Citation Nr: 21026082 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 18-50 341 DATE: April 29, 2021 REMANDED Entitlement to service connection for lung cancer, including as a result of in-service exposure to herbicides, is remanded. Entitlement to service connection for peripheral neuropathy, bilateral upper extremities, including as secondary to diabetes mellitus, type II, is remanded. Entitlement to service connection for peripheral neuropathy, bilateral lower extremities, including as secondary to diabetes mellitus, type II, is remanded. Entitlement to service connection for diabetes mellitus, type II, including as a result of in-service exposure to herbicides, is remanded. Entitlement to service connection for tremors is remanded. REASONS FOR REMAND The Veteran had active military service from March 1961 to August 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2017 rating decision of a VA Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a March 2021 hearing before the Board of Veterans’ Appeals (Board). 1. Entitlement to service connection for lung cancer, including as a result of in-service exposure to herbicides, is remanded. The Veteran asserts that his lung cancer arose during or as a result of active service exposure to herbicides. The Veteran’s military personnel records, entered into the claims file in February 2017, confirm that he served at Udorn Royal Thai Air Force Base (RTAFB) during the Vietnam War era as an aircraft maintenance technician. During the Veteran’s January 2017 VA examination for respiratory conditions and accompanying VA medical opinion, the VA examiner opined that his lung cancer was at least as likely as not caused by herbicide exposure. In a February 2017 statement in support of his claim, the Veteran asserted that his service duties caused him to work near the perimeter of the base many times. A March 2017 VA memorandum indicates that VA lacked the information the Joint Services Records Research Center (JSRRC) required to verify whether the Veteran was exposed to herbicides in Thailand. In his April 2017 Notice of Disagreement (NOD) statement, the Veteran asserted that he worked near the perimeter of the base. He also stated that rain during the monsoon season would flood the base’s septic system and may have exposed him to herbicides at that time. During the Veteran’s March 2021 Board hearing, the Veteran testified under oath that he served as an aircraft mechanic crew chief for aircraft that were serviced in the same hangar as C-123 aircraft, which were used to spray herbicides. He believed his close proximity to the aircraft caused him to be exposed to herbicides. He also stated that he was in Da Nang, Vietnam at one point. The Board finds that there is insufficient information in the evidence of record to verify whether the Veteran was exposed to herbicides during active service; however, the Veteran has presented additional information since the March 2017 VA memorandum. Notably, during his March 2021 Board hearing, he asserted that he was in Vietnam at one point, possibly during active service. Accordingly, this claim must be remanded for an additional attempt to verify the Veteran’s asserted herbicide exposure. 2. and 3. Entitlement to service connection for peripheral neuropathy of all four extremities is remanded. In a January 2017 VA medical opinion, the VA examiner opined that the Veteran’s peripheral neuropathy conditions were at least as likely as not due to his treatment for lung cancer. As a decision on the issue of service connection for lung cancer would affect the outcome for these issues, the matters of entitlement to peripheral neuropathy for bilateral upper and lower extremities are thus inextricably intertwined with the Veteran’s claim being remanded herein. Harris v. Derwinski, 1 Vet. App. 180 (1991). Remand of the inextricably intertwined service connection for peripheral neuropathy claims is therefore also required. 4. Entitlement to service connection for diabetes mellitus, type II, is remanded. During the Veteran’s January 2017 VA examination for diabetes mellitus, the VA examiner found that the Veteran did not meet the criteria for a diagnosis for diabetes mellitus and only met the criteria for pre-diabetes. Consequently, the VA examiner did not offer an etiology on the claimed condition. The Veteran’s subsequent VA treatment records reflect diabetes mellitus being listed as an active medical problem. See, e.g., July 2018 VA treatment record. Additionally, verification of the Veteran’s asserted exposure to herbicides could affect the outcome of this issue, therefore this issue must also be remanded for additional development. 5. Entitlement to service connection for tremors is remanded. During examination for Parkinson’s disease, the VA examiner opined that the Veteran was diagnosed with essential tremors, which was not associated with herbicide exposure and was not a presumptive diagnosis related to Vietnam service. During the March 2021 Board hearing, the Veteran asserted that his tremors may have been caused directly by service due to the strain placed on his arms and upper body by his duties as a mechanic. As this theory of causation has not been addressed by a VA examiner, this claim must be remanded for a VA addendum medical opinion. The matters are REMANDED for the following action: 1. Contact the Veteran and invite him to submit further information indicating that he was exposed to herbicides during his service in Thailand or reported service in Vietnam, including but not limited to, any information which indicates that he visited or worked at or near the perimeter of the base. Examples of useful information might include written statements from persons who served at Udorn with the Veteran, pictures or other documents showing connection with the base perimeter, or the Veteran’s own recollections. 2. After waiting a reasonable time for the Veteran to respond, send a request to the Joint Services Records Research Center for verification of the Veteran's statements regarding his claimed exposure to herbicides while assigned to the Udorn RTAFB in Thailand. The JSRRC should also address the Veteran's claims of visiting the Republic of Vietnam during active service. If exposure to herbicides is not corroborated, prepare a formal finding that sufficient information required to verify herbicide exposure does not exist. 3. Regardless of whether the JSRRC finds that the Veteran was exposed to herbicides while in service, schedule the Veteran for an appropriate VA examination to determine the nature and etiology of his diabetes mellitus. The electronic claims file must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. After a review of the claims file, the examiner should address whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s diabetes mellitus, if diagnosed, had its onset in service or is caused by or related at least in part to his active service, to include exposure to herbicides in service. If a diagnosis is not rendered, this should be fully explained. In providing all of the requested opinions, the examiner should consider the Veteran’s competent lay claims regarding the observable symptoms he has experienced; the examiners cannot rely exclusively on the absence of relevant treatment in the Veteran’s medical history; and the VA examination report must include a complete rationale for all opinions expressed. 4. Obtain a VA addendum medical opinion from a medical professional with appropriate expertise to address the nature and etiology of the claimed tremor condition. The electronic claims file must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. After a review of the claims file, the examiner should address whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s tremor condition had its onset in service or is caused by or related at least in part to his active service, this includes but is not limited to exposure to herbicides in service and his work as a mechanic. In providing all of the requested opinions, the examiner should consider the Veteran’s competent lay claims regarding the observable symptoms he has experienced; the examiners cannot rely exclusively on the absence of relevant treatment in the Veteran’s medical history; and the VA examination report must include a complete rationale for all opinions expressed. 5. After completion of the preceding actions, the RO shoulder consider whether additional action, including scheduling additional VA examinations or medical opinions, is needed regarding the claims for service connection for lung cancer and peripheral neuropathy of the upper and lower extremities. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Hicks, 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.