Citation Nr: 21012420 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 14-07 702 DATE: March 4, 2021 ORDER Entitlement to service connection for diabetes mellitus type II, to include as due to herbicide agent exposure, is denied. FINDING OF FACT The Veteran was not exposed to herbicide agents during service and his diabetes mellitus type II is not otherwise etiologically related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for diabetes mellitus type II are not met. 38 U.S.C. §§ 1110, 1113, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.3.07, 3.3.09. REASONS AND BASES FOR FINDING AND CONCLUSION In October 2015, the Veteran testified before a Veterans Law Judge. A copy of the transcript has been associated with the claims file. This hearing was before a now-retired judge. In a September 2018 correspondence, the Veteran was given the opportunity to request another hearing. In an October 2018 correspondence, the Veteran declined to appear at another hearing. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Additionally, for those veterans exposed to an herbicide agent during active service, certain diseases shall be presumptively service connected, even when there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are met. 38 C.F.R. § 3.309(e). 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. See 38 C.F.R. § 3.307(a)(6). A veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period during the Vietnam Era 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. Special consideration of herbicide exposure on a factual basis is also extended to veterans whose duties placed them on or near the perimeters of military bases in Thailand during the Vietnam Era. VA has acknowledged that there was significant use of herbicide agents on the fenced-in perimeters of military bases in Thailand intended to eliminate vegetation and ground cover for base security purposes. If a veteran served in the U.S. Air Force in Thailand at U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat or Don Muang Royal Thai Air Force Base as an Air Force security policeman, security patrol dog handler, member of a security police squadron, or otherwise served near the air base perimeter, herbicide agent exposure should be conceded on a facts-found or direct basis. An individual who performed service in the Air Force or Air Force Reserve under circumstances in which the individual concerned regularly and repeatedly operated, maintained, or served onboard C-123 aircraft known to have been used to spray an herbicide agent during the Vietnam era shall be presumed to have been exposed during such service to an herbicide agent. For purposes of this paragraph, “regularly and repeatedly operated, maintained, or served onboard C-123 aircraft” means that the individual was assigned to an Air Force or Air Force Reserve squadron when the squadron was permanently assigned one of the affected aircraft and the individual had an Air Force Specialty Code indicating duties as a flight, ground maintenance, or medical crew member on such aircraft. VA has published a list of military personnel who had regular and repeated exposure to contaminated Operation Ranch Hand (ORH) C-123s, used to spray Agent Orange in Vietnam, as flight, maintenance, or medical crewmembers. See http://www.benefits.va.gov/compensation/docs/AO_C123_AFSpecialityCodesUnits.pdf. The provisions for presumptive service connection do not preclude a claimant from establishing service connection with proof of actual direct causation, on the basis that exposure to herbicides led to the development of the claimed disability after service. See Combee v. Brown, 34 F.3d 1039, 1044 (Fed. Cir. 1994). Analysis The Veteran contends that his current diabetes mellitus is due to exposure to herbicide agents during service in Thailand. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease, to include claimed herbicide agent exposure. The Board concludes that, while the Veteran has a current diagnosis of diabetes mellitus type II, the preponderance of the evidence weighs against finding that the Veteran was exposed to herbicide agents and that his diagnosis of diabetes mellitus began during service or is otherwise related to an in-service injury, event, or disease. The Veteran contends that he was exposed to herbicide agents during service in Thailand, to include at Udorn, U-Tapao and Nakhon Phanom. The Board finds that the evidence establishes that the Veteran had active service during the Vietnam era in Thailand, to include at Udorn and U-Tapao Royal Thai Air Force Bases. However, the evidence does not establish that the Veteran was exposed to herbicide agents during service in Thailand. The evidence does not establish that he served along the perimeter of the bases as security policeman, security patrol dog handler, or member of a security police squadron. Rather, personnel records indicate that the Veteran’s military occupational specialty was jet engine mechanic and lab technician. Additionally, the Veteran has not asserted that he served along the perimeter of the bases. During the October 2015 hearing, the Veteran reported that he spent most of his time in the base laboratory, which was located more or less in the middle of the base. The Board finds that the preponderance of the evidence does not establish that the Veteran served near the air base perimeter in Thailand. Accordingly, herbicide agent exposure cannot be conceded on a facts-found or direct basis. The Veteran’s military occupational specialty was jet engine mechanic. As such, the Board’s inquiry turns to whether the Veteran regularly and repeatedly operated, maintained, or served onboard C-123 aircraft known to have been used to spray an herbicide agent during the Vietnam era. As a preliminary matter, September 2019 and November 2019 correspondences requested additional information to verify whether the Veteran worked with contaminated C-123 aircraft. The Veteran did not provide the requested information. As such, service with contaminated C-123 could not be verified. Additionally, as discussed below, service records do not indicate that the Veteran worked with contaminated Operation Ranch Hand C-123s. Personnel records do not indicate that the Veteran worked with any C-123 aircraft. The Veteran has not reported that he worked with C-123 aircraft. Rather, he has reported working with other aircraft such as B-52s and C-131s. Further, the evidence does not establish that the Veteran served in active duty Air Force units that were known to be exposed to C-123 aircraft used in Operation Ranch Hand, to include the 405th Fighter Wing at Clark Air Force Base. Though service treatment records indicate that the Veteran was sent to Clark Air Force Base for medical treatment in 1974, he was not there during the time period when contaminated C-123s were determined to be at Clark Air Force Base, from 1969 to 1970. See https://www.benefits.va.gov/compensation/docs/AO_C123_AFSpecialityCodesUnits.pdf. For these reasons, the Board finds that the Veteran was not exposed to herbicide agents through exposure to contaminated C-123s. The Veteran has not asserted, and the evidence does not establish, that he had service in the Republic of Vietnam. For these reasons, the Board finds that the Veteran was not exposed to herbicide agents in Thailand or Clark Air Force Base and was not exposed to contaminated C-123s. Accordingly, herbicide agent exposure is not conceded and the presumptive service connection provisions governing herbicide agent exposure do not apply. Though the provisions for presumptive service connection do not apply, the Veteran is not precluded from establishing service connection with proof of actual direct causation. See Combee v. Brown, 34 F.3d 1039, 1044 (Fed. Cir. 1994). The evidence does not establish that diabetes mellitus manifested in service. Service treatment records do not contain any treatment, complaints, or diagnosis of diabetes mellitus during active service. The Veteran has not alleged any in-service events or injuries, with the exception of claimed herbicide agent exposure. As discussed extensively above, herbicide agent exposure has not been shown. Additionally, private treatment records show the Veteran was not diagnosed with diabetes mellitus until July 2009, several decades after his separation from service. For these reasons, and in the absence of an in-service event or injury, the Board finds that the record does not establish direct causation. While the Veteran is competent to report his sincere belief that diabetes is related to service, he is not competent to provide a diagnosis in this case or determine that that his diabetes is related to service. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). In conclusion, the Board finds that the preponderance of the evidence does not demonstrate an in-service event or injury, to include herbicide agent exposure. The evidence is not in equipoise and, as such, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Service connection for diabetes mellitus is not warranted and the claim is denied. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Vang, Stephanie 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.