Citation Nr: 21040431 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 18-29 422 DATE: July 3, 2021 REMANDED Entitlement to service connection for diabetes mellitus, type II is remanded. Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded. Entitlement to service connection for peripheral neuropathy of the right upper extremity is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1968 to December 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision of the Department of Veterans Affairs (VA) Regional Offices (ROs) in Cleveland, Ohio. In July 2020, the Veteran had a hearing before the undersigned judge and a transcript of that hearing is of record. 1. Entitlement to service connection for diabetes mellitus, type II is remanded. The Veteran and representative assert that his diabetes mellitus originated due to exposure to herbicides during his active duty service. Although further delay is regrettable, the Board finds that additional development is necessary prior to appellate review. During the July 2020 Board hearing the Veteran provided sworn testimony and explained how his in-service duties placed him on the perimeter of a military base in Thailand. The Veteran also noted that he was directly exposed to herbicides, as one of his recurring tasks was to pull weeds after the herbicides were sprayed. As the Veteran is competent to report that which he perceives, the Board finds this sworn statement to be competent and credible to report what he witnessed first-hand during his active duty service. Layno v. Brown, 6 Vet. App. 465 (1994). VA's Compensation & Pension Service (C&P) has issued information concerning the use of herbicides in Thailand during the Vietnam War. In a May 2010 bulletin, C&P indicated that it has determined that there was significant use of herbicides on the fenced in perimeters of military bases in Thailand intended to eliminate vegetation and ground cover for base security purposes. A primary source for this information was the declassified Vietnam era Department of Defense (DoD) document titled Project CHECO Southeast Asia Report: Based Defense in Thailand. Although DoD indicated that the herbicide use was commercial in nature rather than tactical (such as Agent Orange), C&P has determined that there was some evidence that herbicides of a tactical nature, or that of a "greater strength" commercial variant, were used. Given this information, C&P has determined that special consideration should be given to veterans whose duties placed them on or near the perimeters of Thailand military bases. Consideration of herbicide exposure on a "facts found or direct basis" should be extended to those veterans. Significantly, C&P stated that "[t]his allows for presumptive service connection of the diseases associated with herbicide exposure." The Veteran was not afforded a VA examination. However, according to private treatment records, the Veteran was diagnosed with diabetes mellitus, type II. As the Veteran's lay statements, and treatment records indicate that the Veteran has a disability that could be related to active duty service, the Board finds that a medical examination with an opinion is necessary to decide the claim. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 70 (2006). Specifically, a remand is required to afford the Veteran a VA examination so as to determine the nature, etiology, and severity for his diabetes mellitus. 2. Entitlement to service connection for erectile dysfunction is remanded. 3. Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded. 4. Entitlement to service connection for peripheral neuropathy of the right upper extremity is remanded. The Veteran and the representative claim that his erectile dysfunction and bilateral upper extremity peripheral neuropathy are due to his diabetes mellitus, which he alleges originated due to his exposure to herbicides during his active duty service. Regrettably, a remand is necessary for further evidentiary development of the Veteran's appeal. The Veteran was not afforded VA examinations for these service connection claims. However, according to private treatment records, the Veteran was diagnosed with erectile dysfunction. As the Veteran's lay statements, and treatment records indicate that the Veteran has an erectile dysfunction disability that could be related to his diabetes mellitus, the Board finds that a medical examination with an opinion is necessary to decide the claim. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 70 (2006). Specifically, a remand is required to afford the Veteran a VA examination so as to determine the nature, etiology, and severity for his erectile dysfunction. As the Veteran's lay statements indicate that the Veteran may have bilateral upper extremity peripheral neuropathy that could be related to his diabetes mellitus, the Board finds that a medical examination with an opinion is also necessary to decide these claims. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 70 (2006). Specifically, a remand is required to afford the Veteran a VA examination so as to determine the nature, etiology, and severity for his bilateral upper extremity peripheral neuropathy. The matters are REMANDED for the following action: 1. Contact the JSRRC or other appropriate agency and ask them to provide any available information that might corroborate the Veteran's alleged in-service exposure to herbicides such as Agent Orange while serving in Thailand. The Veteran's personnel records show that he was stationed in Thailand from July 1969 to July 1970. 2. Schedule a VA examination with a new examiner who has appropriate expertise to determine the nature and etiology of the Veteran's diagnosed diabetes mellitus, type II. The examiner should review the Veteran's claims file. Based on a review of the record and examination, the examiner must address whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's diabetes mellitus, type II is related to his active service, to include potential exposure to herbicides during his active duty service. The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In all opinions rendered, the examiner is advised that the Veteran is competent to report his symptoms and treatment history due to his in-service injury with continued symptoms to the present. 3. Schedule a VA examination with a new examiner who has appropriate expertise to determine the nature and etiology of the Veteran's diagnosed erectile dysfunction. The examiner should review the Veteran's claims file. Based on a review of the record and examination, the examiner must address: a) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's diagnosed erectile dysfunction is related to his active service. b) The examiner is also asked to address whether the Veteran's diabetes mellitus at least as likely as not (a 50 percent or greater probability) caused or aggravated his diagnosed erectile dysfunction. The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In all opinions rendered, the examiner is advised that the Veteran is considered competent to report his symptoms and treatment history due to his in-service injury with continued symptoms to the present. 4. Schedule a VA examination with a new examiner who has appropriate expertise to determine the nature and etiology of the Veteran's claimed bilateral upper extremity peripheral neuropathy. The examiner should review the Veteran's claims file. Based on a review of the record and examination, the examiner must address: a) Confirm whether the Veteran has a current bilateral upper extremity peripheral neuropathy disability. b) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's claimed bilateral upper extremity peripheral neuropathy disability is related to his active service. c) The examiner is also asked to address whether the Veteran's diabetes mellitus at least as likely as not (a 50 percent or greater probability) caused or aggravated the Veteran's claimed bilateral upper extremity peripheral neuropathy disability. The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In all opinions rendered, the examiner is advised that the Veteran is competent to report his symptoms and treatment history due to his in-service injury with continued symptoms to the present. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. R. Montalvo, 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.