Citation Nr: 21027645 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 17-21 089 DATE: May 6, 2021 REMANDED 1. Entitlement to service connection for coronary artery disease (CAD), to include as due to exposure to herbicide agents, is remanded. 2. Entitlement to service connection for type 2 diabetes mellitus (diabetes), to include as due to exposure to herbicide agents, is remanded. 3. Entitlement to service connection for erectile dysfunction (ED), to include as secondary to CAD and/or diabetes, is remanded. 4. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from January 1967 to January 1971. These matters are before the Board of Veterans' Appeals (Board) on appeal of an August 2014 rating decision. In January 2021, a virtual hearing was held before the undersigned; a transcript is in the record. 1., 2. Entitlement to service connection for CAD and diabetes. An August 2014 rating decision denied service connection for CAD and diabetes because although current diagnoses of CAD and diabetes were shown in the record, exposure to herbicide agents in service could not be verified. The Veteran asserts that he served along the base perimeter of Don Muang Royal Thai Air Force Base (RTAFB) and that he periodically served as an assistant crew member on flights from Don Muang to Vietnam. However, an October 2013 VA memorandum notes that VA lacked the information that the Joint Services Records Research Center (JSRRC) requires to verify herbicide exposure in Thailand. A February 2017 VA memorandum (essentially an addendum to the October 2013 memorandum) notes that additional evidence was submitted by the Veteran (pictures of him sitting in an aircraft and standing in front of a maintenance shed, buddy statements from fellow Airmen who claimed that the Veteran had told them he was an assistant crewmember on flights which flew in and out of Vietnam, and his lay statements asserting that he worked on the flight line at Don Muang, which was near the base perimeter) but also found that VA lacked the information that the JSRRC requires to verify herbicide exposure in Thailand. At the January 2021 virtual hearing, the Veteran testified that he was stationed at Don Muang RTAFB in 1969 (and personnel records confirm that he was there from April 1969 to April 1970). He related that the 631st Combat Support Group Field Maintenance Shops (where he worked as a corrosion specialist) were directly across from the perimeter, and the flight line (where he worked as a flight line director) was near the base perimeter. He also seems to suggest that his barracks and the dining facility were near the base perimeter. Therefore, there is a critical question whether he served near the base perimeter; there has not been any development to determine whether the maintenance shops, dining facility, barracks, and especially the flight line at the base (where he states his duties placed him) were near the base perimeter. Certain chronic diseases (listed in 38 C.F.R. § 3.309 (e)) to include CAD and diabetes, may be presumed to be service connected as due to exposure to herbicide agents if manifested in a veteran who served in Vietnam during the Vietnam Era. 38 U.S.C. § 1116; 38 C.F.R. §§ 3.307, 3.309(e). The presumptive provisions of 38 U.S.C. § 1116 have been extended to encompass veterans shown to have been otherwise exposed to tactical herbicide agents in service, including those whose duties placed them on or near the perimeters of Thailand military bases (to include Don Muang). 38 U.S.C. § 1113(b); Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994). Therefore, the presumptive provisions of 38 U.S.C. § 1116 may be for consideration in this matter. The Veteran's service personnel records note he worked as a corrosion specialist and flight line director, and his January 2021 testimony (that he worked near the base perimeter) suggests that he may have served near the Don Muang RTAFB perimeter. If that is confirmed, it may reasonably be conceded that he was exposed to herbicide agents while serving in Thailand. A remand for the JSRRC to provide an assessment of the proximity of the maintenance shops, barracks, dining facility, and flight line to the base perimeter is necessary. The Board also notes that the Veteran testified that he was periodically assigned as an assistant crew member and helped transport cargo and personnel from Thailand to Vietnam. He related that he did not receive temporary duty (TDY) orders for such flights; he simply had the pilot sign off on a form, and he submitted the form to payroll to receive a tax exemption for that month. He reported he did not retain a copy of any of those forms, his being involved in any flights to Vietnam is not noted in his service personnel records. His service finance records, if available, may reflect he received in-county pay if he was on a plane that landed in Vietnam and/or came under fire in Vietnam. Development for corroboration of his alleged service in Vietnam is necessary. 3. Entitlement to service connection for ED. The claim of service connection for ED is essentially presented as a claim of secondary (to CAD and/or diabetes) service connection. Therefore, it is inextricably intertwined with the service connection for CAD and diabetes claims. As those claims are being remanded, consideration of service connection for ED must be deferred at this time. If service-connection for CAD and/or diabetes is established, further development of the ED claim would be necessary. 4. Entitlement to service connection for tinnitus. On August 2013 VA hearing loss and tinnitus examination, the Veteran reported that he had experienced constant bilateral tinnitus for approximately 20 years. The examiner opined that it was less likely than not that the tinnitus was due to hearing loss because tinnitus and hearing loss can occur separately (although they are commonly present at the same time), they have varying causes, and hearing loss does not cause tinnitus. The examiner also opined that the Veteran's tinnitus was less likely due to noise exposure during service because there were no complaints of tinnitus in the service treatment records (STRs), and he had only noticed tinnitus for the last 20 years (well after his separation from service). However, in an April 2021 written argument, the Veteran's attorney alleged that the August 2013 VA examination was inadequate because it did not (properly) address a secondary service connection theory of entitlement. The attorney asserts that service connection for tinnitus is warranted on that basis that such disability is secondary to the Veteran's service-connected bilateral hearing loss. Whether or not a service-connected disability has caused or aggravated another disability for which service connection is sought is essentially a medical question. The Board's review of the record found that the asserted secondary service connection theory of entitlement has indeed not been adequately addressed by any medical opinion currently in the record. The August 2013 examiner attempted to address causation, but did not address aggravation. Therefore, development for a medical opinion that addresses this specifically argued theory of entitlement is necessary. The matters are REMANDED for the following: 1. Arrange for exhaustive development (to include a search for the Veteran's service finance records, if available, to determine whether he received combat/[Vietnam] in-country pay for his asserted service on flights as an assistant crew member from Don Muang RTAFB in Thailand to Vietnam for confirmation of his alleged service in Vietnam (and any other official records that may corroborate that events such as the Veteran describes occurred when he would have been there). The scope of the development should include confirmation from service department sources whether being added to a flight to a combat area in another country in the manner hr has described is consistent with (plausibly could have occurred) in the manner he describes. He must assist in the matter by providing any further information necessary for the development to proceed. [If pay records are unavailable, it must be so noted for the record, the scope of the search should be described, and the Veteran must be so notified.] The nature and scope of all development conducted should be noted in the record. Then prepare a memorandum for the record indicating whether the Veteran's accounts of being added to flights to Vietnam in the manner he describe may reasonably be found to be credible and consistent with known practices. The sources for all information obtained for the Memorandum should be identified. 2. Also arrange for appropriate development, including by inquiry to the JSRRC, to ascertain whether the Veteran's barracks, dining facility and especially his duties in the 631st maintenance shops and at or near the flight line at Don Muang would have placed him at, or in close proximity to, the base perimeter. [A map of the base showing the maintenance shops, barracks, dining facility, and runways and perimeter should suffice to provide the information needed.] Provide a description of the Veteran's accounts of his alleged exposure to herbicides to the JSRRC in connection with the inquiry. Undertake any recommended follow-up action. The responses from JSRRC provided should include: Comment on the plausibility of the Veteran's contentions regarding exposure to herbicide agents in the course of duties in the maintenance shops and near the flight line (and from the location of his barracks and the dining facility in proximity to the base perimeter) at Don Muang RTAFB. Indicate the approximate distances from the maintenance shops, runway, barracks, and dining facility to the perimeter. Then arrange for any further development indicated, and readjudicate the claims of service connection for CAD and diabetes considering the responses to the development sought above. 3. If (and only if) service connection for CAD and/or diabetes is established, arrange for the Veteran's record to be forwarded to an appropriate physician for review and an advisory medical opinion regarding whether his ED has been caused or aggravated (the opinion must address aggravation) by the CAD and/or diabetes (as alleged). [If further examination of the Veteran is deemed necessary for the opinion sought, such should be arranged]. The consulting physician must explain the rationale for all opinions. 4. Also arrange for the Veteran's record to be forwarded to the August 2013 audiology examiner for review and an addendum opinion. [If that provider is unavailable, the record should be forwarded to another audiologist for review and the opinion sought. If further examination is deemed necessary, it should be arranged.] On review of the record, to include this remand, the consulting audiologist should provide an opinion that responds to the following: (a) Is it at least as likely as not (a 50% or better probability) that the Veteran's tinnitus was caused or aggravated (the opinion must address aggravation) by his service-connected bilateral hearing loss disability? Cite to clinical findings and/or medical literature that support the conclusion. (b) If the tinnitus is determined to not have been caused or aggravated by the Veteran's service connected bilateral hearing loss disability, identify the etiology for the tinnitus that is considered to be more likely. The examiner must include rationale for all opinions. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bayles, 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.