Citation Nr: 22014584 Decision Date: 03/14/22 Archive Date: 03/14/22 DOCKET NO. 17-45 126 DATE: March 14, 2022 ORDER Entitlement to service connection for hypertension is granted. Entitlement to service connection for chronic myelomonocytic leukemia (CMML) is granted. FINDINGS OF FACT 1. The Veteran was exposed to herbicide agents while serving around the perimeter of his base in Thailand during the Vietnam era. 2. The Veteran's hypertension was etiologically related to his in-service exposure to herbicide agents. 3. The Veteran's CMML was etiologically related to his in-service exposure to herbicide agents. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for hypertension are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(b), 3.307, 3.309(a). 2. The criteria for entitlement to service connection for CMML are met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(b), 3.307, 3.309(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1970 to September 1974 and from June 1979 to August 1995, including overseas service in Thailand. He died in June 2018. His surviving spouse has been substituted as the Appellant for purposes of processing the claim to completion. See March 2019 administrative decision. The Veteran appealed June 2016 and April 2017 rating decisions by the Agency of Original Jurisdiction (AOJ). In January 2020, the Board of Veterans' Appeals (Board) remanded the Veteran's claims to the AOJ for further action consistent with the Board's remand directives. The claims are back before the Board for further appellate proceedings. The Board finds there has been substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). A veteran is entitled to Department of Veteran Affairs (VA) disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service. 38 U.S.C. §§ 1110, 1131. Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an 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, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that a disease was incurred in service. 38 C.F.R. § 3.303(d). A veteran who during active military, naval, or air service served in the Republic of Vietnam during the period beginning January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed during such service to an herbicide agent, unless there is affirmative evidence establishing that the veteran was not exposed to any such agent. 38 U.S.C. § 1116(f); 38 C.F.R. § 3.307(a)(6). In order to benefit from the presumption of service connection for diseases associated with herbicide agent exposure, the veteran must have one of the diseases enumerated in 38 C.F.R. § 3.309(e). Although a veteran who served in Thailand during the Vietnam era is not entitled to the legal presumption of exposure to an herbicide agent, VA's Adjudication Procedure Manual, M21-1, provides that exposure to an herbicide agent may be considered on a "direct/facts-found basis" if a veteran served in Thailand during the Vietnam Era at one of the RTAFBs as an Air Force security policeman, security patrol dog handler, member of the security police squadron, or "otherwise near the air base perimeter" as shown by evidence of daily work duties, performance evaluation reports, or other credible evidence. M21-1, Part IV, Subpart ii, Chapter 1, Section H. Importantly, presumptive service connection based on herbicide exposure extends to those Veterans whose duties placed them on or near the perimeter of Thailand military bases. See M21-1, Part IV, Subpart ii, 1.H.5.b. The Veteran was diagnosed with hypertension and CMML. See February 2018 and April 2018 examination reports; April 2018 treatment records. As noted in the January 2020 Board decision, exposure to herbicide agents is conceded based on the Veteran's service in Ubon, Thailand and his proximity to the perimeter fence line on a daily basis. As to nexus, the August 2020 opinion found the Veteran's hypertension was at least as likely as not related to service and that the Veteran's Agent Orange exposure caused his hypertension. The August 2020 opinion provided a history and adequate rationale. The Board finds the August 2020 opinion probative. Regarding CMML, a February 2018 treatment record by the Veteran's treating physician noted that the Veteran's CMML is more likely than not caused by his in-service exposure to herbicide agents. The Board therefore finds that the evidence for and the evidence against the Veteran's claim is in relative equipoise. Accordingly, a grant of service connection is warranted for hypertension and CMML. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Zheng, 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.