Citation Nr: 21068960 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 19-12 745 DATE: November 17, 2021 ORDER Entitlement to service connection for prostate cancer is granted. Entitlement to service connection for voiding dysfunction is granted. Entitlement to service connection for erectile dysfunction (ED) is granted. Entitlement to service connection for right ear hearing loss is granted. FINDINGS OF FACT 1. While stationed at Udorn Royal Thai Air Force Base (RTAFB), the Veteran served near the air base perimeter and was exposed to herbicide agents on a facts-found basis. 2. The Veteran's prostate cancer is etiologically related to his time on active duty. 3. The Veteran's ED and voiding dysfunction are proximately due to his service-connected prostate cancer. 4. Affording the Veteran the benefit of the doubt, his right ear hearing loss is etiologically related to in-service noise exposure. CONCLUSIONS OF LAW 1. The criteria for service connection for prostate cancer due to herbicide exposure are met. 38 U.S.C. §§ 1110, 1112, 1113, 5107(b) (2019); 38 C.F.R. §§ 3.102, 3.303(b), 3.307, 3.309(a) (2020). 2. The criteria for service connection for ED are met. 38 U.S.C. §§ 1110, 1112, 1113, 5107(b) (2019); 38 C.F.R. §§ 3.102, 3.303(b), 3.307, 3.309(a), 3.310 (2020). 3. The criteria for service connection for voiding dysfunction are met. 38 U.S.C. §§ 1110, 1112, 1113, 5107(b) (2019); 38 C.F.R. §§ 3.102, 3.303(b), 3.307, 3.309(a), 3.310 (2020). 4. The criteria for service connection for right ear hearing loss are met. 38 U.S.C. §§ 1110, 1131, 5107 (2019); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran honorably served on active duty from February 1961 to October 1988. He appeals a September 2014 rating decision by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) denying entitlement to service connection for bilateral hearing loss, prostate cancer, incontinence, and ED. During the appeal period, the AOJ granted service connection for the Veteran's left ear hearing loss. See September 2019 rating decision. A Board of Veterans' Appeals (Board) hearing was held in August 2021. A transcript is of record. A Veteran is entitled to VA disability compensation if there is a current disability resulting from personal injury or disease incurred in, or aggravated by, active service. 38 U.S.C. §§ 1110, 1131. The determination of whether the requirements of service connection have been met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. For a claim to be denied on the merits, a preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Prostate cancer with residuals of urinary dysfunction and ED The Veteran asserts he was exposed to herbicide agents during active service at Udorn RTAFB in Thailand and is entitled to service connection for prostate cancer with residuals on a presumptive basis. Certain diseases associated with exposure to certain herbicide agents used in support of military operations in the Republic of Vietnam during the Vietnam era will be considered to have been incurred in service. 38 U.S.C. § 1116(a)(1); 38 C.F.R. § 3.307(a)(6). Prostate cancer is associated with herbicide agent exposure for purposes of the presumption. 38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e). The presumption requires exposure to an herbicide agent and manifestation of the disease to a degree of 10 percent or more at any time after service. 38 C.F.R. § 3.307(a)(6)(ii). Generally, a veteran who served in Thailand during the Vietnam era is not entitled to the legal presumption of exposure to an herbicide agent. However, VA has determined that special consideration of exposure to an herbicide agent on a factual basis should be extended to veterans who served on or near the perimeters of Thailand military bases during the Vietnam era. In pertinent part, exposure to an herbicide agent will be conceded on a direct/facts found basis where a veteran served in the United States Air Force at Udorn RTAFB near the air base perimeter as shown by evidence of daily work duties, performance evaluation reports, or other credible evidence. See, e.g., U.S. Dep't of Veterans Affairs, Thailand Military Bases and Agent Orange Exposure, https://www.publichealth.va.gov/exposures/agentorange/locations/thailand.asp (last accessed November 11, 2021). Here, several foundational facts are not in dispute. The Veteran has a diagnosis prostate cancer. See February 2013 Urology Associates of Dover records. The Veteran's DD Form 214s reflect the Veteran served in Thailand and was stationed at Udorn RTAFB in August 1974, during the Vietnam era. As a medical nexus between herbicide agent exposure and prostate cancer is not in dispute, the dispositive factual inquiry in this case is whether the Veteran was exposed to herbicide agents during service. In other words, if the Veteran was exposed to herbicide agents at Udorn RTAFB, entitlement to service connection is warranted. The record reflects the Veteran served as a jet engine technician while serving at the Udorn RTAFB. See DD Form 214. The Veteran consistently stated he was "assigned to the test cell area that tested J-70 engines for the F-4 aircrafts." See May 2015 notice of disagreement (NOD). This area was located "off the south end of the aircraft runway," near the perimeter of the base where he witnessed people spraying the foliage around the base. Id. He further testified that he was stationed "about 1,500 maybe 2,000 feet away from the perimeter," and every day he "walked up the end of taxiway...near the perimeter" to where he worked. See August 2021 Board Hr. Tr. at 4-7. Given that the Veteran served for a period of time at Udorn RTAFB, he is certainly competent to comment on the location he worked at within the base, and the Board finds no evidence contradicting the Veteran's assertion that his duties took him to the base perimeter on a regular basis. As such, the Board deems this testimony credible and finds the Veteran served near the air base perimeter. Thus, as to this particular Veteran, the record supports exposure to herbicide agents on a facts-found basis. As a result, the Board finds the Veteran's prostate cancer related or attributable to service, and grants entitlement to service connection for prostate cancer. Additionally, the Board finds the evidence supports a finding that the Veteran's ED and voiding incontinence are residuals of his now service-connected prostate cancer. Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disease or injury. See 38 C.F.R. § 3.310(a). Here, the Veteran's urology medical record reflect the Veteran has voiding dysfunction and ED. See February 2012 Urology Associates of Dover treatment records. Pursuant to the Order above, he is now service connected for prostate cancer. The Veteran credibly testified he did not experience symptoms of voiding dysfunction or ED prior to his prostate cancer. Id. at 7. Further, the Veteran's urologist treated the Veteran's prostate cancer and continued to treat him for his residuals during the appeal period, which the record reflects include voiding dysfunction and ED. See, e.g., February 2013 and June 2019 Urology Associates of Dover treatment records. Thus, the Board finds the evidence reflects the Veteran's ED and voiding dysfunction are secondary to his now service-connected prostate cancer. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Accordingly, the Board grants service connection for ED and voiding dysfunction as secondary to the Veteran's now service-connected prostate cancer. Right ear hearing loss Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an 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, the so-called "nexus" requirement. See Shedden v. Principi, 381 F.3d 1163, 1167 (2004). The Veteran has right ear hearing loss for VA purposes. See August 2019 VA examination report. The record reflects the Veteran served in the Air Force for over twenty-five years, mainly as a jet engine mechanic, which has a high probability for excess noise exposure. See DD Forms 214. The Veteran testified he was "exposed to noise constantly." See August 2021 Board Hr. Tr. at 3. Indeed, the Veterans service treatment records (STRs) contain numerous routine audiological examinations due to the Veteran's military occupational specialty (MOS). A January 1985 occupational health examination noted the Veteran was "exposed to hazardous noise levels" daily due to his MOS and work in the jet engine shop. An August 2019 VA examiner opined that only the Veteran's left ear hearing loss was related to service, not his right ear hearing loss. As rationale, the VA examiner noted a significant permanent shift in the Veteran's left ear hearing threshold at 4000 Hertz from his date of entrance to separation of service, which was indicative of possible auditory damage from conceded noise on active duty. See August 2019 VA examination report. However, the VA examiner found no significant permanent shift in hearing thresholds in the Veteran's right ear during service; thus, he concluded the Veteran's right ear hearing loss could be related to another etiology. Id. However, a review of the Veteran's in-service audiological examinations from September 1966 to December 1982 reflect his right ear hearing experienced a more severe decline in hearing than his left ear. Specially, the Veteran's right ear experienced a larger decline in hearing than the left ear at 1000, 3000, and 4000 Hertz. See September 1966 and December 1982 STRs. Additionally, his right ear also had a significant threshold shift of 20 decibels at 500 Hertz. Id. Thus, the Board finds the same reasoning for the August 2019 VA examiner's finding that the Veteran's left ear hearing loss related to service applies equally to the Veteran's right ear hearing loss. Providing the Veteran the benefit of the doubt, the Board finds all three elements for service connection are met and grants service connection for right hearing loss. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bona, 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.