Citation Nr: 21008657 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 18-04 824 DATE: February 17, 2021 ISSUES 1. Whether new and material evidence has been received to reopen a claim of service connection for diabetes mellitus, type II, to include as due to herbicide exposure. 2. Whether new and material evidence has been received to reopen a claim of service connection for neuritis or radiculopathy of the bilateral upper extremities, claimed as secondary to diabetes mellitus, type II. 3. Whether new and material evidence has been received to reopen a claim of service connection for neuritis or radiculopathy of the bilateral lower extremities, claimed as secondary to diabetes mellitus, type II. 4. Entitlement to service connection for diabetes mellitus, type II, to include as due to herbicide exposure. 5. Entitlement to service connection for neuritis or radiculopathy of the bilateral upper extremities, claimed as secondary to diabetes mellitus, type II. 6. Entitlement to service connection for neuritis or radiculopathy of the bilateral lower extremities, claimed as secondary to diabetes mellitus, type II. ORDER New and material evidence sufficient to reopen the claim of service connection for diabetes mellitus, type II, to include as due to herbicide exposure has been received, and to that extent only, the claim is granted. New and material evidence sufficient to reopen the claim of service connection for neuritis or radiculopathy of the bilateral upper extremities, claimed as secondary to diabetes mellitus, type II has been received, and to that extent only, the claim is granted. New and material evidence sufficient to reopen the claim of service connection for neuritis or radiculopathy of the bilateral lower extremities, claimed as secondary to diabetes mellitus, type II has been received, and to that extent only, the claim is granted. Entitlement to service connection for diabetes mellitus, type II, to include as due to herbicide exposure is granted. Entitlement to service connection for neuritis or radiculopathy of the bilateral upper extremities, as secondary to diabetes mellitus, type II is granted. Entitlement to service connection for neuritis or radiculopathy of the bilateral lower extremities, as secondary to diabetes mellitus, type II is granted. FINDINGS OF FACT 1. An April 2014 Rating decision denied service connection for diabetes mellitus, type II associated with herbicide exposure. The Veteran was notified of his rights, but did not express timely disagreement or submit new evidence within one year. That decision became final. 2. The evidence associated with the record since the April 2014 Rating decision relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim of service connection for diabetes mellitus, type II, to include as due to herbicide exposure. 3. An April 2014 Rating decision denied service connection for peripheral neuropathy, bilateral upper extremities. The Veteran was notified of his rights, but did not express timely disagreement or submit new evidence within one year. That decision became final. 4. The evidence associated with the record since the April 2014 Rating decision relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim of service connection for neuritis or radiculopathy of the bilateral upper extremities, claimed as secondary to diabetes mellitus, type II. 5. An April 2014 Rating decision denied service connection for peripheral neuropathy, bilateral lower extremities. The Veteran was notified of his rights, but did not express timely disagreement or submit new evidence within one year. That decision became final. 6. The evidence associated with the record since the April 2014 Rating decision relates to an unestablished fact necessary to substantiate the claim, and raises a reasonable possibility of substantiating the claim of service connection for neuritis or radiculopathy of the bilateral lower extremities, claimed as secondary to diabetes mellitus, type II. 7. The Veteran’s duties at Korat Royal Thai Air Force Base likely placed him near the perimeter of the base. Herbicide agent exposure may be presumed. 8. The Veteran has diabetes mellitus, type II. 9. The competent, credible, and probative lay and medical evidence is in relative equipoise as to whether the Veteran’s peripheral neuropathy of the of the bilateral upper extremities was proximately caused by, or aggravated by, service-connected diabetes mellitus, type II. 10. The competent, credible, and probative lay and medical evidence is in relative equipoise as to whether the Veteran’s peripheral neuropathy of the of the bilateral lower extremities was proximately caused by, or aggravated by, service-connected diabetes mellitus, type II. CONCLUSIONS OF LAW 1. New and material evidence sufficient to reopen the claim of service connection for diabetes mellitus, type II, to include as due to herbicide exposure has been received. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (a) (2018). 2. New and material evidence sufficient to reopen the claim of service connection for neuritis or radiculopathy of the bilateral upper extremities, claimed as secondary to diabetes mellitus, type II has been received. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (a) (2018). 3. New and material evidence sufficient to reopen the claim of service connection for neuritis or radiculopathy of the bilateral lower extremities, claimed as secondary to diabetes mellitus, type II has been received. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (a) (2018). 4. Diabetes mellitus, type II is presumed to have been incurred in wartime service. 38 U.S.C. §§ 1101, 1110, 1116, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 5. Resolving reasonable doubt in the Veteran’s favor, peripheral neuropathy of the of the bilateral upper extremities is proximately due to, or the result of, service-connected diabetes mellitus, type II. 38 U.S.C. §§ 1110; 38 C.F.R. §§ 3.303, 3.310 (2018). 6. Resolving reasonable doubt in the Veteran’s favor, peripheral neuropathy of the of the bilateral lower extremities is proximately due to, or the result of, service-connected diabetes mellitus, type II. 38 U.S.C. §§ 1110; 38 C.F.R. §§ 3.303, 3.310 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1966 to March 1969. This matter is before the Board of Veterans Appeals (Board) on appeal from an April 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The Veteran testified before the undersigned Veterans Law Judge (VLJ) in January 2021. A copy of the hearing transcript has been associated with the claims file. Please note that the case has been advanced on the docket pursuant to 38 C.F.R. § 20.900 (c) (2018). See January 2021 Hearing Transcript, p. 16. The Board observes that during the pendency of his appeals, an April 2019 Rating decision granted service connection for erectile dysfunction and special monthly compensation (SMC) for loss of use of a creative organ. A May 2019 Rating decision granted service connection for gastroesophageal reflux disease (GERD). Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2018). The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015, cert denied, U.S.C. Oct. 3, 2016) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board....to search the record and address procedural arguments when the [appellant] fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant’s failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran’s claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Finality of Service Connection Claims 1. Whether new and material evidence has been received to reopen a claim of service connection for diabetes mellitus, type II, to include as due to herbicide exposure 2. Whether new and material evidence has been received to reopen a claim of service connection for neuritis or radiculopathy of the bilateral upper extremities, claimed as secondary to diabetes mellitus, type II 3. Whether new and material evidence has been received to reopen a claim of service connection for neuritis or radiculopathy of the bilateral lower extremities, claimed as secondary to diabetes mellitus, type II The Board incorporates its discussion from the sections above by reference. Service connection for diabetes mellitus, type II and peripheral neuropathy of the bilateral upper and lower extremities was denied in an April 2014 Rating decision. The Veteran was informed of the decision and of the right to appeal. He did not appeal or submit new and material evidence within one year of notification. That decision is final. At the time of the decision, the record included the claims and the service records. Service in the Republic of Vietnam and exposure to herbicide agents in Thailand were both not conceded. There was no presumptive nexus to service. There was no accepted evidence of the claimed disabilities in service or another link (nexus) to service. However, if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. 38 U.S.C. § 5108. New evidence means existing evidence not previously submitted to agency decision makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). The United States Court of Appeals for Veterans Claims (Court) interpreted the language of 38 C.F.R. § 3.156(a) as creating a low threshold. See Shade v. Shinseki, 24 Vet. App. 110 (2010). The Court emphasized that the regulation is designed to be consistent with 38 C.F.R. § 3.159(c)(4), which “does not require new and material evidence as to each previously unproven element of a claim.” See id. In February 2016 VA received the Veteran’s application to reopen the claims of service connection for diabetes mellitus, type II and peripheral neuropathy of the bilateral upper and lower extremities. The additional evidence presented includes post-service lay and historical evidence (maps, photographs) showing service near the perimeter of a Royal Thai Air Force Base (RTAFB) during the Vietnam era. Additional evidence includes lay and general historical evidence of a stopover in the Republic of Vietnam during a return flight, and treatment reports from hospitals and medical centers. The evidence establishes that the Veteran has the claimed disabilities, and served on a RTAFB near the perimeter where he may have been exposed to herbicides. Upon a successful showing of exposure to herbicides in service, the Veteran may be entitled to service connection on the basis of having a presumptive disease associated with exposure to herbicides. As a lack of evidence supporting a nexus to service was one of the bases for the previous denial of the claim was one of the bases for the previous denial of the claim, this evidence is new and material under 38 C.F.R. § 3.156. In light of this new and material evidence, the Veteran’s claims of service connection for diabetes mellitus, type II, and peripheral neuropathy of the bilateral upper and lower extremities are reopened. These issues are adjudicated on their merits below. Service Connection 4. Entitlement to service connection for diabetes mellitus, type II, to include as due to herbicide exposure 5. Entitlement to service connection for neuritis or radiculopathy of the bilateral upper extremities, claimed as secondary to diabetes mellitus, type II 6. Entitlement to service connection for neuritis or radiculopathy of the bilateral lower extremities, claimed as secondary to diabetes mellitus, type II The Board incorporates its discussion from the sections above by reference. To establish service connection a Veteran must generally 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.” Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also 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). For the showing of chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word “Chronic.” When the disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim. 38 C.F.R. § 3.303 (b). Except as provided in § 3.300(c), disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310 (a). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310 (b). A disease specified in paragraph (2) of this subsection becoming manifest as specified in that paragraph in a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975; and (B) each additional disease (if any) that (i) the Secretary determines in regulations prescribed under this section warrants a presumption of service-connection by reason of having positive association with exposure to an herbicide agent, and (ii) becomes manifest within the period (if any) prescribed in such regulations in a veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, and while so serving was exposed to that herbicide agent, shall be considered to have been incurred in or aggravated by such service, notwithstanding that there is no record of evidence of such disease during the period of such service. 38 U.S.C. § 1116 (a)(1). A veteran who, during active military, naval, or air 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 such service to an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such 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. Service in the Republic of Vietnam includes service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam. 38 C.F.R. § 3.307 (a)(6)(iii). Compensation 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 Thailand military bases. When a Veteran with service in Thailand during the Vietnam Era claims service connection (SC) for disability based on herbicide exposure, follow the steps in the table below to verify exposure to herbicides. Did the Veteran serve in the U.S. Air Force in Thailand during the Vietnam Era at one of the following Royal Thai Air Force Bases (RTAFBs) U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat, or Don Muang; and as an Air Force security policeman, security patrol dog handler, member of the security police squadron, or otherwise near the air base perimeter as shown by evidence of daily work duties, performance evaluation reports, or other credible evidence. See M21-1, Part IV, Subpart ii, Chapter 1, Section H - Developing Claims for Service Connection (SC) Based on Herbicide Exposure. For the purposes of this section, the term herbicide agent means a chemical in an herbicide used in support of the United States and allied military operations in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, specifically: 2,4-D; 2,4,5-T and its contaminant TCDD; cacodylic acid; and picloram. 38 C.F.R. § 3.307 (a)(6)(i). If a veteran was exposed to an herbicide agent during active military, naval, or air service, the following diseases shall be service-connected if the requirements of §3.307(a)(6) are met even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of §3.307(d) are also satisfied. AL amyloidosis, chloracne or other acneform disease consistent with chloracne, type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes), Hodgkin’s disease, ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal’s angina), all chronic B-cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia), multiple myeloma, non-Hodgkin’s lymphoma, Parkinson’s disease, early-onset peripheral neuropathy, porphyria cutanea tarda, prostate cancer, Respiratory cancers (cancer of the lung, bronchus, larynx, or trachea), soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma). 38 C.F.R. § 3.309 (e). The diseases listed at § 3.309(e) shall have become manifest to a degree of 10 percent or more at any time after service, except that chloracne or other acneform disease consistent with chloracne, porphyria cutanea tarda, and early-onset peripheral neuropathy shall have become manifest to a degree of 10 percent or more within a year after the last date on which the veteran was exposed to an herbicide agent during active military, naval, or air service. 38 C.F.R. § 3.307 (a)(6)(ii). VA has determined there is no positive association between exposure to herbicides and any other condition for which the Secretary has not specifically determined that a presumption of service connection is warranted. See Notice, 68 Fed. Reg. 27630-27641 (2003). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154 (a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). The Board, as fact finder, is obligated to, and fully justified in, determining whether lay evidence is credible in and of itself, i.e., because of possible bias, conflicting statements, etc. Id. By way of history, the Service Treatment Records (STRs) and Service Personnel Records (SPRs) show that the Veteran’s Military Occupational Specialty (MOS) was as Communications Specialist. His service included being stationed at Korat Thai AFB in Thailand. The STRs include a February 1969 Report of Medical Examination from separation. It disclosed a clinically normal evaluation of the abdomen and viscera, endocrine system, upper extremities, feet, lower extremities, and neuralgic system. There were no recommendations for future specialist examinations. The physician indicated that the Veteran was qualified for separation. There were no other signs, symptoms, or complaints of diabetes mellitus or peripheral neuropathy in service. Years later, a March 31, 2014 Administrative Decision from the Joint Services Records Research Center (JSRRC) Coordinator is of record. It reads in part, “We have determined that the information required to verify service in the Republic of Vietnam, or Agent Orange exposure during military service is insufficient to concede that the Veteran was exposed to herbicides.” Next, the April 2014 Rating decision denied service connection for the claimed disabilities. Later, received in February 2016, the Veteran submitted a clutch of lay and historical evidence accompanied by an explanatory VA 21-4138 Statement in Support of Claim. This was included with his application to reopen the previously denied service connection claims. The first VA Form 21-4138 is signed on January 27, 2016. In it, the Veteran explains that herbicides were sprayed in and around the Korat base in Thailand. He was stationed at Camp Friendship in Korat Thailand from March 1967 to March 1968. He was assigned to the 442nd LL Signal Battalion and worked at Jones Park (Communication Arrays) off base. He worked 12 hour shifts with some days off. They were transported to and from the site in an open “deuce and a half truck” at the beginning of each shift and for lunch. They were responsible for providing their own security patrols. The guard shack was located on the interior perimeter of the compound. On multiple occasions, while on guard duty, he observed trucks with spray rigs spraying to keep foliage back. There was never any vegetation growing around the arrays. The Veteran cited various primary documents, including a U.S. Army Field Manual that reportedly shows that communication lines were to be defoliated. The Veteran continued explaining that his hooch was exposed to the elements, with wide open shutters to allow for airflow. Anything in the wind blew in, and they did laundry outside. He lived near the perimeter of the base in his assigned hooch. The Veteran referenced attached pictures, maps, and other evidence. In accompanying correspondence, the Veteran submitted photographs and maps corroborating the details regarding the setup and features of Camp Friendship, the hooches, and Jones Park. Another page from the February 2016 cache shows that the Veteran was later diagnosed with diabetes mellitus, type II. He began Metformin on February 23, 2009. Medical evidence includes glucose and A1C readings from 2012. In January 2014, during a routine medical visit, he mentioned pain in his legs and tingling in his limbs. The Veteran was diagnosed with peripheral neuropathy and began Gabapentin. The Veteran also submitted VA Compensation & Pension Service Bulletins showing that the VA ROs should develop the record to determine whether the Veteran’s service activities involved duty “on or near the perimeter of the military base[s]” in Thailand. The Veteran highlighted relevant portions of the Bulletins. Significantly, a May 2010 Bulletin includes a section that allows for credible lay evidence of security duty along the perimeter to establish that herbicide exposure may be presumed. See May 2010 C&P Bulletin Correspondence, p. 3. Next, the Veteran filed a timely May 2016 Notice of Disagreement (NOD). He asserted that he has provided the evidence needed to prove that he ate, slept, and worked on or near the perimeter during the entire year he was in Thailand. The Veteran explained that he was diagnosed with diabetes mellitus, type II in 2009. Since then he has developed bilateral peripheral neuropathy. He hurts all the time and has tripled his medication since it was diagnosed in 2014. The Veteran referenced and attached additional supporting evidence. The Veteran submitted a detailed lay history from May 2016. His accounts are consistent with prior lay statements. He also attached maps showing the areas on base he described. Next, the Veteran perfected his appeals in January 2018. He wrote that he lived on the perimeter of the Royal Thai Air Force Base (RTAFB) and Camp Friendship at Korat for one year while stationed at Camp Friendship. He believes he has proof that he was exposed to herbicide agents there. He cites a C&P Bulletin from May 2010 showing that he qualifies for the presumption because he was “on or near the perimeter of the base.” Ongoing VA treatment records establish diagnosed diabetes mellitus, type II and bilateral peripheral neuropathy. For example, an April 11, 2018 VA Neurology Consultation shows in part: CONSULT DATE: 4/11/18 ASSESSMENT/DIAGNOSIS: (1)Diabetic neuropathy with neuropathic in legs, symptoms worsen by walking (2)Low back pain, we have to exclude anatomical abnormalities causing spinal claudication. … MAIN COMPLAINT: neuropathic pain SUBJECTIVE/HISTORY PRESENT ILLNESS:72 WM for ten years has burning in feet which gets much worse after walking or standing, he is able to walk 5 blocks the pain and burning and tingling gets unbearable and he has to sit down he is unable to tell if the legs get weak or not. No spontaneous burning in feet at night but feet are sensitive to touch. He has intermittent back pain received nerve blocks never MRI lumbar B12, hepatitis c TSH normal gabapentin 2400mg completely ineffective PAST MEDICAL HISTORY: As above FAMILY HISTORY: noncontributory. Additional VA and private treatment records are substantially the same. Next, the Veteran presented consistent and credible testimony at the January 2021 hearing. The Board incorporates his lay statements by reference. Regarding guard duties placing him in the perimeter, the Veteran described: In Thailand, the communications was in a major relay station off base at a place called Jones Park, and in that Jones Park, we had about a 600-yard defoliated area, and we pulled guard duty there and watched them spray it to keep the weeds out of it. See January 2021 Hearing Transcript, p. 5. Next, he explained the demands of guard duty: Okay. We pulled guard duty usually about every other day. We were a small outfit, and we were the only ones that pulled it between us and the repair people that was on it, and it was like a daily roster. When you was on duty, if you pulled it the day before you got a day relief. We worked on --no telling how many days till we got one day off. Usually the day off was when we swapped from night shift to day shift or vice versa. See January 2021 Hearing Transcript, p. 5. The Veteran described that he would see spraying during the day about once per week. Id. Regarding his living situation, he explained: I lived on the perimeter fence, the perimeter fence between the air base and the Army base. I was about 20 feet from it in my open-air hooch. … I was whatever wind because we wanted every minute of wind we could get in that hooch. See January 2021 Hearing Transcript, p. 6. The Veteran went on to explain that nobody else in his family had diabetes going back to his great great grandfather. His problems began in 2009, but he was prediabetic prior to that. Id. at pp.7-8. Later, the Veteran’s witness related that the Veteran reports landing in Saigon on his way home. Id. at p.11. Regarding his daily activities in Thailand, the Veteran described that he would load on a bus and go downtown, thereby crossing the base perimeter. He crossed the gate of the base multiple times per day going back and forth to Jones Park. Id. at pp.12-13. Also in January 2021, the Veteran submitted a trove of additional primary documents, photographs, maps, lay histories, buddy statements, and medical evidence. We have considered this evidence, and it is consistent with the Veteran’s continued assertions. First are historical records that include Commander’s Recommendations from 1967 showing that United States troops were to be utilized to augment Thai Security Guards, where required. A series of relatively thorough lay statements describe the storage of chemical drums at RTAFBs and efforts to cut and spray all foliage around the perimeter and behind it on base as result of sapper attacks. A signed affidavit from the State of Georgia by J. D. H. shows that he was assigned to Mukdahan Royal Thai Air Force Base (RTAFB) from June 1966 to June 1967. He observed spraying of herbicides to control vegetation at the perimeter and miscellaneous fences, around structures, and around bunkers. The names of the herbicides were unknown to him. The was sworn to on June 19, 2003. The Veteran also submitted a substantially the same VA 21-4138 Statement in Support of Claim citing the attached primary documents showing security guard duties by U.S. personnel. The Veteran submitted an additional document labeled as Correspondence containing tables breaking down the evidence supporting each of his contentions. In addition to the guard duties and living situation contentions, he adds “All New Info” regarding alleged boots on the ground in Saigon in the Republic of Vietnam. He reports that he landed in Saigon while it was being bombed during the Tet Offensive. The Veteran recounts that they had to deplane while the plane refueled. It was common knowledge that the planes did not have the range to fly non-stop from Thailand to the United States. Additional evidence received in January 2021 is substantially the same. Of note, received on January 6, 2021 and dated January 25, 2019 is an “Independent Medical Examination” from the Ellis Clinic. It shows that Dr. J. W. E., M. D. performed an examination as part of evaluating the Veteran. The physician documented the Veteran’s detailed history of exposure to toxic defoliate/herbicide from his time in Thailand. Dr. E. wrote in part: The patient started having symptoms of fatigue, increased urination and weight gain of forty pounds in 2007. He was diagnosed with borderline diabetes and was placed on a diabetic diet and exercise, which did not work. The patient was started on Metformin in 2009. In 2010 when the patient bought a house in Texas, his exercise level went up and he’ was on a strict diabetic diet, which brought his Al level down to 6.8. Currently, the patient is on a maximum dose of Metformin daily with diet and exercise to control the blood sugar. The patient started experiencing tingling and numbness in his feet in 2012 and he started on Gabapentin to help with peripheral neuropathy secondary to diabetes type 2. Later on, the patient developed symptoms in his hands. After maxing out on Gabapentin and trying other drugs to try and control symptoms, the patient’s neuropathy symptoms are not under good control Next, on page 2, Dr. E. diagnosed the claimed diabetes mellitus and bilateral upper and lower extremity diabetic peripheral neuropathy. He rendered a series of positive nexus opinions. For diabetes, he concluded: It is my medical opinion, it is more likely than not, that the patient’s diabetes nad its complications are service connected because of the exposure to herbicide/toxic defoliant when he was serving in the U.S. Army. The patient was exposed to herbicide/Agent Orange when he was stationed and lived in the vicinity of military place guard station on the perimeter fence between Korat Air Base and Camp Friendship Army Base due to the wind direction and the amount of Agent Orange that was sprayed via aircraft over Thailand during the Vietnam War. Next, the physician also rendered a positive nexus opinion for secondary service connection for bilateral upper and lower extremity diabetic peripheral neuropathy. The private physician wrote: It is my medical opinion, it is more likely than not, that the patient’s diabetic neuropathy is service connection because of the exposure to Agent Orange, which caused the patient to develop diabetes type 2. Due to increased oxidative stress, the patient developed burning, prickling and allodynia (which is hypersensitivity) and numbness in the extremities…This distal symmetrical sensory polyneuropathy is secondary to diabetes type 2, which developed in this patient from exposure to the herbicide. Dr. J. W. E. attached laboratory reports and examination results from the Veteran. He signed the document under penalty of perjury. He enclosed the C&P Bulletin from May 2010. The Veteran contends that he is entitled to service connection for diabetes mellitus type II, as due to herbicide exposure; and that secondary service connection is warranted for bilateral upper and lower extremity diabetic peripheral neuropathy. As a threshold issue, the evidence from his DD-214s does not show the Veteran’s presence in the Republic of Vietnam. Nevertheless, the Veteran’s Service Personnel Records (SPRs) include several copies of an Extract from the Department of The Army 442nd Signal Battalion (Long Lines) showing transportation on May 31, 1968 to Don Muang Bangkok APO. See Military Personnel Record, received by VA on May 16, 2014. Consistently, Service Treatment Records (STRs) received on August 2, 2013 include a log of the Veteran’s “Foreign Service” on page 5 of 21. The log shows that the Veteran served as a Communications Specialist at USARPAC (Thailand) for 12 months, form June 2, 1967 to June 1, 1968. Additional SPRs intermingled with these Service Treatment Records (STRs) on page 8 show that the Veteran served at Korat beginning in June 1967. Later, January 2021 hearing testimony is consistent with the records. It confirms the Veteran’s service at Korat Royal Thai Air Force Base (RTAFB) for one year, including near the gate of Camp Friendship. Based upon the STRs, maps, and the supporting evidence discussed below, we recognize the Veteran’s service at Korat RTAFB during the Vietnam Era. Thus, the first critical element as to whether the Veteran is entitled to the presumption of herbicide exposure is whether he served along the perimeter of the Korat RTAFB. The Veteran has continued to submit consistent and credible lay statements asserting that U.S. personnel had to pull guard duty near the base perimeter. Photographs establish that those perimeters were defoliated. Regarding herbicide exposure, the Veteran has continued to submit consistent and credible lay statements that U.S. personnel had to pull guard duty near the base perimeter. Of many lay statements, a signed affidavit from the State of Georgia by J. D. H. shows that he was similarly assigned to Mukdahan Royal Thai Air Force Base (RTAFB) from June 1966 to June 1967. He observed spraying of herbicides to control vegetation at the perimeter and miscellaneous fences, around structures, and around bunkers. Photographs establish that the perimeters of Korat were defoliated. The Veteran’s lay statements and the collection of third party buddy statements establish that this was partially due to spraying herbicides. The lay statements are corroborated by photographs and maps of the base. See January 2021 Correspondence. Next, the Veteran explained the demands of guard duty: Okay. We pulled guard duty usually about every other day. We were a small outfit, and we were the only ones that pulled it between us and the repair people that was on it, and it was like a daily roster. When you was on duty, if you pulled it the day before you got a day relief. We worked on --no telling how many days till we got one day off. Usually the day off was when we swapped from night shift to day shift or vice versa. See January 2021 Hearing Transcript, p. 5. The Veteran described that he would see spraying during the day about once per week. Id. Regarding his living situation, he explained: I lived on the perimeter fence, the perimeter fence between the air base and the Army base. I was about 20 feet from it in my open-air hooch.… I was whatever wind because we wanted every minute of wind we could get in that hooch. In addition, the Veteran and his spouse testified at the January 2021 hearing that the Veteran had to cross the perimeter several times per day as part of his duties to get to Jones Park. See January 2021 Hearing Transcript, pp. 12-13. The lay statements are corroborated by photographs and maps of the base. See January 2021 Correspondence. The Board is satisfied that the Veteran has established service and living that included crossing, working, guarding, and sleeping near the perimeter. Ongoing lay statements are consistent with the Veteran’s testimony establishing that herbicide agents were sprayed along the perimeter of the base, consistent with primary documents from that time frame. See January 2021 Correspondence. Photographs show defoliated areas. The Veteran asserted that he was in and near the perimeter as part of his official duties and living assignment. To the extent the March 31, 2014 VA Memorandum shows that for this Veteran herbicide exposure at Korat cannot be confirmed, it is outweighed by the maps, photographs, lay statements, and primary documents submitted by the Veteran. In short, the Veteran’s credible lay assertions collectively establish his presence in the perimeter of the base where herbicide agents were used. Indeed, the Board finds that the Veteran has been a consistent historian regarding his duties, the layout of the base, nature of living in a hooch, guard duty by U.S. troops on the RTAFB, and other relevant details. The Board therefore affords significant probative weight to the Veteran’s competent and credible lay testimony. His statements and MOS indicate that he regularly traveled across the base perimeter during his year in Thailand from 1967 to 1968. Exposure to herbicide agents is conceded. The issue of exposure to herbicide agents as it relates to his service connection claims will be discussed further below. In short, based on the Veteran’s credible assertion of serving along the perimeter of Korat RTAFB, the Board finds that the weight of the evidence shows that the Veteran is presumed to have been exposed to herbicide agents during service. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102 (2017); M21-1, Part IV, Subpart ii, Chapter 1, Section H - Developing Claims for Service Connection (SC) Based on Herbicide Exposure. In rendering this decision, the Board has assigned significant probative weight to the maps, manuals, and photographs placing the Veteran in areas at Korat that were clear of foliage. Turning to the merits of the appeals, the Veteran contends that he is entitled to service connection for diabetes mellitus, type II. The Veteran has submitted copies of historical private treatment records showing laboratory findings for A1C and blood glucose. Received on January 6, 2021 and dated January 25, 2019 is an “Independent Medical Examination” from the Ellis Clinic. It shows that Dr. J. W. E., M. D. performed an examination as part of evaluating the Veteran. The physician documented the Veteran’s detailed history of exposure to toxic defoliate/herbicide from his time in Thailand. Dr. J. W. E. opined in part, “The patient started having symptoms of fatigue, increased urination and weight gain of forty pounds in 2007. He was diagnosed with borderline diabetes and was placed on a diabetic diet and exercise, which did not work. The patient was started on Metformin in 2009.” The Veteran went on to explain that nobody else in his family had diabetes going back to his great great grandfather. His problems began in 2009, but he was prediabetic prior to that. See January 2021 Hearing Transcript, pp. 7-8. In the instant case, the Veteran is now presumed to have been exposed to herbicide agents in service, and diabetes mellitus, type II is a disease that has been shown to be associated with exposure to herbicide agents. It is presumed that his diabetes disability was incurred in service even without evidence of that disease during service. 38 U.S.C. § 1116 (a); 38 C.F.R. §§ 3.307 (a)(6), 3.309(e). Consequently, service connection for diabetes mellitus, type II, as due to herbicide exposure, is warranted. Next, the Board will consider the service connection claims for the bilateral upper and lower extremity diabetic peripheral neuropathy. The Veteran’s central theory of entitlement is that the peripheral neuropathies developed as a result of his diabetes mellitus, type II. The Veteran’s spouse testified, “It [was] probably 2012, 2014, somewhere along through there is when he – he was complaining about his feet and legs bothering him all the time.” See January 2021 Hearing Transcript, p. 7. Consistently, Dr. J. W. E., M. D. rendered a positive nexus opinion for secondary service connection for bilateral upper and lower extremity diabetic peripheral neuropathy. For clarity, the Board observes that although this was received on January 6, 2021, it is dated January 25, 2019. The private physician opined: It is my medical opinion, it is more likely than not, that the patient’s diabetic neuropathy is service connection because of the exposure to Agent Orange, which caused the patient to develop diabetes type 2. Due to increased oxidative stress, the patient developed burning, prickling and allodynia (which is hypersensitivity) and numbness in the extremities…This distal symmetrical sensory polyneuropathy is secondary to diabetes type 2, which developed in this patient from exposure to the herbicide. Dr. J. W. E. attached laboratory reports and examination results from the Veteran. He signed the document under penalty of perjury. He enclosed the C&P Bulletin from May 2010. Here, the Veteran contends that service connection for bilateral upper and lower extremity diabetic peripheral neuropathy is warranted on a secondary basis. More specifically, he contends that his bilateral upper and lower extremity diabetic peripheral neuropathy is proximately due to his service-connected diabetes mellitus, type II. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (2012); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the evidence must preponderate against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Service connection has been established for diabetes mellitus, type II. The Board has considered the evidence of record, and finds that bilateral upper and lower extremity diabetic peripheral neuropathy is proximately due to, or aggravated by diabetes mellitus, type II. Importantly, the January 6, 2021 private medical opinion from Dr. J. W. E. dated January 25, 2019 related to secondary service connection includes a positive nexus opinion. Dr. J. W. E. interviewed the Veteran, performed a physical examination, and based his medical opinion upon his medical expertise. He specifically wrote in a signed statement at the end that his opinion is based upon reasonable medical probably and reasonable medical certainty. The Board has considered that the physician conducted an interview with the Veteran. It does not show that the claims file was reviewed, only that “records” were reviewed. However, given the theory of entitlement, the physician had sufficient information to render a probative medical opinion. We afford moderate probative weight to Dr. J. W. E.’s private examination with medical opinion. Therefore, resolving all reasonable doubt in the Veteran’s favor, the Board finds that it is at least as likely as not that the Veteran’s current bilateral upper and lower extremity diabetic peripheral neuropathy, was either proximately caused by, or aggravated by, service-connected PTSD. There is no probative evidence to the contrary regarding the relationship between peripheral neuropathy and diabetes. The Veteran is therefore entitled to the benefit of the doubt. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, service connection for bilateral upper and lower extremity diabetic peripheral neuropathy, as secondary to service-connected diabetes mellitus, type II is warranted. 38 C.F.R. § 3.310. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). This represents a full grant of these benefits sought. AB v. Brown, 6 Vet. App. 35, 38 (1993). Michael A. Pappas Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Bodi, 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.