995). 1. Service connection for diabetes mellitus type II is denied. 2. Service connection for neuropathy of the left upper extremity is denied. 3. Service connection for neuropathy of the right upper extremity is denied. 4. Service connection for neuropathy of the left lower extremity is denied. 5. Service connection for neuropathy of the left lower extremity is denied. The Veteran contends that the current diabetes mellitus type II, left and right upper extremity neuropathy, and left and right lower extremity neuropathy are related to herbicide exposure and/or jet fuel exposure during service. He also asserts that the bilateral upper and lower extremity neuropathies were due to diabetes mellitus type II. The Veteran contends that he was exposed to Agent Orange while stationed at Eglin Air Force Base (AFB) from 1966 to 1967. The Veteran wrote that he worked as maintenance on the flight line 3214 OMS (Ordinance Maintenance Squad). The Veteran asserts that he was exposed to Agent Orange due to contact with C-123 aircraft while at Eglin AFB working in the hangars. See June and July 2020 Statement in Support of Claim. The Veteran reported that he jogged around the perimeter of the base. Additionally, the Veteran has expressed that his diabetes may also be due to exposure to JP-4/5/8 jet fuel. See VA Form 9. The Veteran's service personnel records verify that the Veteran worked as an Administrative Clerk at 3214 Organization Maintenance Squad, Eglin AFB, from December 1966 through August 1967. The service personnel records note that the Veteran performed clerical duties in the supervision office of the Fighter Maintenance Section. After review of the lay and medical evidence of record, the Board finds that the weight of the evidence is against a finding of endocrine or neurological injury or disease during service or chronic symptoms of diabetes mellitus type II or lower and upper extremity peripheral neuropathies during service. The service treatment records, which are complete, are absent of any report, complaint, findings, diagnosis, or treatment for diabetes mellitus or peripheral neuropathy. At the November 1969 service separation examination, the endocrine and neurological systems and upper and lower extremities were clinically evaluated as normal, and the urinalysis was negative. On the November 1969 service separation report of medical history, the Veteran checked "No" when asked if he then had or had ever had sugar or albumin in the urine and neuritis. The service treatment records are negative for any relevant symptoms, the endocrine and neurological systems were clinically evaluated at the November 1969 service separation examination and determined to be normal, and the Veteran denied having had sugar in the urine and neuritis at service separation. An endocrine system injury, endocrine system disease, neurological injury, neurological disease, diabetes mellitus type II, and peripheral neuropathy are conditions that would likely have been noted during service, if they had been present; therefore, the lay and medical evidence generated contemporaneous to service, which shows no endocrine system injury or disease, no neurological injury or disease, no chronic symptoms of diabetes mellitus or peripheral neuropathy during service, and no clinical findings suggestive of diabetes or neuropathy, is likely to reflect accurately the Veteran's physical condition, so is of significant probative value and provides evidence against a finding of endocrine system injury, endocrine system disease, neurological system injury, neurological system disease, or chronic symptoms of diabetes mellitus or peripheral neuropathy during service. The weight of the evidence is against a finding of continuous symptoms of diabetes mellitus type II or peripheral neuropathy since service, including to a compensable degree within one year of service separation. Diabetes mellitus type II was diagnosed in about 1987, which is approximately 18 years after service. Peripheral neuropathy was diagnosed in about 2015, approximately 46 years after service. The gap of approximately 18 years between service and the onset of diabetes mellitus symptoms, as well as the gap of approximately 46 years between service and the onset of peripheral neuropathy symptoms, is one factor, among other factors in this case, that tends to weigh against a finding of continuous symptoms of diabetes mellitus or peripheral neuropathy after service separation, including to a compensable degree within one year of service separation. The weight of the evidence is against finding that diabetes mellitus type II and peripheral neuropathy, which were manifested many years after service, are otherwise related to service. The weight of the evidence is against linking the Veteran's diabetes mellitus type II or peripheral neuropathy to service, to include any exposure to jet fuel. After a review of the evidence of record, the June 2021 VA examiner medical examiner opined that it was less likely than not that diabetes mellitus type II or peripheral neuropathies were incurred in service or are related to service, to include as due to exposure to jet fuel during service. In support of the medical opinion, the June 2021 VA examiner explained that there was not sufficient evidence in the medical records to support that the diabetes mellitus type II or peripheral neuropathy was due to exposure to jet fuel during service. Thus, even assuming exposure to jet fuel during service, it is not shown to have caused diabetes mellitus type II or peripheral neuropathy. The weight of the evidence is against a finding of herbicide exposure during service. In May 2016 email correspondence, it is noted that testing for herbicide spraying techniques was conducted at Eglin AFB during November and December of 1952 and from June to September of 1968. The email reads that a two square-mile area of Eglin's 88 square miles was used to test various herbicides from 1962 to 1970, and the testing was done at a remote forested site called C-52A, which was not located near base personnel and was not open to base personnel. The email further reads that there was no general acknowledgement of AO exposure associated with service at Eglin, and the Veteran, as a clerk, would need to provide evidence of working at, or being associated with, the C-52A test site for exposure to be considered. In May 2016, the Defense Personnel Records Information Retrieval System (DPRIS) reported that it was unable to locate 1966 histories submitted by the squadron or its higher headquarters and reported that the unit histories and supporting documents were in the custody of the Air Force Historical Research Agency at Maxwell Air Force Base (AFB). In March 2021 email correspondence, an archivist at the Air Force Historical Research Agency wrote that, while the official unit histories address the testing of Agent Orange in Area C-52A, they did not note sending any administrative specialists to the remote site by the 3214th Maintenance Squadron. As stated above, the Veteran contends that he was exposed to Agent Orange due to his contact with C-123 aircraft during his time at Eglin AFB while working in the hangars. He does not contend that he was otherwise sent to Area C-52A during service, and it is not otherwise shown. In consideration of the foregoing, the Board finds that the evidence shows no in-service herbicide exposure in this case. Diabetes mellitus type II and peripheral neuropathy are not simple medical condition capable of lay diagnosis, but involve complex body systems, particularly the endocrine and neurological system, respectively, that are unseen by the lay person. Accordingly, the Veteran, as a lay person, under the facts of this case, does not have the medical expertise to render a competent medical opinion regarding the probability of a nexus relationship between diabetes mellitus and service and peripheral neuropathy and service. While the Veteran is competent to report elevated blood sugar at any given time, he is not competent to diagnose diabetes mellitus type II or peripheral neuropathy or render an opinion regarding their etiology. Such opinions as to causation involve making findings based on medical knowledge and clinical testing results, and the endocrine system and neurologic systems are complex and involve unseen systems processes and disease processes that are not observable by the five senses of a lay person. Furthermore, the weight of the lay and medical evidence shows that diabetes mellitus type II symptoms began approximately 18 years after service separation, and peripheral neuropathy symptoms began approximately 46 years after service separation. This evidence outweighs any lay opinion that symptoms of diabetes mellitus type II and peripheral neuropathy that began many years after service are related to service. Although the evidence shows that peripheral neuropathy of the upper and lower extremities was caused by diabetes mellitus type II, service connection is not in effect for the diabetes mellitus type II for reasons explained above; therefore, service connection for peripheral neuropathy of the upper and lower extremities as secondary to diabetes mellitus type II is not warranted as a matter of law. In consideration of the foregoing, the Board finds that the preponderance of the evidence weighs against the appeals; therefore, service connection for diabetes mellitus type II and peripheral neuropathy of the upper and lower extremities, under all theories of service connection, must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Palmer, 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.