Citation Nr: 21023452 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 16-11 797 DATE: April 20, 2021 ORDER Entitlement to service connection for diabetes mellitus, type II is granted. Entitlement to service connection for coronary artery disease (CAD) is granted. Entitlement to service connection for peripheral neuropathy of left lower extremity is granted. Entitlement to service connection for peripheral neuropathy of right lower extremity is granted. FINDINGS OF FACT 1. There is credible evidence that the Veteran’s daily activities and work duties as a medical services specialist involved service near the perimeter of the Takhli Royal Thai Air Force Base (RTAFB) such that he was exposed to herbicide agents. 2. The Veteran’s diabetes mellitus, type II and CAD are presumed to be related to his in-service herbicide agent exposure. 3. Medical evidence indicates the Veteran’s bilateral lower extremity peripheral neuropathy was a diabetic complication. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for diabetes mellitus, type II have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107(b); 38 C.F.R. §§ 3.1, 3.6, 3.102, 3.303, 3.307, 3.309. 2. The criteria for entitlement to service connection for CAD have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1116, 5107(b); 38 C.F.R. §§ 3.1, 3.6, 3.102, 3.303, 3.307, 3.309. 3. The criteria for entitlement to service connection for peripheral neuropathy of left lower extremity have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310. 4. The criteria for entitlement to service connection for peripheral neuropathy of right lower extremity have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Air Force from January 1970 to August 1973 and from January 1991 to April 1991. These matters come before the Board of Veterans’ Appeals (Board) on appeal from September 2015 and September 2016 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, the Board denied the Veteran’s claims for service connection, finding insufficient evidence of the Veteran’s herbicide exposure while he was stationed at the Takhli RTAFB. The Veteran appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (Court). In a December 2020 order, the Court vacated the Board’s decision and remanded the matter for action consistent with the Joint Motion for Remand (JMR). As the JMR reflects, the Board failed to address statements by the Veteran as to his duties at Takhli RTAFB that placed him at or near the Takhli RTAFB base perimeter. In June 2020, VA received notice the Veteran had passed away. The Appellant requested substitution the same month. In August 2020, the RO granted the Appellant’s request for substitution for all matters pending before VA. 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). Service connection may also be granted on a secondary basis for a disability that is proximately due to or the result of an established service-connected disorder. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability either (a) was caused by or (b) is aggravated by a service-connected disability. See 38 C.F.R. § 3.310 (a); Allen v. Brown, 7 Vet. App. 439 (1995). 1. Entitlement to service connection for diabetes mellitus, type II is granted. 2. Entitlement to service connection for CAD is granted. The Appellant contends the Veteran’s diabetes and CAD developed due to the Veteran’s exposure to herbicide agents while stationed at the Takhli RTAFB from August 1972 to August 1973. The Board finds service connection is warranted. In order to establish presumptive service connection for a disease associated with exposure to certain herbicide agents, the evidence must show the following: (1) that the veteran served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 (or was otherwise exposed to an herbicide agent during active service); (2) that he currently suffers from a disease associated with exposure to certain herbicide agents listed under 38 C.F.R. § 3.309(e); and (3) that the current disease process manifested to a degree of 10 percent or more within the specified time period prescribed in section 3.307(a)(6)(ii).  38 U.S.C. § 1116; 38 C.F.R. §§ 3.307(a)(6), 3.309(e). If a veteran was exposed to an herbicide agent during active military, naval, or air service, the certain diseases shall be service connected, if the requirements of 38 C.F.R. § 3.307 (a) are met, even if there is no record of such disease during service. The list of diseases associated with exposure to certain herbicide agents includes Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes). 38 C.F.R. § 3.309(e). Although statutory and regulatory provisions do not establish a presumption of exposure to herbicide agents based on service in Thailand, per information from the Department of Defense, VA recognizes that herbicide agents, including Agent Orange, were used at certain times and places at some military bases in Thailand during the Vietnam Era between January 1962 and May 1975. Current VA policy provides for special consideration of herbicide agent exposure for veterans whose duties placed them on or near the perimeters of certain designated RTAFBs in Thailand during the Vietnam Era. Specifically, 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 RTAB as an Air Force security policeman, security patrol dog handler, or member of a security police squadron, or otherwise served near a base perimeter, as shown by the Veteran’s military occupational specialty (MOS), daily work duties, performance evaluations, or other credible evidence, then herbicide agent exposure should be conceded on a facts-found or direct basis. See U.S. Dep’t of Veterans Aff., Compensation and Pension Service Bulletin 3 (May 2010). The Veteran’s service treatment records are silent for symptoms or onset of diabetes or CAD. The Veteran’s 1969 entrance report of medication examination and April 1973 separation report of medical examination are also silent for any diagnoses or symptoms relating to diabetes or CAD. Notably, the Appellant does not contend the Veteran’s diabetes or CAD had their onset during service. However, military personnel records reflect his MOS was as a Medical Services Specialist and that he arrived at the Takhli RTAFB in August 1972. Moreover, post-service treatment records indicate the Veteran was diagnosed with diabetes mellitus, type II in 1990 and CAD in 2016. The question for the Board is whether there is competent and credible evidence of whether the Veteran’s daily activities and/or work duties placed him in proximity to the base perimeter at Takhli RTAFB such that he may be presumed to have been exposed to herbicide agents. The Board finds there is. In an October 2014 Statement in Support of Claim, the Veteran reported frequently performing “medical duties on the base perimeter fence line, flight line . . . during [his] year at Takhli RTAFB.” In a July 2015 statement, the Veteran reported that he assisted with inflight emergencies and that the perimeters were sprayed to kill foliage around the flight line. Moreover, the Veteran asserted that he was involved in a program called MEDCAP, where he would regularly travel off-base to provide the local population public health services. In an October 2015 notice of disagreement, the Veteran reported being “called out on mobile units to attend to service people on base which included the outskirts of the base.” In April 2017, the Veteran supplied a VA Form 9 in which he described passing along the surrounding perimeter of the Takhli RTAFB where “defoliant was sprayed to keep the perimeter and air strip clear” to treat fellow servicemen. After reviewing the record, and resolving any reasonable doubt in the Veteran’s favor, the Board finds the Veteran’s daily activities and job duties placed him near the perimeter of the Takhli RTAFB such that he was at least as likely as not exposed to herbicide agents during service. Notably, veterans are competent to report information within the realm of their personal knowledge, including proximity to a base perimeter fence. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). To this end, the Board accepts as credible the Veteran’s statements as to the nature and responsibilities of his service while at Takhli RTAFB. His personnel records confirm he was stationed at Takhli RTAFB and worked as medical services specialist. Indeed, his personnel records contain performance reviews noting the Veteran’s excellent service while assisting with MEDCAP, driving emergency vehicles, and patient movements by air evacuation. The record also includes a certificate from the Veteran’s work in the MEDCAP program, where he is commended for providing medical assistance to local populations. As such, the Board finds it reasonable to infer that the Veteran’s duties regularly placed him near the Takhli RTAFB base perimeter. As this RTAFB is one of the facilities where herbicide agents were sprayed in Thailand, the Veteran’s in-service herbicide exposure is acknowledged on a facts-found basis. Finally, again, evidence shows the Veteran was diagnosed with diabetes in 1990 and CAD in 2016. Medical records from during the pendency of this appeal confirm current diagnoses. As indicated above, type II diabetes and CAD are disease recognized as being associated with herbicide agent exposure. 38 C.F.R. § 3.309(e). Accordingly, after resolving all reasonable doubt in the Veteran’s favor, service connection for diabetes mellitus, type 2 and CAD is warranted. 3. Entitlement to service connection for peripheral neuropathy of left lower extremity is granted. 4. Entitlement to service connection for peripheral neuropathy of right lower extremity is granted. The Appellant asserts the Veteran’s bilateral lower extremity neuropathy was secondary to his service-connected diabetes. VA treatment records from December 2018 identify the Veteran’s neuropathy as “diabetic peripheral neuropathy” diagnosed by a Dr. D. Further medical records indicate “diabetic neuropathy,” again associated with a Dr. D. Moreover, a November 2015 Agent Orange registry assessment identifies the Veteran’s conditions as ‘diabetes and neuropathy,’ which supports the conclusion that the Veteran’s bilateral lower extremity peripheral neuropathy is a complication of the Veteran’s diabetes. Thus, resolving any reasonable doubt in the Veteran’s favor, secondary service connection is warranted. See 38 C.F.R. § 3.310. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.A. Infante, 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.