Citation Nr: 21042077 Decision Date: 07/11/21 Archive Date: 07/11/21 DOCKET NO. 18-34 462 DATE: July 11, 2021 ORDER Entitlement to service connection for prostate cancer is granted. Entitlement to service connection for erectile dysfunction, as secondary to prostate cancer, is granted. FINDINGS OF FACT 1. Herbicide exposure is conceded as the Veteran was stationed at the U-Tapao Air Base in Thailand and his duties regularly placed him near the base perimeter. 2. The evidence shows that the Veteran's erectile dysfunction is secondary to his prostate cancer. CONCLUSIONS OF LAW 1. Prostate cancer is presumed to be due to herbicide agent exposure. 38 U.S.C. §§ 1110, 1116, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 2. The criteria for service connection for erectile dysfunction have been met. 38 U.S.C. §§ 1110, 1131; 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1969 to September 1970, to include service at the U-Tapao Air Base, Thailand. This appeal to the Board of Veterans' Appeals (Board) is from a March 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The appeal was previously before the Board in June 2020, and the Board remanded for further development. The appeal has now been returned to the Board for further appellate review. The Veteran contends that he is entitled to presumptive service connection for prostate cancer because he was exposed to herbicide agents during his military service in Thailand, and that he is entitled to service connection for erectile dysfunction because it is secondary to his prostate cancer. Service Connection 1. Entitlement to service connection for prostate cancer As an initial matter, the Board recognizes that the medical records clearly demonstrate the Veteran has a diagnosis of prostate cancer. The law provides a presumption of service connection for certain diseases associated with exposure to herbicide agents, even if there is no record of evidence of such disease during the period of service. For purposes of the presumption, "herbicide agents" are 2,4-D, 2,4,5-T, and its contaminant TCDD, cacodylic acid, and picloram. 38 C.F.R. § 3.307(a)(6)(i). For those Veterans who have been exposed to herbicide agents, certain diseases, to include prostate cancer, are acknowledged to be presumptively related to such exposure. 38 U.S.C. § 1116(a)(2); 38 C.F.R. § 3.309(e). Such diseases, with exceptions not applicable in the instant case, shall have become manifest to a degree of 10 percent or more at any time after service. 38 C.F.R. § 3.307(a)(6)(ii). The Board notes that upon diagnosis of prostate cancer it is manifested to a degree of 100 percent, qualifying it for presumptive service connection. See 38 C.F.R. § 4.115B, Diagnostic Code 7528. VA 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, as evidenced in a declassified Vietnam era Department of Defense document titled "Project CHECO Southeast Asia Report: Base Defense in Thailand." Special consideration of herbicide exposure on a facts-found or direct basis should be extended to those Veterans whose duties placed them on or near the perimeters of Thailand military bases. This allows for presumptive service connection of the diseases associated with herbicide exposure. The record reveals that the Veteran's military occupation specialty was social worker and that he was in Thailand during his military service. See DD 214 Form. The Veteran states that he was stationed at several bases in Thailand where herbicide agents were sprayed heavily. The record shows an August 1970 application for shipment of the Veteran's household goods from U-Tapao Air Field, Thailand, indicating that was his last duty station prior to discharge in September 1970. The Veteran explains that he was at Samisan Army Base, Thailand, and was transferred to U-Tapao Air Base, Thailand, but he was the only social worker for the whole area. He provided assessments for airmen and soldiers, would travel back and forth between the bases passing through the base perimeters, and would frequently perform follow-ups, visiting the patients at their place of work, which were on or near the base perimeters. He stated that his duties as a social worker required him to meet with flight mechanics, security guards, and construction workers that worked on the perimeter of the bases. Therefore, the duties of the Veteran required that he regularly be at or near the perimeter of the bases. The RO developed for information from the Joint Services Records Research Center and the Air Force Historical Research Agency to corroborate the Veteran's contentions. Neither were able to identify any information corroborating the Veterans statements. However, a witness statement from the Veteran's supervisor, E.R., M.D., Maj. USAF, was received in July 2020. The statement confirmed the Veteran's explanation of his work duties and that those duties regularly placed him at the perimeter of bases. E.R. M.D., Maj. USAF, stated, "The Veteran worked for me for about 8 months. I was the Air Force psychiatrist for the entire country of Thailand that service all troops, both Army and Air Force. Our duties required constant movement between Samisan and Utapao. At Samisan and Utapao Air Force Base a large number of troops ended up with drug problems, and psychological issues. I can verify that both the Veteran and I traveled frequently to where our patients worked. That meant going to the perimeter where the military police worked, where the perimeter guards were stationed, and where the construction workers performed their duties. Both the Veteran and I passed through the gates of both Samisan and Utapao frequently." As E.R., M.D., Maj. USAF, was the supervisor of the Veteran, his witness statement is competent and credible and provides highly probative evidence as to the issue of whether the Veteran was regularly at or near base perimeters related to his military duties. His statement is also perfectly consistent with the statements of the Veteran, showing that the Veteran's testimony is also competent and credible. Therefore, based on the probative evidence of record, the Board finds that the Veteran's military duties as a social worker regularly placed him at or near base perimeters in Thailand during the Vietnam War. As such, herbicide agent exposure is conceded and service connection for the Veteran's diagnosed prostate cancer is presumed. Accordingly, service connection for prostate cancer is granted. 2. Entitlement to service connection for erectile dysfunction, as secondary to prostate cancer Service connection may be granted on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 U.S.C. §§ 1131; 5107; 38 C.F.R. § 3.310. The evidence must show: (1) that a current disability exists; and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated (permanently worsened in severity beyond its natural progress) by a service-connected disability. Id.; Allen v. Brown, 7 Vet. App. 439, 44849 (1995). A July 2015 progress note explains that the Veteran's prostatectomy for prostate cancer caused his erectile dysfunction. The report states that, "[a]lthough nerve sparing occurred, this is a cause of organic erectile dysfunction. Patient has no history of nitrate use and he is aware of the contraindication with PDE 5 inhibitors and nitrates. Penile rehabilitation was initiated with prescriptions for Cialis and a VED to treat the organic erectile dysfunction as a result of the davinci robot assisted laparoscopic radical prostatectomy. He did not have issues with organic erectile dysfunction prior to surgery and has not used treatments for erectile dysfunction in the past." Therefore, the evidence shows that the Veteran has the condition of erectile dysfunction and that the condition was proximately caused by his service-connected prostate cancer. Accordingly, service connection for erectile dysfunction is warranted. DUSTIN L. WARE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Temple, 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.