Citation Nr: 21064223 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 18-07 769 DATE: October 19, 2021 ORDER Entitlement to service connection for Type II diabetes mellitus, claimed as the result of herbicide agent exposure, is granted. Entitlement to service connection for right lower extremity diabetic neuropathy is granted. Entitlement to service connection for left lower extremity diabetic neuropathy is granted. REMANDED Entitlement to service connection for a right eye disability to include a cataract, claimed as the result of herbicide agent exposure, is remanded. Entitlement to service connection for a left eye disability to include a cataract, claimed as the result of herbicide agent exposure, is remanded. Entitlement to service connection for hypertension, claimed as the result of herbicide agent exposure, is remanded. Entitlement to service connection for a respiratory disability, claimed as the result of herbicide agent exposure, is remanded. Entitlement to service connection for a recurrent right ear disability, claimed as the result of herbicide agent exposure, is remanded. Entitlement to service connection for a recurrent left ear disability, claimed as the result of herbicide agent exposure, is remanded. Entitlement to service connection for bilateral hearing loss is remanded. FINDINGS OF FACT 1. The Veteran was exposed to herbicide agents while at Ubon Royal Thai Air Force Bases, Thailand, in 1967 and 1968. 2. Type II diabetes mellitus was diagnosed following active service. 3. Right lower extremity diabetic neuropathy is related to the service connected Type II diabetes mellitus. 4. Left lower extremity diabetic neuropathy is related to the service connected Type II diabetes mellitus. CONCLUSIONS OF LAW 1. The criteria for service connection for Type II diabetes mellitus have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309; VA Adjudication Procedures Manual, M21-1MR, Part IV.ii.2.C.10.q. 2. The criteria for service connection for right lower extremity diabetic neuropathy have been met. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.310(a). 3. The criteria for service connection for left lower extremity diabetic have been met. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from June 1964 to May 1968. Service Connection for Type II Diabetes Mellitus The Veteran contends that service connection is warranted for diabetes mellitus as he was exposed to herbicide agents while performing his military duties near the perimeter of Ubon Royal Thai Air Force Base in 1967 and 1968. Service connection may be established for recurrent disability arising from disease or injury incurred in or aggravated by wartime service. 38 U.S.C. § 1110. 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). Where a veteran was exposed to herbicide agents during active service and Type II diabetes mellitus becomes manifest to a degree of 10 percent or more at any time after service, service connection shall be established for that disability if the requirements of 38 C.F.R. § 3.307(a)(6) are met even though there is no record of that 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; 38 C.F.R. § 3.309(e). A veteran who, during active service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during that service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any herbicide agent during that service. The last date on which such a veteran shall be presumed to have been exposed to an herbicide agent shall be the last date on which he or she served in the Republic of Vietnam during the period beginning on January 9, 1962 and ending on May 7, 1975. 38 C.F.R. § 3.307(a)(6)(iii). The VA Compensation and Pension Service has determined that a special consideration of herbicide exposure on a factual basis should be extended to veterans whose duties placed them on or near the perimeters of certain Royal Thai Air Force bases anytime between February 28, 1961, and May 7, 1975. The listed Thai military facilities include Ubon Royal Thai Air Force Base. If a veteran's service duties, as shown by evidence of daily work duties, performance evaluation reports, or other credible evidence, placed him near the air base perimeter, then VA is to concede herbicide exposure on a direct or facts found basis. The service personnel records reflect that the Veteran served as a refueling maintenance repairman and a fire truck mechanic with the Fire Fighting Equipment Section at Ubon Royal Thai Air Force Base between June 1967 and May 1968. In an October 2020 written statement, the Veteran conveyed that: "as a crash fire truck mechanic, I was stationed on the flight line which was located right near the perimeter of the base;" "I spent most of my 12 hour workday whether repairing fire trucks near the flight line or fuel trucks in the designated area;" he went to the off base ammo dump; and "going to the ammo dump required me to pass through the perimeter of the base." The Board of Veterans' Appeals (Board) observes that the Veteran's written statements as to his proximity to the perimeter of Ubon Royal Thai Air Force Base are consistent with his military duties. Therefore, the Veteran's presumed exposure to herbicide agents while stationed at Ubon Royal Thai Air Force Base is conceded. VA clinical documentation dated in August 2016 states that the Veteran was diagnosed with Type II diabetes mellitus. Resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran was exposed to herbicide agents while stationed at Ubon Royal Thai Air Force Base, Thailand, as his service duties required him to work extensively on and near the base perimeter. He subsequently manifested Type II diabetes mellitus following service separation. Therefore, the Board concludes that service connection for Type II diabetes mellitus is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Service connection for Right Lower Extremity and Left Lower Extremity Diabetic Neuropathy. Service connection may be granted for disability which is proximately due to or the result of a service connected disease or injury. 38 C.F.R. § 3.310(a). Service connection has been granted for Type II diabetes mellitus above. A May 2017 VA treatment record states that the Veteran was diagnosed with diabetic neuropathy in the feet. Therefore, service connection for right lower extremity diabetic neuropathy and left lower extremity diabetic neuropathy is granted. 38 C.F.R. § 3.310(a). REASONS FOR REMAND 1. Entitlement to service connection for a right eye disability to include a cataract and a left eye disability to include a cataract, claimed as the result of herbicide agent exposure, is remanded. The Veteran contends that service connection is warranted for both a right eye disability and a left eye disability as cataracts were manifested as the result of the service connected Type II diabetes mellitus and/or his conceded exposure to herbicide agents in Thailand. Private clinical documentation indicates that the Veteran underwent November 2014 left eye cataract surgery and December 2014 right eye cataract surgery. VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). The Veteran has not been afforded a VA eye examination to determine the relationship, if any, between the right eye and left eye cataracts and the active service and the service connected disabilities. Clinical documentation dated after December 2017 is not of record. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran's claims. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). 2. Entitlement to service connection for hypertension, claimed as the result of herbicide agent exposure, is remanded. The Veteran asserts that service connection is warranted for hypertension as the claimed disability was manifested as the result of his conceded exposure to herbicidal agents in Thailand. In support of the claim for service connection, the Veteran's attorney submitted a portion of "Veterans and Agent Orange: Update 11" (2018) discussing an association between hypertension and herbicide agent exposure. VA clinical documentation dated in May 2017 states that the Veteran was diagnosed with hypertension. The Veteran has not been afforded a VA hypertension examination to determine the relationship, if any, between the hypertension and the active service and the service connected disabilities. 3. Entitlement to service connection for a respiratory disability, claimed as the result of herbicide agent exposure, is remanded. The Veteran asserts that service connection is warranted for a respiratory disability as the claimed disability was manifested as the result of his conceded exposure to herbicidal agents in Thailand. VA clinical documentation dated in May 2017 states that the Veteran was diagnosed with reactive airway disease. The Veteran has not been afforded a VA respiratory examination to determine the relationship, if any, between the claimed respiratory disability and the active service and the service connected disabilities. 4. Entitlement to service connection for both a recurrent right ear disability and a recurrent left ear disability, claimed as the result of herbicide agent exposure, is remanded. The Veteran contends that service connection is warranted for recurrent right ear and left ear disabilities as the claimed disabilities were initially manifested during active service. The service treatment records reflect that the Veteran was seen for ear complaints. An August 1965 treatment record states that the Veteran was found to have a boil in his left ear canal and was prescribed Coly Mycin. Treatment records dated in August 1967 and September 1967 conveys that the Veteran was diagnosed with a fungal infection of the external ear and was prescribed Cortisporin. Treatment records dated in November 1967 and December 1967 note that the Veteran was diagnosed with recurrent otitis externa and a possible ear infection and prescribed Cortisporin and boric acid. The report of the April 1968 physical examination for service separation states that the Veteran had a history of ear trouble in 1968 treated with ear drops with no recurrence, no complications, and no sequela. Private treatment records dated in December 2003 note that the Veteran was diagnosed with "left ear otitis with cough." The Veteran has not been afforded a VA ear examination. Entitlement to service connection for bilateral hearing loss is remanded. The Veteran contends that service connection is warranted for bilateral hearing loss as the claimed disability was manifested secondary to his significant in-service noise exposure. The reports of the physical examination for service entrance and physical examination for service separation document threshold shifts of 5 to 15 decibels. The report of a January 2017 VA audiological examination states that the Veteran was diagnosed with bilateral sensorineural hearing loss. The examiner concluded that the bilateral hearing loss was less likely than not caused by or a result of active service. The examining audiologist did not address the in service threshold shift. Therefore, the examination report is of limited probative value. When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that further VA audiology evaluation is needed. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who has treated any eye, hypertension, respiratory, ear, and hearing loss disabilities. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Obtain any VA treatment records not of record, to include those pertaining to treatment after December 2017. 3. Schedule the Veteran for a VA eye examination conducted by a medical doctor to assist in determining the nature and etiology of any right eye and left eye disabilities. The examiner must review the record and should note that review in the reports. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all eye disabilities found. (b) Opine whether it is at least as likely as not (a 50 percent probability or greater) that any identified eye disability had its onset during active service or is related to any incident of service, including the conceded herbicide agent exposure. (c) Opine whether it is at least as likely as not (a 50 percent probability or greater) that any identified eye disability, including cataracts, is due to or the result of Type II diabetes mellitus and the other service-connected disabilities. (d) Opine whether it at least as likely as not (50 percent probability or greater) that any identified eye disability, including cataracts, has been aggravated (increased in severity beyond the natural progression of the disorder) by Type II diabetes mellitus and the other service-connected disabilities. 4. Schedule the Veteran for a VA hypertension examination conducted by a medical doctor to assist in determining the nature and etiology of the diagnosed hypertension. The examiner must review the record, including the medical article submitted by the Veteran, and should note that review in the reports. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all hypertensive disabilities found. (b) Opine whether it is at least as likely as not (a 50 percent probability or greater) that any identified hypertension had its onset during active service or is related to any incident of service, including the conceded herbicide agent exposure. The examiner should specifically discuss the medical article submitted by the Veteran. (c) Opine whether it is at least as likely as not (a 50 percent probability or greater) that the hypertension is due to or the result of Type II diabetes mellitus and the other service-connected disabilities. (d) Opine whether it at least as likely as not (50 percent probability or greater) that any hypertension has been aggravated (increased in severity beyond the natural progression of the disorder) by Type II diabetes mellitus and the other service-connected disabilities. 5. Schedule the Veteran for a VA respiratory examination conducted by a medical doctor to assist in determining the nature and etiology of any identified respiratory disability. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all respiratory disabilities found. (b) Opine whether it is at least as likely as not (a 50 percent probability or greater) that any identified respiratory disability had its onset during active service or is related to any incident of service, including the conceded herbicide agent exposure. (c) Opine whether it is at least as likely as not (a 50 percent probability or greater) that the any identified respiratory disability is due to or the result of Type II diabetes mellitus and the other service connected disabilities. (d) Opine whether it at least as likely as not (50 percent probability or greater) that any identified respiratory disability has been aggravated (increased in severity beyond the natural progression of the disorder) by Type II diabetes mellitus and the other service-connected disabilities. 6. Schedule the Veteran for a VA examination conducted by a medical doctor to assist in determining the nature and etiology of any identified recurrent ear disability. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all ear disabilities found. (b) Opine whether it is at least as likely as not (a 50 percent probability or greater) that any identified recurrent ear disability had its onset during active service or is related to any incident of service, including the documented in service otitis externa and other ear infections. 7. Schedule the Veteran for a VA audiology examination to assist in determining the nature and etiology of any identified l hearing loss disability and any relationship to active service. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all hearing loss disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified hearing loss disability had its onset during active service or is related to any incident of service, including the documented in service threshold shifts and exposure to engine noise while performing his military duties. J. T. HUTCHESON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.R. Kardian, 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.