Citation Nr: 21031099 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 18-04 128 DATE: May 20, 2021 ORDER Service connection for prostate cancer is granted. Service connection for left lower extremity neuropathy, as secondary to prostate cancer, is granted. Service connection for right lower extremity neuropathy, as secondary to prostate cancer, is granted. Service connection for erectile dysfunction (ED), as secondary to prostate cancer, is granted. The claim for special monthly compensation (SMC) based on ED, for loss of use of a creative organ, is granted. REMANDED Service connection for depression, as secondary to service-connected prostate cancer, is remanded. FINDINGS OF FACT 1. Resolving all reasonable doubt in favor of the Veteran, he has established that he had service in the Korean demilitarized zone (DMZ) between April 1, 1968 and August 13, 1971. 2. The Veteran's prostate cancer is presumptively related to his in-service herbicide agent exposure. 3. The weight of the evidence supports finding that the Veteran's bilateral lower extremity neuropathy was caused by his prostate cancer and its associated treatment. 4. The weight of the evidence supports finding that the Veteran's ED is caused by his prostate cancer and its associated treatment. CONCLUSIONS OF LAW 1. The criteria for service connection for prostate cancer have been met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.309. 2. The criteria for service connection for left lower extremity neuropathy have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 3. The criteria for service connection for right lower extremity neuropathy have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 4. The criteria for service connection for ED have been met. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 5. The criteria for entitlement to SMC for loss of use of a creative organ have been met. 38 U.S.C. § 1114 (k); 38 C.F.R. § 3.350 (a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1968 to August 1971. The Veteran provided testimony before the undersigned Veterans Law Judge (VLJ) at an August 2020 Board hearing. A complete transcript is of record. Service Connection Service connection requires competent evidence showing: (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. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). 1. Service connection for prostate cancer is granted. The Veteran asserts that his prostate cancer is due to his exposure to herbicide agents, while he was stationed in Korea, while he performed his duties as a paid dispersing specialist. Specifically, he testified that he was regularly taken by helicopter to the Korean DMZ to go through individual records with soldiers when they had complaints or problems with their pay. Agent Orange, classified as a "herbicide agent," was used along the southern boundary of the DMZ in Korea. The Department of Defense has identified specific military units that were assigned or rotated to areas along the DMZ where Agent Orange was used. If a Veteran was exposed to a "herbicide agent," such as Agent Orange, used in support of the United States and allied military operations in the Republic of Vietnam from January 9, 1962, to May 7, 1975, or in a unit identified by the DOD that operated in or near the DMZ between April 1, 1968 and August 31, 1971, then, absent affirmative evidence to the contrary, certain diseases, including prostate cancer, will be presumptively service connected even if there is no record of the disease in service. 38 U.S.C. §§ 1110, 1116; 38 C.F.R. §§ 3.307 (a)(6), (d), 3.309(e). A review of the Veteran's medical records show that he was diagnosed with prostate cancer in 2013. See Private Treatment Record dated March 13, 2013. The Veteran credibly testified that he was stationed at Camp Casey, Korea, which was approximately 11 miles away from the DMZ. He reported that he served at the 7th Infantry Administration, and that he would have to do records checks at the DMZ and would spend the whole day there. He testified that a helicopter would take him to the DMZ so that he could review records with individual soldiers and rectify any complaints of problems they had with their pay. He testified that he knew he was within the DMZ because the fence had loud foliage and there was quite an area in between the two borders. He also testified that he was stationed at Camp Casey, the entire time he was in Korea. A review of the Veteran's military personnel records confirm that the Veteran served in Korea from August 21, 1970 to February 14, 1971; and that he had service with the 7th infantry administration from October 5, 1970 to February 14, 1971. The Board acknowledges that a May 2015 response from the Defense Personnel Records Information Retrieval System (DPRIS) confirmed that the Veteran served at Camp Casey, but could not confirm whether the Veteran performed specific duties along or near the DMZ. The Board notes that the Veteran is capable and permitted to describe his in-service experiences, to include his reports that he traveled between military bases located in and near the DMZ. The Board notes that the Veteran credibly described the duties that took him to the DMZ and that his military personnel records corroborate his testimony. He served at Camp Casey, Korea from August 21, 1970 to February 14, 1971, which is between April 1, 1968 and August 31, 1971, the dates for which presumptive service connection is recognized for service in or near the Korean DMZ. Here, after considering the evidence of record, the Board resolves any reasonable doubt in his favor and finds that he was likely exposed to herbicide agents during his service in Korea, at the DMZ. Despite the DPRIS being unable to confirm his exposure to herbicide agents, as per §3.307(a)(6)(iii), the Veteran is presumed to have been exposed to herbicide agents based on his credible testimony which is consistent with military personnel service records. Because the Veteran developed prostate cancer, in the absence of any evidence to the contrary, it is presumed to be associated with his exposure to herbicide agents in service. The evidence is at least in equipoise. Accordingly, service connection for prostate cancer is granted. 2. Service connection for bilateral lower extremity neuropathy is granted. 3. Service connection for ED is granted. 4. Service connection for SMC-K is granted. The Veteran asserts that his bilateral lower extremity neuropathy and his ED are secondary to his prostate cancer and its associated radiation treatment. A review of the Veteran's post-service medical records shows that he was diagnosed with ED and bilateral lower extremity neuropathy during the period on appeal. See Private Treatment Record dated January 8, 2015. VA received the Veteran's service connection claims on January 23, 2014. The Veteran's treating physician noted that he had a history of prostate cancer and underwent external beam radiation. See Private Treatment Record dated January 8, 2015. The physician noted that his cancer was in remission, but had several complications related to his radiation treatment, including neuropathy and ED. The physician explained that he started to get numbness in both lower extremities around the time of his 6th external beam radiation treatment and that his symptoms became more pronounced as his treatment progressed, which continued to worsen upon completion of radiation. At the time of the report, the Veteran was reported to have almost complete numbness in both feet and an unsteady gait. The physician also reported that the Veteran had experienced ED symptoms since his prostate cancer treatment. Subject to certain limitations, special monthly compensation is payable under 38 U.S.C. § 1114 (k) for each anatomical loss of or the loss of use of one or more creative organs as a result of a service-connected disability. 38 C.F.R. § 3.350 (a). Here, the Veteran has been diagnosed with ED secondary to his service connected prostate cancer, and SMC based on loss of use of a creative organ is therefore warranted. Regarding his neuropathy, the Veteran testified that he did not have neurologic symptoms prior to prostate surgery, but developed pain into his legs, mostly at the bottom of his feet. The Board acknowledges that the Veteran has also testified that the neuropathy symptoms have improved over time and indicated that he is a lot more mobile now. Although the record is unclear as to whether he has a current diagnosis for bilateral lower extremity neuropathy, the Board finds that the criteria for a current disability has nonetheless been met because the Veteran's treating physician reported that he was diagnosed with bilateral lower extremity neuropathy, during the pendency of the appeal. The Board finds that service connection for ED, service connection for bilateral lower extremity neuropathy, and SMC based on ED, for loss of use of a creative organ, as secondary to the service-connected prostate cancer is warranted. Here, the Veteran is service-connected for prostate cancer and his treating private physician has attributed his bilateral lower extremity neuropathy and ED as secondary to his prostate cancer and its associated external beam radiation treatment. The Board is satisfied that the evidence of record makes it at least as likely as not (50 percent or greater) that the Veteran's prostate cancer have caused him to develop ED and bilateral lower extremity neuropathy. Accordingly, the service connection claims for ED and for bilateral lower extremity neuropathy and the claim for SMC for the loss of use of a creative organ, is granted. REASONS FOR REMAND Service connection for an APD, to include depression, is remanded. The Veteran asserts that he has depression as a result of his prostate cancer and ED. The Veteran testified that he feels depressed, but has not been clinically diagnosed with depression. He also testified that has not received treatment or medication for a psychiatric condition. A review of the Veteran's post-service treatment records corroborates his testimony that he does not have a clinical diagnosis for depression, or for any other APD. However, the Board notes that the Veteran has provided credible testimony that he experiences depressive symptoms due to his service-connected prostate cancer and ED. The Veteran has not received a VA examination to determine whether there is a clinical diagnosis for any APD, and if so, whether any such diagnosis is secondary to his service-connected prostate cancer and/or ED. As such, the Board finds that remand is necessary. The matters are REMANDED for the following action: (Continued on the next page) Schedule the Veteran for an examination to determine whether he meets the DSM criteria for an acquired psychiatric disability, to include depression, and if so, the examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that it was caused by his service-connected prostate cancer and/or ED, or whether it is at least as likely as not (50 percent or greater probability) that the acquired psychiatric disability was aggravated (made worse) by his ED, peripheral neuropathy or prostate cancer. Why or why not? MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Fu, 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.