Citation Nr: 21072247 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 18-13 601 DATE: December 2, 2021 ORDER Service connection for diabetes mellitus is denied. REMANDED The following issues are remanded for further development: (1) entitlement to service connection for hypertension; (2) entitlement to service connection for peripheral neuropathy of the left lower extremity; (3) entitlement to service connection for peripheral neuropathy of the right lower extremity; (4) entitlement to service connection for prostate cancer; and (5) entitlement to service connection for a heart condition, to include mitral valve stenosis. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had diabetes mellitus at any time during or approximate to the claim period. CONCLUSION OF LAW The criteria for service connection for diabetes mellitus are not met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303; Brammer v. Derwinski, 3 Vet. App. 223 (1992). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from June 1966 to March 1970. These matters are before the Board of Veterans' Appeals (Board) on appeal from an August 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Jurisdiction of the Veteran's claims file currently resides with the St. Paul, Minnesota RO. In September 2020, the Veteran testified at a Board hearing before the undersigned. A transcript of the hearing is of record. Service Connection for Diabetes Mellitus As indicated above in the Conclusions of Law section, the Board finds that service connection for diabetes mellitus is not warranted in the instant case. Accordingly, the Board denies the Veteran's claim. In support of this determination, the Board notes that evidence of a present disability is necessary before service connection may be granted. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) ("Congress specifically limits entitlement to service-connected disease or injury where such cases have resulted in a disability... in the absence of a proof of present disability there can be no claim."). The requirement of a "current disability" is satisfied if a disorder is diagnosed at the time a claim is filed or at any time during the pendency of the appeal. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); see also Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). Here, the Board finds that the Veteran was not diagnosed with diabetes mellitus by a medical professional during or approximate to the claim period. Specifically, the Veteran was provided a VA diabetes examination in June 2017. After reviewing the Veteran's claims file and conducting a physical examination, the VA examiner opined that the Veteran did not meet the criteria for a diagnosis of diabetes. The examiner remarked that, in May 2016, the Veteran was diagnosed with impaired fasting glucosenot diabetes. The examiner then stated that a more recent fasting plasma glucose from June 2017 did not substantiate even the impaired fasting glucose diagnosis. Lastly, the examiner indicated that the Veteran did not experience any current functional impairment associated with the impaired fasting glucose. A review of VA treatment records associated with the Veteran's claims file is consistent with the June 2017 VA examiner's conclusions. The Veteran was not diagnosed with diabetes mellitus by any VA medical provider during treatment at VA facilities both prior to and during the claim period. Lastly, the Board notes that, in November 2020, physician assistant M.L. at the St. Cloud VA Medical Center stated that the Veteran had a current diagnosis of impaired fasting glucose, also known as "pre-diabetes." From this evidence of record, the Board concludes that the Veteran has not received a confirmed diagnosis of diabetes mellitus during or approximate to the claim period. Rather, he has received the diagnosis of impaired fasting glucose. For VA compensation purposes, impaired fasting glucose is a laboratory finding and not a disability. See generally 61 Fed. Reg. 20440 (May 7, 1996) (stating, regarding hyperlipidemia, elevated triglycerides, and elevated cholesterol, that such are "laboratory test results, and are not, in and of themselves, disabilities.") Further, even though it is a laboratory finding, there is no indication that the Veteran's impaired fasting glucose caused any functional impairment during the claim period. Accord Saunders v. Wilkie, 866 F.3d 1356, 1368 (Fed. Cir. 2018) (stating that pain alone, when causing functional impairment, may constitute a disability for VA compensation purposes, even if the pain does not have an accompanying diagnosis). Accordingly, as the Veteran does not have a current disability, service connection must be denied. Brammer, 3 Vet. App. at 225. REASONS FOR REMAND Service Connection for Hypertension, Peripheral Neuropathy of the Bilateral Lower Extremities, Prostate Cancer, and a Heart Condition The Veteran has contended that he has experienced hypertension, bilateral lower extremity peripheral neuropathy, prostate cancer, and a heart condition as a result of in-service exposure to herbicide agents. See, e.g., Board Hearing Tr. at 2-3. After reviewing the evidence of record, the Board concludes that remand is warranted prior to adjudication of these issues on their merits. In support of this determination, the Board first notes that the Veteran has stated that he was exposed to herbicide agents in Guam. See, e.g., March 2018 VA Form 9. The Veteran's service personnel records (SPRs) indicate that the Veteran was assigned to the U.S. Naval Magazine in Guam from approximately March 1967 to October 1968. Currently, 38 C.F.R. § 3.307(a)(6) does not establish a presumption of exposure to herbicide agents based on service in Guam. Additionally, in August 2017, correspondence was associated with the Veteran's claims file which indicated that, in the Veteran's case, the Department of Defense could not identify any location on the island of Guam, including Andersen Air Force Base, where Agent Orange was used, tested, stored, or transported. Accordingly, the Board may not conclude that the Veteran was exposed to herbicide agents as contemplated by 38 C.F.R. § 3.307(a)(6)(i) during his service on Guam. Nevertheless, the above-referenced August 2017 correspondence concerning information released by the Department of Defense noted that any herbicides used on Guam were of a commercial variety and not Agent Orange. Consistent with this information provided by the Department of Defense, the Veteran provided detailed testimony during his September 2020 Board hearing concerning his observations of herbicide use during his time on Guam. Board Hearing Tr. at 3-4. In light of this evidence of record, the Board finds that remand is required for the Agency of Original Jurisdiction (AOJ) to request information from the Department of Defense concerning the use of commercial herbicides. If the Department of Defense can provide such information, the Veteran should then be provided VA medical opinions concerning whether the Veteran's hypertension, bilateral lower extremity peripheral neuropathy, prostate cancer, and heart condition were caused by or related to exposure to such commercial herbicides. In addition, the Board notes that, in October 2021, the Veteran's representative stated that the Veteran served aboard the USS Isle Royal (AD-29) and that VA had already conceded that this ship had crewmembers go ashore in Vietnam in connection with salvaging the beached USS Mahnomen County at Chu Lai. The representative indicated that, based upon these circumstances, the Veteran could be entitled to service connection presumptively under the Blue Water Navy Vietnam Veterans Act. See 38 U.S.C. § 1116A. The representative's October 2021 statement was in reference to an August 2017 formal finding associated with the Veteran's claims file. The formal finding did in fact note that (1) the Veteran served aboard the USS Isle Royal (AD-29), and (2) crewmembers of the USS Isle Royal (AD-29) did go ashore in Vietnam in connection with salvaging the beached USS Mahnomen County (LST-912) at Chu Lai. However, the formal finding also indicated that this activity occurred in January 1967 and that the Veteran was assigned to the USS Isle Royal (AD-29) after this event in October 1968. Thus, the formal finding concluded that there was no evidence that the Veteran physically visited the landmass of Vietnam. However, the Blue Water Navy Vietnam Veterans Act was signed into law by the President in 2019, approximately 2 years after the issuance of the August 2017 formal findings. The Act expanded the definition of service in Vietnam to include veterans who served offshore of Vietnam from January 9, 1962 to May 7, 1975. See 38 U.S.C. § 1116A(b). The Act also provided that such veterans who had qualifying offshore service were to be presumed to have been exposed to herbicide agents, including Agent Orange. Id. The Act went into effect on January 1, 2020. The Veteran's SPRs indicate that he was assigned to the USS Isle Royal (AD-29) from October 28, 1968 until the end of his active duty service in March 4, 1970. In light of (1) the enactment of the Blue Water Navy Vietnam Veterans Act; (2) the Veteran's service aboard the USS Isle Royal (AD-29) between the qualifying years of January 9, 1962 and May 7, 1975; and (3) the USS Isle Royal (AD-29)'s documented presence within 12 nautical miles of the landmass of Vietnam between January 9, 1962 and May 7, 1975, the Board finds that remand is warranted to determine whether the USS Isle Royal (AD-29) was present within 12 nautical miles of the landmass of Vietnam during the Veteran's assignment to that ship between October 28, 1968 and March 4, 1970. The matters are REMANDED for the following action: 1. Contact any appropriate repository of records to verify whether the Veteran was exposed to herbicide agents during his service aboard the USS Isle Royal (AD-29) from October 1968 to March 1970, to include service within 12-nautical miles of the Vietnamese coast, and/or within the points identified in 38 U.S.C. § 1116A. 2. Contact the Compensation Service or any other appropriate entity and request information from the Department of Defense regarding the use of commercial herbicides in Guam between March 1967 and October 1968. Such information should include the names of the commercial herbicides used as well as any known health risks. If such information is not available, please associate a formal finding in the Veteran's claims file and inform the Veteran. 3. If information regarding commercial herbicides is received pursuant to Item (2), forward the Veteran's claims file to an appropriate VA clinician for a medical opinion about the nature and etiology of the Veteran's hypertension. After reviewing the claims file, and performing a physical examination if deemed necessary, the clinician should address whether it is at least as likely as not (50 percent probability or more) that the Veteran's hypertension was incurred in, caused by, or related to serviceto include exposure to commercial herbicides on Guam The clinician should consider medical and lay evidence dated both prior to and since the filing of the claim. The clinician must provide a complete rationale for any opinion rendered. If the clinician cannot provide an opinion without resorting to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.). 4. If information regarding commercial herbicides is received pursuant to Item (2), forward the Veteran's claims file to an appropriate VA clinician for a medical opinion about the nature and etiology of the Veteran's bilateral lower extremity peripheral neuropathy. After reviewing the claims file, and performing a physical examination if deemed necessary, the clinician should address whether it is at least as likely as not (50 percent probability or more) that the Veteran's bilateral lower extremity peripheral neuropathy was incurred in, caused by, or related to serviceto include exposure to commercial herbicides on Guam The clinician should consider medical and lay evidence dated both prior to and since the filing of the claim. The clinician must provide a complete rationale for any opinion rendered. If the clinician cannot provide an opinion without resorting to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.). 5. If information regarding commercial herbicides is received pursuant to Item (2), forward the Veteran's claims file to an appropriate VA clinician for a medical opinion about the nature and etiology of the Veteran's prostate cancer. After reviewing the claims file, and performing a physical examination if deemed necessary, the clinician should address whether it is at least as likely as not (50 percent probability or more) that the Veteran's prostate cancer was incurred in, caused by, or related to serviceto include exposure to commercial herbicides on Guam The clinician should consider medical and lay evidence dated both prior to and since the filing of the claim. The clinician must provide a complete rationale for any opinion rendered. If the clinician cannot provide an opinion without resorting to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.). 6. If information regarding commercial herbicides is received pursuant to Item (2), forward the Veteran's claims file to an appropriate VA clinician for a medical opinion about the nature and etiology of the Veteran's heart condition After reviewing the claims file, and performing a physical examination if deemed necessary, the clinician should address the following: (a.) Please identify all current heart conditions by diagnosis. For the purposes of answering this prompt, "current" means occurring from March 2017 onward. (b.) For each condition identified in part (a), please indicate whether the condition qualifies as ischemic heart disease. (c.) For each condition identified in part (a), please state whether it is at least as likely as not (50 percent probability or more) that the Veteran's condition was incurred in, caused by, or related to serviceto include exposure to commercial herbicides on Guam The clinician should consider medical and lay evidence dated both prior to and since the filing of the claim. The clinician must provide a complete rationale for any opinion rendered. If the clinician cannot provide an opinion without resorting to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.). (Signature on Next Page) S.C. KREMBS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N.S. Pettine, 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.