Citation Nr: 21007055 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 16-52 852 DATE: February 8, 2021 REMANDED Entitlement to service connection for a heart condition, including coronary artery disease (CAD), to include as due to exposure to herbicide agents, is remanded. Entitlement to service connection for diabetes mellitus, type II (diabetes), to include as due to exposure to herbicide agents, is remanded. Entitlement to service connection for a back condition is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1969 to June 1973. In April 2019, the Veteran and his spouse testified at a travel Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In September 2019, the Board remanded this appeal for further development. Regrettably, for the reasons discussed below, the Board finds that another remand is warranted prior to the adjudication of the claims on appeal. Heart Condition and Diabetes Here, the Veteran contends that she was exposed to herbicide agents while she was stationed at the Korat Royal Thai Air Force Base (RTAB) during the Vietnam War from September 1971 to September 1972. Specifically, the Veteran stated that while she was a clerk typist during combat operations at Korat RTAB, her duties varied between administrative functions, courier duties aboard an aircraft, and normal lower enlisted flight line duties such as guard duty. The Veteran described that she worked for the Chief of Flight line Operations and her office was located on the flight line. The Veteran stated as part of her daily duties she frequented the end of the runway. Additionally, the Veteran submitted maps and photographs of the Korat RTAFB, which showed the Korat RTAFB base perimeter. She also labeled areas that she frequented that were either at the perimeter, or near the perimeter, to include her living quarters (with no glass, just screens), physical fitness training areas, and an area she claimed was where barrels of “Agent Orange” were stored. The Veteran also submitted photographs which depictured the close proximity of the Korat RTAFB perimeter and the “hootch” living quarters (where she lived). The Veteran notes that the area at the perimeter was sprayed with herbicide agents, depicted as defoliation on both sides of the perimeter in the photograph, and that the dust from the road and spraying of herbicide agents entered the “hootches,” where she slept. The Veteran also noted that herbicide agents were used to kill vegetation and she submitted a photograph of the Korat RTAB in 2002, which shows that the vegetation has not grown back. The Veteran also submitted a photograph that depicts multiple orange and white barrels on the Korat RTAFB. There are no regulatory or statutory presumptions regarding herbicide exposure in Thailand. However, VA’s Compensation & Pension Service (C&P) has issued information concerning the use of herbicides in Thailand during the Vietnam War. In a May 2010 bulletin, C&P indicated that it has determined that there was significant use of herbicides on the fenced in perimeters of military bases in Thailand intended to eliminate vegetation and ground cover for base security purposes. Given this information, C&P has determined that special consideration should be given to Veterans whose duties placed them on or near the perimeters of Thailand military bases. Consideration of herbicide exposure on a “facts found or direct basis” should be extended to those Veterans. Significantly, C&P stated that “[t]his allows for presumptive service connection of the diseases associated with herbicide exposure.” A primary source of this information was the declassified Vietnam-era Department of Defense (DOD) document entitled, “Project CHECO Southeast Asia Report: Base Defense in Thailand.” In light of this information, VA has determined that special consideration should be extended to those Veterans whose duties placed them on or near the perimeters of Thailand military bases. Based on the facts provided by the Veteran, the Board remanded for a request to the Joint Services Records Research Center (JSRRC) to verify whether the Veteran was exposed to herbicide agents during service. Here, in the March 2020 DPRIS response, the JSRRC researched available records from “January 1972 through March 1972” and found that the Veteran, nor her unit, were exposed to Agent Orange while performing her daily duties. The Board finds that this response from the JSRRC is incomplete. Here, the Veteran specifically noted she was stationed at the Korat RTAB during the Vietnam War from September 1971 to September 1972. However, the JSRRC only researched records from January 1972 to March 1972. As such, the Board is requesting another response from the JSRRC that covers a search of records from September 1971 to September 1972 in three month increments. Additionally, the Board acknowledges that the Veteran’s military records do not document an assignment of guard duty. However, in her April 1971 to January 1972 performance report, although her role was as an administrative specialist, it is noted that she had additional duties to the Secretary of the Chief of Maintenance. Furthermore, it is also noted that the Veteran “performs many functions not normally required of her specialty.” Thus, it appears that her duties may have included more than just clerical/administrative duties. Given such, the Board is requesting another request to JSRRC to verify whether the Veteran was exposed to herbicide agents during the Veteran’s service, to include the entire period of September 1971 to September 1972 in three month increments. Back Condition Here, the Veteran contends that her current back condition is related to her in-service automobile accident. The Veteran noted although her condition resolved enough during service for her to return to her duties, her condition had residuals that she believes resulted in her current back condition. See October 2016 Statement in Support of Claim. Here, in a June 2013 VA examination report for back conditions, the VA examiner noted that the Veteran was involved in an automobile accident during service, in which there was a diagnosis of lumbar sacral strain. The VA examiner noted that the Veteran was eventually discharged from physical therapy and returned to normal duty. Although the VA examiner opined that the Veteran’s current lumbar degenerative disc disease is less likely than not related to her service, the VA examiner did not provide a rationale as to the basis of this opinion. As such, the Board found that this opinion holds no probative value. Consequently, the Board requested another VA medical opinion. Thus, an addendum was provided in March 2020. In the March 2020 addendum, the VA examiner noted that the Veteran was evaluated in the military for back strain and pain that stemmed from an automobile accident. The VA examiner noted that the Veteran was eventually discharged from physical therapy and returned to normal duty. The VA examiner noted that the Veteran is morbidly obese and has additional diagnoses of osteoarthritis, Sjogren’s syndrome, and rheumatoid arthritis, and finds that none of the additional diagnoses are related to service. However, the VA examiner did not discuss the Veteran’s diagnosis of degenerative disc disease. Nor did the VA examiner discuss the Veteran’s lay statements of ongoing back pain, as specifically directed to in the Board’s previous remand. Therefore, the Board finds that the March 2020 addendum opinion is inadequate. The matters are REMANDED for the following action: 1. Verify the Veteran’s overseas service, to include service dates at Korat Air Force Base. Request the Veteran’s Service Records. 2. The RO is asked to verify whether the Veteran worked GUARD DUTY AS PART OF HER SERVICE at the Korat RTAFB. The Veteran’s military occupational specialty (MOS) should be included. 3. Contact the JSRRC or other appropriate government records repositories, and attempt to verify the Veteran’s report of herbicide agent exposure at the Korat RTAFB from September 1971 to September 1972 in 3 month increments based on the evidence of record to include the following: (a) April 2019 Hearing Related Documents (includes all photographs and maps submitted). (b) The Veteran’s lay statements in which the Veteran stated that while she was a clerk typist during combat operations at Korat RTAFB, her duties varied between administrative functions, courier duties aboard aircrafts, and normal lower enlisted flight line duties such as guard duty. The Veteran described that she worked for the Chief of Flight line Operations, Colonel Galpin, and her office was located on the flight line. The Veteran stated as part of her daily duties she frequented the end of the runway. (c) The Veteran stated that spraying of Agent Orange occurred while she was on base as they never mowed the grass, check to see if actual spraying occurred. (d) January 1971 to January 1972 performance report, which notes that that the Veteran had additional duties as a secretary to the Chief of Maintenance, and that she performed many functions not normally required of her specialty. 4. Obtain an addendum opinion from a VA medical professional. The Veteran may be recalled for examination, if deemed necessary. The examiner must review the claims file and must note that review in the report. All necessary tests and studies should be accomplished, and all clinical findings reported in detail. The examiner should set forth all examination findings, along with the complete rationale for all conclusions reached. The VA examiner should address the following: (a) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s current back condition, to include degenerative disc disease, is at least as likely as not caused by or related to the Veteran’s service. The examiner must discuss: 1. the Veteran’s service treatment records, which document an automobile accident, 2. complaints of back pain, 3. a diagnosis of lumbar sacral strain, 4. the Veteran’s back symptoms reported during service as to whether they were early manifestations of her current back disability. The examiner MUST discuss the Veteran’s lay statements regarding the history and chronicity of symptomatology, to include the Veteran’s ongoing reports of back pain. S/he should outline that history in the report. a) Are the Veteran’s assertions consistent with medical knowledge or implausible? b) Are the Veteran’s reports about symptoms or an in-service injury align with how the disease or disability is known to develop? • The examiner is advised that the Veteran is competent to report her symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. • If the examiner rejects the Veteran’s reports of symptomatology, a reason for doing so must be provided. • Any opinion expressed by the VA examiner must “contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). 5. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Abdelbary, 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.