Citation Nr: 21022870 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 15-38 378 DATE: April 19, 2021 ORDER Entitlement to service connection for prostate cancer, to include as due to exposure to herbicides, is granted. Entitlement to service connection for diabetes mellitus, to include as due to exposure to herbicides, is granted. Entitlement to service connection for a left hip disability is denied. FINDINGS OF FACT 1. The Veteran had regular contact with base perimeters during service in Thailand. 2. The Veteran’s prostate cancer is related to exposure to herbicides in service. 3. The Veteran’s diabetes mellitus is related to exposure to herbicides in service. 4. A left hip disability is not shown to be causally or etiologically related to any disease, injury or incident during service, and arthritis did not manifest within one year of the Veteran’s discharge from active duty. CONCLUSIONS OF LAW 1. The criteria for service connection for prostate cancer, to include as due to exposure to herbicides, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for diabetes mellitus, to include as due to exposure to herbicides, have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for a left hip disability have not been met. 38 U.S.C. §§ 1101, 1110, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from May 1968 to May 1972, and from June 1972 to May 1989. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a May 2012, rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In October 2018, a Board hearing was held before the undersigned. Service Connection 1. Entitlement to service connection for prostate cancer 2. Entitlement to service connection for diabetes mellitus. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(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.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection for certain chronic diseases, including diabetes mellitus, type II, and prostate cancer, may be established on a presumptive basis by showing that such a disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 11101, 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service, even if there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307(a). In addition, for veterans exposed to an herbicide agent during active service, certain diseases, including diabetes mellitus, type II, and prostate cancer, shall be service connected if the requirements of 38 C.F.R. § 3.307(a)(6) are met. 38 C.F.R. § 3.309(e). VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). In an August 2018 statement, the Veteran explained that while stationed at the U-Tapao Royal Thai Air Force Base (RTAFB), he was in frequent, and close proximity to the perimeter. The Veteran reported being a vehicle maintenance supervisor and being responsible for cleaning and repairing all vehicles that were shipped from Vietnam that were exposed to Agent Orange. He reported being responsible for burning chemicals and equipment from Vietnam and coming in contact with aircraft that flew bombing missions. In a December 2020 detailed account of his duties, he reported washing and repairing military vehicles that were used to deliver and spray agent orange. He reported having to travel to the perimeter in order to retrieve the vehicle with mechanical problems in order to make necessary repairs, followed by washing and inspecting the exposed vehicle. Military personnel records show he served in Thailand from June 1970 to June 1971, with the 635th Squadron at U-Tapao Airfield, and his job duties were of motor vehicle maintenance. Performance reports show he inspected and repaired all types of special purpose vehicular equipment, starter generators, electrical systems, hydraulic system carburetor sand transmissions. Records further indicate he served in the 432nd Transportation Squadron at the Udorn RTAFB, Thailand, as a special purpose vehicle repairman. He performed scheduled and unscheduled maintenance to all assigned fire fighting vehicles. He provided technical assistance to base fire-fighting personnel in performing operator maintenance. He removed, repaired, and reinstalled major components. These records also document that he was selected for participation in a classified project that involved several days of temporary duty to a friendly foreign nation. STRs show treatment in March 1987 and August 1988 for prostatitis. The Veteran has contended that exposure to herbicide agents in Thailand caused his diabetes and prostate cancer. At the Board hearing he testified to being located in U-Tapao, Thailand, parallel with the flight line. He reported not being more than 50 to 100 yards from the actual runway. He reported that people would come through and spray the shop he was working in and clean it out. He reported also working on heavy fire equipment from fire trucks to refueling, to forklifts, and also working in the bomb dump. He reported the bomb dump was located up against the perimeter. He reported working on heavy equipment that cleared the perimeter. He reported that when vehicles broke down in the perimeter he would go out and retrieve them. He reported constantly having vehicles coming in from Vietnam, and working on them. A response was received from the Joint Services Records Research Center (JSRRC) indicating they researched the available history from the 365th Transportation Squadron stationed at U-Tapao Royal Thai Navy Airfield (RTNAF), Thailand. The information was negative and did not report or discuss the Veteran’s unit personnel duty assignment location in proximity to the base perimeter. To date, available historical information does not document Agent Orange of tactical herbicide spraying, testing, or storage at U-Tapao RTNAF, Thailand. Medical records indicate he was diagnosed with diabetes soon after service—in the early-1990s, and prostate cancer in 2011. In a November 2014 statement from Dr. C. M., it was acknowledged the Veteran served in U-Tapao and Udorn RTAFB, Thailand. The Veteran was a long-term patient who had been treated for diabetes and prostate cancer. Dr. M. concluded there is a 50 percent chance the onset of diabetes and prostate cancer developed due to his exposure to Agent Orange while in service. In October 2018, at the Travel Board hearing, the Veteran reported having prostate problems during service. In October 2019, the Veteran had a diabetes and prostate examination. He was diagnosed with diabetes and was noted to be taking insulin. As for his prostate, he reported that during service he began to experience pain in his groin area after a long convoy. He reported being prescribed medication at that time which helped his symptoms. He reported in 1989 he began to experience increased pain in his groin. During a routine visit in 2010 he was told his prostate was enlarged, and that after having a biopsy the results confirmed he had prostate cancer. He underwent cryotherapy in 2011, and his PSA is monitored every 6 months. He reported urinary leakage, fecal leakage, and urinary frequency with stress incontinence. The examiner concluded prostate cancer and diabetes mellitus are at least as likely as not incurred in or caused by an in-service, injury, event, or illness. The examiner noted the Veteran served in Cambodia and was exposed to 50-gallon drums with agent orange residuals. In July 2020, an addendum opinion was rendered. The examiner noted the Veteran served at the U-Tapao and Udorn Royal Thai Air Bases. He reported observing planes fly around the base spraying perimeter of the base in the manner of a crop duster. He reported that within a short amount of time, the vegetation in the area turned brown. During service he had instances of prostatitis. He was diagnosed with prostate cancer in 2011, and was treated with a cryosurgery to remove the prostate gland. Since the operation, he has residuals of urinary urgency, leakage, and erectile disorder. As for diabetes, the Veteran was diagnosed with diabetes in 2006. The Veteran was noted to have other symptoms of diabetes prior to the diagnosis. During service, there was evidence the Veteran was treated for yeast infections of the skin, in the groin, and athletes’ foot. The examiner noted that these particular skin conditions are more common in the presence of elevated glucose levels. Further, the examiner noted the Veteran battled with high triglycerides throughout much of his military career which is also associated with high glucose. The Veteran reported bilateral foot pain, as well as diabetic macular edema. The examiner concluded the Veteran’s prostate cancer and its residuals, and diabetes mellitus and its associated complications are at least as likely as not due to or the result of agent orange exposure at the Royal Thai Air Bases of Thailand. The examiner noted there is a study by the Department of Defense which suggests that Vietnam era Veterans may have been exposed to Agent Orange in the time periods February 1968 to May 1975 in Thailand at Royal Thai Air Bases, including Udorn, and U-Tapao, among others. The study indicates Agent Orange was used to remove foliage that provided coverage for the enemy. In a September 2020 opinion, an examiner indicated the Veteran’s prostate cancer and diabetes were not at least as likely as not due to service. The rationale was the prostatitis was acute, wherein prostate cancer is a condition composed of malignant cells. As for diabetes, there is no evidence of record the Veteran was diagnosed or treated for diabetes during service, and he was not diagnosed with diabetes until the early-1990s. Having served in Thailand with duties placing him at or near the base perimeters of a RTAFB in Thailand, exposure to herbicides is established on a direct or facts-found basis. This is particularly so when resolving reasonable doubt in the Veteran’s favor. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. These findings apply to the specific facts of this Veteran’s case. VA has determined that there was use of herbicide agents on or near the perimeters of military bases in Thailand intended to eliminate vegetation and ground cover for base security purposes. See https://www.publichealth.va.gov/exposures/ agentorange/locations/thailand.asp. If a veteran served in the U.S. Air Force in Thailand during the Vietnam era at U-Tapao, Ubon, Nakhon Phanom, Udorn, Takhli, Korat or Don Muang Royal Thai Air Force Base (RTAFB) as an Air Force security policeman, security patrol dog handler, member of a security police squadron, or otherwise served near the air base perimeter, as shown by MOS (military occupational specialty), performance evaluations, or other credible evidence, herbicide agent exposure should be conceded on a facts-found or direct basis. The Veteran consistently reported where he served while on the base, and reported visiting the perimeter to service vehicles. The record indicates the Veteran served in Thailand with duties placing him at or near the base perimeters of a RTAFB in Thailand, and therefore, resolving reasonable doubt in the Veteran’s favor, the Board finds that he was exposed to herbicide agents while in Thailand. Finally, diabetes and prostate cancer are diseases listed as presumptively due to herbicide exposure. For the limited purpose of resolving this appeal, the Board assumes that the diseases manifested to at least a degree of 10 percent, particularly given his reports of prostate issues during service, and evidence of elevated glucose during service and a diabetes diagnosis not long after discharge as well as his insulin dependent status. Moreover, there is no affirmative evidence to the contrary. Accordingly, a nexus to service is established, and service connection for diabetes and prostate cancer are warranted. 3. Entitlement to service connection for left hip pain The Veteran asserts that he suffers from a left hip disability as a result of his time in service. During service, the Veteran served as a fire truck mechanic, mostly working in heavy equipment shops. The Veteran’s service treatment records (STRs) document the Veteran’s complaints of left thigh and hip spasms in 1977. Upon discharge he was not diagnosed with a left hip disability. At the Board hearing, he reported hurting his back and leg and having a cast on his leg, due to an injury sustained while playing baseball. VA treatment records confirm a history of left hip pain related complaints. In October 2019 the Veteran underwent an examination, and was diagnosed with a left hip strain. The Veteran reported that while in service he injured his left hip while playing baseball, and being in a cast for 6 weeks after surgery. He reported after the injury continuing to experience left hip pain. He also reported being part of a long convoy which he believes aggravated his left hip. The examiner concluded a left hip disability was less likely than not incurred in or caused by an in-service injury, event, or illness. The in-service report of hip pain was acute. The examiner noted that although there is a report of left hip spasms in 1977, there are no other records indicating a hip condition during service. The examiner found no evidence of chronicity of care for the left hip. The Board acknowledges that the Veteran is competent to describe symptoms that he is able to perceive through the use of his senses. See Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). In addition, arthritis is a condition explicitly recognized as chronic under 38 C.F.R. § 3.309(a), and therefore, the Veteran’s statements regarding continuity of symptomatology may be sufficient for purposes of establishing service connection. Although the record reflects an in-service complaint of spasms, this was an acute episode with no mention of a left hip condition on discharge, or for several years post-service. Further, the record does not indicate he suffers from arthritis, with the diagnosis being a left hip strain. The Veteran has reported on occasion, experiencing left hip pain ever since his time in service; however, he did not file a claim for service connection until 2011, over twenty years post discharge. The first indication in the treatment records of left hip complaints was in November 2011 when he was noted as having left hip pain, still 20 years post-discharge. As such, the Board finds the Veteran’s statements of having experienced a left hip disability ever since service to lack credibility. The contemporaneous medical records show the onset of left hip pain several decades after service. Although the Veteran believes his current left hip pain is proximately due to the in-service boxing, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body/interpretation of complicated diagnostic medical testing. Further, he was not shown to have arthritis in the first post-service year or for many years thereafter. His contentions that he experienced left hip pain since service are not corroborated by the contemporaneous medical evidence of record and are controverted by the probative VA opinion, noting the in-service complaint was acute in nature, with no indication of its chronicity. Consequently, the Board does not afford the Veteran’s lay statements probative value. The VA examiner’s opinion has significant probative value as it reflects consideration of all relevant facts—to include the Veteran’s lay statements regarding in-service injuries and the in-service and post-service treatment records. It also provided a detailed rationale for the conclusions reached. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (“[A]medical opinion...must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Ultimately, the most probative evidence of record does not show that he suffers from a left hip disability that is directly due to service or presumptively related to service. Absent probative evidence linking his claimed disability to service, service connection must be denied. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Skiouris, 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.