Citation Nr: 21072425 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 16-61 947 DATE: December 3, 2021 ORDER Service connection for diabetes mellitus type II is denied. Service connection for right leg amputation at the knee is denied. Service connection for amputation of the left fourth toe is denied. Service connection for foot ulcers is denied. Service connection for peripheral neuropathy of the right upper extremity is denied. Service connection for peripheral neuropathy of the left upper extremity is denied. Service connection for peripheral neuropathy of the left lower extremity is denied. Service connection for peripheral neuropathy of the right lower extremity is denied. Service connection for erectile dysfunction is denied. FINDINGS OF FACT 1. The record shows that the Veteran did not serve in the Republic of Vietnam during the period where herbicide agents were used. 2. There is no competent evidence to suggest that the Veteran's diabetes, peripheral neuropathy, foot ulcers, amputations, or erectile dysfunction are related to service, including chemicals such as photograph chemicals or jet fuel. 3. The weight of the evidence is against finding current erectile dysfunction is related in-service elective circumcision. CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes mellitus type II have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for service connection for right leg amputation at the knee have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 3. The criteria for service connection for amputation of the left fourth toe have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 4. The criteria for service connection for foot ulcers have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 5. The criteria for service connection for peripheral neuropathy of the right upper extremity have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 6. The criteria for service connection for peripheral neuropathy of the left upper extremity have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 7. The criteria for service connection for peripheral neuropathy of the left lower extremity have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 8. The criteria for service connection for peripheral neuropathy of the right lower extremity have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 9. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Navy from December 1970 to December 1972, October 1975 to September 1977, and September 1977 to September 1980. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a Veteran must show: "(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" also known as the "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). The Board must consider all the evidence of record and make appropriate determinations of competence, credibility, and weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). When there is an approximate balance of positive and negative evidence regarding any material issue, all reasonable doubt is resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 1. Service connection for diabetes mellitus type II 2. Service connection for right leg amputation at the knee 3. Service connection for amputation of the left fourth toe 4. Service connection for foot ulcers 5. Service connection for peripheral neuropathy of the right upper extremity 6. Service connection for peripheral neuropathy of the left upper extremity 7. Service connection for peripheral neuropathy of the left lower extremity 8. Service connection for peripheral neuropathy of the right lower extremity Based on the record, the Board finds the criteria for service connection for diabetes, peripheral neuropathy, foot ulcers, and amputation of the right leg and left fourth toe have not been met. 38 C.F.R. § 3.303. First, the evidence shows current disabilities. In a January 2015 letter, Dr. RM wrote that the Veteran has diabetes mellitus II and severe complications of diabetes that include peripheral neuropathy of the hands and feet and diabetic foot ulcers. VA treatment records also show diabetes, diabetic peripheral neuropathy, diabetic foot ulcers, and amputation of the right leg at the knee and the left fourth toe due to diabetes. Thus, the first element of service connection is established. See Holton, 557 F.3d at 1366. Next, the evidence does not show an onset of these disabilities in service. Service treatment records are silent for diabetes, peripheral neuropathy, ulcers, and amputations. Indeed, in his December 2021 statement, the Veteran reported being diagnosed with diabetes and related disabilities around 1994, approximately 14 years after discharge. Dr. RM noted that the first documentation of the Veteran's diabetes was in May 1997. Therefore, the evidence does not establish a direct link to service. Instead, the Veteran has asserted that his diabetes and related disabilities are due to in-service exposure to Purple K, Agent Orange (herbicide agents), jet fuel, and photographic chemicals. Although diabetes is a disability presumed to be associated with exposure to herbicide agents, the record does not show that the Veteran served in an area where or when herbicide agents were used or stored. See 38 C.F.R. §§ 3.307(a)(6), 3.309(e). In August 2014 statements, the Veteran reported serving in Vietnam while taking intelligence photographs. For the period of service from December 1970 to December 1972, the Veteran's service personnel records show he did not have foreign service and served within the United States. Service personnel records show he was stationed on the USS Saratoga shortly after beginning his second period of service and that his primary specialty was photographer's mate. However, this period of service and the last period of service are outside the window of time when herbicide agents are known to have been used in Vietnam January 9, 1962, to May 7, 1975. 38 C.F.R. § 3.307(a)(6). Exposure to herbicide agents is not known to have occurred in Vietnam after May 1975 when the Veteran served his second periods of active duty. See id. Regarding the other chemicals, including Purple K, photographic chemicals, and jet fuel, the Board notes that the Veteran was a photographer's mate and that the USS Saratoga operated as an aircraft carrier. However, the Veteran has not identified, and the record does not include, any competent evidence to suggest that diabetes mellitus type II, peripheral neuropathy, or associated disabilities of ulcers and amputation are related to these chemicals. While the Veteran has generally asserted that he believes his disabilities are due to these chemicals, he does not have the requisite medical training or knowledge to provide competent evidence on the cause of complex medical disabilities like diabetes. See Jandreau, 492 F.3d at 1377. Medical evidence is required to establish a connection. See id. Further, the Veteran has not identified or provided competent evidence to suggest a connection between his disabilities and chemical exposure to prompt VA's duty to provide a medical examination and opinion. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Accordingly, there is insufficient evidence to reach the level of equipoise and find that the Veteran's diabetes, peripheral neuropathy, foot ulcers, and amputation of the right leg and left fourth toe are related to his service, and the claims must be denied. See 38 U.S.C. § 5107(a). 9. Service connection for erectile dysfunction After reviewing the evidence, the Board finds the criteria for service connection for erectile dysfunction have not been met. 38 C.F.R. § 3.303. The evidence shows a current disability and in-service incurrence. VA treatment records show complaints of and medication for erectile dysfunction. The Veteran's reports of experiencing erectile dysfunction are competent evidence of a current disability as it is observable by his senses. See Jandreau, 492 F.3d at 1377. Additionally, the Veteran's service treatment records show he underwent an elective circumcision in August 1977 and experienced post-operative bleeding, which required two additional surgeries. Therefore, the Board finds he has a current disability and in-service incurrence. However, the weight of the evidence is against finding a connection between the Veteran's in-service circumcision and current erectile dysfunction. The December 2019 VA examiner opined that the Veteran's erectile dysfunction is less likely than not due to or the result of the circumcision procedure in service. The examiner noted that erectile dysfunction can be caused by many factors, including diabetes, hypertension, and depression, which the Veteran has. The examiner further explained that medical literature on the long-term effects of circumcision on sexual function shows circumcision did not adversely affect sexual function but caused significant improvement in erectile function and overall sexual satisfaction. Moreover, the Veteran reported the onset of erectile dysfunction many years after service during the June 2016 examination and VA treatment. The record does not include competent evidence that the Veteran's erectile dysfunction is related to the in-service circumcision. Instead, the Veteran has asserted that his disability is related to in-service chemical exposure. As discussed above, the record does not support that the Veteran served in a location where and when herbicide agents were used. Moreover, the Veteran has not identified, and the record does not include, competent evidence suggesting the Veteran's erectile dysfunction is related to chemical exposure to grant service connection or prompt a medical opinion on this theory of entitlement. See McLendon, 20 Vet. App. at 79. While the Veteran is competent to provide evidence on the observable condition of erectile dysfunction, he does not have the requisite medical knowledge or training to provide evidence on the cause of erectile dysfunction. See Jandreau, 492 F.3d at 1377. Therefore, the Board finds insufficient evidence to reach the level of equipoise and find that the Veteran's erectile dysfunction is related to his service. See 38 U.S.C. § 5107(a). The Board is grateful for the Veteran's honorable service, and this decision is not meant to detract from that service. Unfortunately, the Board concludes that service connection is not warranted at this time based on the evidence. N. RIPPEL Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.P. Armstrong 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.