Citation Nr: 21025905 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 18-52 225 DATE: April 29, 2021 ORDER Entitlement to service connection for coronary artery disease as due to in-service exposure to an herbicide agent is granted. Entitlement to service connection for diabetes mellitus as due to in-service exposure to an herbicide agent is granted. Entitlement to service connection for peripheral neuropathy of the left upper extremity as due to service-connected diabetes mellitus is granted. Entitlement to service connection for peripheral neuropathy of the right upper extremity as due to service-connected diabetes mellitus is granted. Entitlement to service connection for peripheral neuropathy of the left lower extremity as due to service-connected diabetes mellitus is granted. Entitlement to service connection for peripheral neuropathy of the right upper extremity as due to service-connected diabetes mellitus is granted. Entitlement to service connection for a prostate condition is granted. Entitlement to service connection for erectile dysfunction as due to a service-connected prostate condition is granted. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The record evidence reasonably supports finding that the Veteran likely was exposed to an herbicide agent while on active service in Thailand. 2. The record evidence shows that the Veteran’s coronary artery disease and diabetes mellitus are related to his likely in-service exposure to an herbicide agent. 3. The record evidence shows that the Veteran’s peripheral neuropathy in each of his extremities is related to his service-connected diabetes mellitus. 4. The record evidence shows that the Veteran’s prostate condition is related directly to active service. 5. The record evidence shows that the Veteran’s erectile dysfunction is related to his service-connected prostate condition. CONCLUSIONS OF LAW 1. The criteria for service connection for coronary artery disease as due to in-service exposure to an herbicide agent have been met. 38 U.S.C. §§ 1110, 1116, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2019). 2. The criteria for service connection for diabetes mellitus as due to in-service exposure to an herbicide agent have been met. 38 U.S.C. §§ 1110, 1116, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2019). 3. The criteria for service connection for peripheral neuropathy of the left upper extremity as due to diabetes mellitus have been met. 38 U.S.C. §§ 1110, 1116, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2019). 4. The criteria for service connection for peripheral neuropathy of the right upper extremity as due to diabetes mellitus have been met. 38 U.S.C. §§ 1110, 1116, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2019). 5. The criteria for service connection for peripheral neuropathy of the left lower extremity as due to diabetes mellitus have been met. 38 U.S.C. §§ 1110, 1116, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2019). 6. The criteria for service connection for peripheral neuropathy of the right lower extremity as due to diabetes mellitus have been met. 38 U.S.C. §§ 1110, 1116, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2019). 7. The criteria for service connection for a prostate condition have been met. 38 U.S.C. §§ 1110, 1116, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304 (2019). 8. The criteria for service connection for erectile dysfunction as due to a service-connected prostate condition have been met. 38 U.S.C. §§ 1110, 1116, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.310 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the U.S. Air Force from January 1964 to January 1969 and in the U.S. Coast Guard from September to October 1970. The matter is before the Board on appeal from a May 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In a July 2019 decision, the Board reopened a previously denied claim of entitlement to service connection for prostate problems and remanded that claim along with a claim of entitlement to TDIU. The Board also denied claims of service connection for coronary artery disease and diabetes mellitus, each to include as due to in-service exposure to an herbicide agent, and service connection for peripheral neuropathy of the bilateral upper and lower extremities and for erectile dysfunction, each to include as due to diabetes mellitus. The Veteran then appealed the Board’s July 2019 decision to the United States Court of Appeals for Veterans Claims (Court). In July 2020, the Court granted a Joint Motion for Partial Remand (JMPR) which vacated the Board’s July 2019 decision to the extent that it denied service connection. The claims were remanded by the Board in December 2020. Service Connection 1. Entitlement to service connection for coronary artery disease and for diabetes mellitus, to include as due to in-service exposure to an herbicide agent The Veteran asserts that he was exposed to an herbicide agent while stationed at Takhli Air Force Base (AFB) in Thailand. He meets the first threshold criteria for service connection (a current disability). See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). VA medical records note he has been diagnosed as having coronary artery disease and diabetes mellitus. The available service personnel records show that the Veteran was stationed at Takhli AFB as a Maintenance Facility Specialist during active service. There is no basis in the record to question the Veteran’s credibility regarding his statements as to the nature and responsibilities of his service while at Takhli AFB. His statements indicate that he had contact with the base perimeter while serving here. This description appears to be consistent with the duties of his military occupational specialty (MOS). 38 U.S.C. § 1154 (a). Moreover, his accounting as to the type of duties he performed are deemed competent lay evidence of what he observed during his period of service in Thailand. Layno v. Brown, 6 Vet. App. 465 (1994) (noting that a lay witness is competent to testify to that which the witness has actually observed and is within the realm of his personal knowledge). A Maintenance Facility Specialist is not a MOS considered to have been exposed to herbicides in Thailand by VA. Nevertheless, the Board credits the Veteran’s consistent testimony that he would have been near the air base perimeter as part of his in-service duties as a Maintenance Facility Specialist. Accordingly, and after resolving any reasonable doubt in his favor, the Board finds that the Veteran likely was exposed to an herbicide agent during service in Thailand. The Board next notes that the Veteran’s diabetes and heart disease are treated with an oral hypoglycemic agent and continuous medication. Thus, these disabilities are manifested to a compensable level for VA purposes. See 38 C.F.R. § 4.119, Diagnostic Codes (DCs) 7005 and 7913. As noted above, diabetes mellitus and heart disease are presumed to be due to exposure to certain herbicide agents if they have become manifest to a degree of 10 percent or more at any time after service. See 38 C.F.R. §§ 3.307, 3.309(e). In summary, the Board finds that service connection for coronary artery disease and for diabetes mellitus, each as due to in-service exposure to an herbicide agent, is warranted. 2. Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities and of the bilateral lower extremities, each to include as due to diabetes mellitus The Veteran contends that he has peripheral neuropathy of the bilateral upper and lower extremities related to his service-connected diabetes mellitus. As discussed above, the Board granted service connection for diabetes mellitus as due to in-service exposure to an herbicide agent. The question for the Board is whether the Veteran has peripheral neuropathy that is caused or aggravated by his service-connected diabetes mellitus. The Board finds that the preponderance of the evidence establishes that the Veteran’s peripheral neuropathy of the bilateral upper extremities and of the bilateral lower extremities are proximately due to or the result of his service-connected diabetes mellitus. For example, a December 2020 VA examination report noted the Veteran with diabetic peripheral neuropathy of the bilateral extremities. The examination report notes that the onset occurred only after diabetes onset and is a common complication of diabetes. In light of the Veteran’s diagnoses, the objective clinical medical evidence, and his credible and competent statements in support of the claims, the Board finds that service connection for peripheral neuropathy of the bilateral upper extremities and of the bilateral lower extremities, each to include as due to service-connected diabetes mellitus, is warranted. 3. Entitlement to service connection for a prostate condition The Board finds that competent, credible, and probative evidence establishes that the Veteran’s prostate condition is related to his active service. During active service, the Veteran complained of and was treated for recurrent urethral discharge and other urinary conditions. His has asserted consistently that his prostate condition began during active service and continued throughout his life. The Board notes that the Veteran is competent to report the observable manifestations of his claimed disability. See Charles v. Principi, 16 Vet. App. 370, 374 (2002). The medical evidence also supports granting service connection for a prostate condition. The Veteran was provided a VA examination in February 2020. The examination report noted the Veteran had prostatic hypertrophy diagnoses dating back as far at 1971. The Veteran’s prostate condition began as early as 1966 with issues such as urinary hesitancy, weak urine stream, nocturia. In an October 2020 private medical opinion, the examiner concluded that the Veteran’s genitourinary disease manifested during service. This opinion was based on in service treatment for frequent urination, nocturia, and other classic signs and symptoms of benign prostatic hypertrophy. More importantly, this opinion was fully supported. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that a medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). There is no competent contrary opinion of record. In summary, and after resolving any reasonable doubt in the Veteran’s favor, the Board finds that service connection for a prostate condition is warranted. 4. Entitlement to service connection for erectile dysfunction, to include as due to a prostate condition The Board finds that the preponderance of the competent, credible, and probative evidence establishes that the Veteran’s erectile dysfunction is proximately due to or the result of his service-connected prostate condition. As discussed above, the Board granted service connection for a prostate condition. The medical evidence supports the Veteran’s assertions regarding the contended etiological link between his current erectile dysfunction and his service-connected prostate condition. A December 2020 VA examination report noted the Veteran with prostatic hypertrophy. The examination report further noted that the Veteran’s erectile dysfunction is as likely as not attributable to his prostatic hypertrophy. This opinion was fully supported. Id. In summary, and after resolving any reasonable doubt in the Veteran’s favor, the Board finds that service connection for erectile dysfunction as due to a service-connected prostate condition is warranted. REASONS FOR REMAND 1. Entitlement to a TDIU is remanded. The Veteran’s claim for TDIU has been denied by the RO because he did not meet the schedular criteria. See 38 C.F.R. § 4.16(a) (2019). This Board decision has granted service connection for multiple disabilities. Because implementation of the Board’s decision by the RO on post-remand likely will impact adjudication of the TDIU claim, the Board finds that all of these claims are inextricably intertwined. See Henderson v. West, 12 Vet. App. 11, 20 (1998), citing Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that two issues are inextricably intertwined when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). Thus, adjudication of the TDIU claim must be deferred. The Board notes that the Veteran has reported that he was employed between February 1984 and September 2005 by the United States Federal Aviation Administration. It is not clear from a review of the record evidence whether the RO has attempted to obtain information concerning the Veteran’s reported post-service employment history. It also is not clear from the record whether the Veteran has worked since 2005. Thus, the Board finds that, on remand, the RO should conduct appropriate development of the TDIU claim. The matters are REMANDED for the following action: 1. Conduct any appropriate development of the Veteran’s TDIU claim, to include contacting his post-service employer for information concerning his reported post-service employment. 2. Readjudicate the appeal. MICHAEL T. OSBORNE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brandon A. Williams, 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.