Citation Nr: 21015715 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 16-14 193 DATE: March 18, 2021 ORDER Service connection for diabetes mellitus, type II, is granted. REMANDED Entitlement to service connection for retinopathy as secondary to diabetes mellitus and as a result of exposure to herbicides. is remanded. Entitlement to service connection for erectile dysfunction / loss of creative organ as secondary to diabetes mellitus and as a result of exposure to herbicides is remanded. Entitlement to service connection for neuropathy, left hand as secondary to diabetes mellitus and as a result of exposure to herbicides is remanded. Entitlement to service connection for neuropathy, left lower extremity as secondary to diabetes mellitus and as a result of exposure to herbicides is remanded. Entitlement to service connection for neuropathy, right hand as secondary to diabetes mellitus and as a result of exposure to herbicides is remanded. Entitlement to service connection for neuropathy, right lower extremity as secondary to diabetes mellitus and as a result of exposure to herbicides is remanded. Entitlement to service connection for hypertension as secondary to diabetes mellitus and as a result of exposure to herbicides. is remanded. Entitlement to service connection for gum disease as secondary to diabetes mellitus and as a result of exposure to herbicides is remanded. FINDING OF FACT It is as likely as not that the Veteran’s diabetes mellitus, type II, is etiologically related to exposure to toxins in service. CONCLUSION OF LAW With resolution of the doubt in favor of the Veteran, the criteria for entitlement to service connection for diabetes mellitus, type II, have been met. 38 U.S.C. §§ 1110, 1116 (2012); 38 C.F.R. §§ 3.303 , 3.307, 3.309 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 1965 to October 1969 with additional service in the U.S. Air Force National Guard and Reserves. Service Connection Entitlement to service connection for diabetes mellitus, as due herbicide exposure The Board concludes that the Veteran has a diabetes that is as likely as not related to his period of service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The Veteran's DD 214 showed honorable service in the U.S. Air Force from October 1965 to October 1969. Military service personnel records show his military occupation was vehicle operator and service in Guam from July 17, 1968 to October 7, 1969. In a September 2013 statement the Veteran reported exposure to toxins when performing “duties to transect and direct aircraft from Republic of Vietnam” as well as exposure to other environmental toxins while serving at Andersen Air Force Base in Guam. The Veteran submitted an August 2014 letter by Dr. M.M. who indicated that the Environmental Protection Agency (EPA) has established a superfund site at Andersen Air Force Base as being toxic due to the presence of contaminants including dioxins. Dr. M.M. stated that the Veteran’s duties as a vehicle operator required him to be on the flight line where the dioxins were sprayed. Dr. M.M. also referenced several other studies, including a congressional report entitled Hazardous Waste Problems at Department of Defense Facilities, “which include evidence of the long-term presence of persistent organic pollutants and other contaminants in the soil and water sources at Andersen Air Force Base including dioxins, PCBs, and pesticides of the same or similar class as those implicated under 38 C.F.R. § 3.307(a)(6)(i).” Dr. M.M. then opined that given the Veteran’s duties while stationed at Andersen Air Force Base and his likely exposure to pathogenic chemicals, “[i]t is more likely than not that his diabetes is service connected and a result from being exposed while stationed in Guam.” The claims were remanded by the Board in May 2019 to obtain additional information. Pursuant to the Board remand directives, a response from DPRIS stated: Available records show that DOD stored and used commercial herbicides on Guam, possibly including those containing n-butyl 2,4,5-T, during the 1960s and 1970s, but documents do not indicate the use of tactical herbicides on Guam. Commercial herbicides were available through the federal supply system for use on U.S. military installations worldwide. For example, the fuel supply for Andersen Air Force Base was delivered by ship to the port at Naval Base Guam and was then delivered to the Air Force base by a cross-island fuel pipeline. A detailed 1968 report by the Naval Supply Depot states that the Public Works Center sprayed herbicides semi-annually to control the vegetation along fuel pipelines between the depot and Andersen Air Force Base. The Veteran was afforded a VA examination in June 2020. The examiner opined that the Veteran's diabetes was as least as likely as not due to service. The veteran reports exposure to numerous environmental toxins other than Agent Orange while stationed in Guam. The veteran’s duties as a vehicle operator required him to work on flight line where PCBs and dioxins were sprayed. This was at Andersen Air Force Base. A Chinese study from 2008 by Wang et al. found that certain women, who had endured previous exposure to PCBs and dioxins, suffered from increased incidences of diabetes. Although this is one study, it is plausible that the veteran’s diabetes is due to exposure to chemicals in Vietnam. The claimed condition was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service injury, event, or illness. With resolution of the doubt in favor of the Veteran, the Board finds that service connection is warranted. Although the Veteran initially claimed service connection as a result of exposure to herbicides, the private opinion by Dr. M.M. and the VA examiner’s opinion both found that there is evidence to support a finding that his diabetes was caused by exposure to environmental toxins during service. The DPRIS report shows the presence of such toxins during the Veteran's service and his MOS is consistent with exposure. There is no evidence to the contrary. Therefore, after resolving all doubt in favor of the Veteran, service connection is warranted. REASONS FOR REMAND 1. Entitlement to service connection for gum disease as secondary to diabetes mellitus and as a result of exposure to herbicides is remanded. 2. Entitlement to service connection for neuropathy, right hand as secondary to diabetes mellitus and as a result of exposure to herbicides is remanded. 3. Entitlement to service connection for neuropathy, left hand as secondary to diabetes mellitus and as a result of exposure to herbicides is remanded. 4. Entitlement to service connection for neuropathy, left lower extremity as secondary to diabetes mellitus and as a result of exposure to herbicides is remanded. 5. Entitlement to service connection for neuropathy, right lower extremity as secondary to diabetes mellitus and as a result of exposure to herbicides is remanded. 6. Entitlement to service connection for hypertension as secondary to diabetes mellitus and as a result of exposure to herbicides is remanded. 7. Entitlement to service connection for retinopathy as secondary to diabetes mellitus and as a result of exposure to herbicides is remanded. 8. Entitlement to service connection for erectile dysfunction / loss of creative organ as secondary to diabetes mellitus and as a result of exposure to herbicides is remanded. Remand is necessary to afford the Veteran a VA examination to assess the complications, if any, of his diabetes mellitus. Pursuant to the above decision, the Board finds that service connected for diabetes mellitus, type II, is warranted. In the June 2020 VA examination, the VA examiner indicated “no” to whether the Veteran has complications of diabetes, including neuropathies, retinopathies, hypertension, erectile dysfunction, and skin conditions. However, the Veteran's treatment records show diagnoses of diabetes with no complications and with “unspecified complications. Therefore, a VA examination is necessary to determine whether the Veteran has gum disease, hypertension, neuropathies, retinopathy, or erectile dysfunction secondary to his diabetes. The matters are REMANDED for the following action: 1. Obtain all outstanding, relevant treatment records and associate them with the claims file. The Veteran’s assistance in identifying pertinent records should be solicited as needed. All attempts to obtain records should be documented in the claims folder. 2. Afford the Veteran a VA examination(S) to assess his diabetes and determine which, if any, additional disorders are secondary to his diabetes, too specifically include whether any of the disorders listed in the issues above are found. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shana Z. Siesser, 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.