Citation Nr: 18160405
Decision Date: 12/27/18	Archive Date: 12/26/18

DOCKET NO. 17-00 374
DATE:	December 27, 2018
ORDER
Service connection for ischemic heart disease is denied.
Service connection for prostate cancer is denied.
Service connection for diabetes mellitus is denied.
Service connection for erectile dysfunction is denied.
FINDINGS OF FACT
1. The Veteran served in Thailand from July 1966 to July 1967.
2. Exposure to herbicide agents is not presumed and the Veteran has failed to establish actual exposure to herbicide agents during his active duty military service.
3. The preponderance of the evidence is against finding that ischemic heart disease began during active service, or is otherwise related to an in-service injury, event, or disease.
4. The preponderance of the evidence is against finding that prostate cancer began during active service, or is otherwise related to an in-service injury, event, or disease.
5. The Veteran’s diabetes mellitus did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disability is not otherwise etiologically related to an in-service injury, event, or disease. 
6. The Veteran’s erectile dysfunction is neither proximately due to nor aggravated beyond its natural progression by a service-connected disability, and is not otherwise related to an in-service injury, event, or disease.
CONCLUSIONS OF LAW
1. The criteria for service connection for ischemic heart disease have not been met.  38 U.S.C. §§ 1110, 1116 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018).
2. The criteria for service connection for prostate cancer have not been met.  38 U.S.C. §§ 1110, 1116 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018).
3. The criteria for service connection for diabetes mellitus have not been met.  38 U.S.C. §§ 1110, 1116 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2018).
4. The criteria for service connection for erectile dysfunction have not been met.  38 U.S.C. §§ 1110, 1116, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310(a) (2018).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The Veteran served on active duty from August 1965 to January 1969, including service in Thailand from July 1966 to July 1967.
This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a December 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Togus, Maine and an April 2016 rating decision of the VARO in Indianapolis, Indiana.
The Veteran testified at a video conference hearing before the undersigned Veterans Law Judge in April 2017.  A transcript of the hearing is associated with the claims file.
Service Connection
1. Service connection for ischemic heart disease
2. Service connection for prostate cancer
3. Service connection for diabetes mellitus
The Veteran contends that his ischemic heart disease, prostate cancer, and diabetes mellitus were caused by exposure to herbicide agents during his active duty military service in Thailand from July 1966 to July 1967.
Service connection may be granted on a presumptive basis for certain diseases associated with exposure to herbicide agents.  38 C.F.R. § 3.307 (a)(6).
If a veteran was exposed to an herbicide agent during active military, naval, or air service, and develops certain diseases to a compensable degree any time after such service, the disease shall be service-connected even though there is no record of such disease during service, provided that the rebuttable presumption provisions of § 3.307(d) are also satisfied.  38 C.F.R. §§ 3.307 (a)(6), 3.309(e).  These diseases include ischemic heart disease, prostate cancer, and diabetes mellitus.  38 C.F.R. § 3.309 (e).
Although exposure to herbicide agents is presumed for a veteran, who during active service, served in the Republic of Vietnam during the Vietnam era, there is no such presumption of exposure for veterans, like the current veteran, who served in Thailand.  See 38 U.S.C. § 1116 (f); 38 C.F.R. § 3.307 (a)(6)(iii).  The record does not suggest and the Veteran does not allege that he served in the Republic of Vietnam.  Instead, the Veteran contends that he was exposed to herbicide agents due to his frequent proximity to the base’s perimeter.  Specifically, he reported that his sleeping quarters were located along the base perimeter, as were several of his recreational activities.  He also stated that his work routinely involved visiting the aircraft “boneyard” along the fence line and working on the flight line and apron.
In a December 2013 memorandum, the RO found insufficient information to corroborate Agent Orange exposure.  Likewise, the Board does not find sufficient evidence to establish exposure to herbicide agents.  In his lay statements, the Veteran has reported frequent proximity to the fence line.  He has not alleged military duties that placed him on the perimeter.  The Veteran has submitted a private summary of unit duties at Korat Royal Thai Air Force Base during the time period the Veteran was stationed there, which stated that the 388th Tactical Fighter Wing was tasked with vegetation control.  The Veteran was assigned to the 388th Field Maintenance Squadron during his time in Thailand.  His performance appraisal notes the Veteran’s skill in quick removal and recovery of damaged aircraft along the runway, without any mention of vegetation control or other duties that would place him in the base perimeter.  At his hearing, he estimated that the boneyard was probably 25 feet from the fence line while the airfield and his barracks were each about a hundred yards away.  He has not submitted any evidence to show exposure to Agent Orange.  To the extent that the Veteran reports seeing people spray unknown substances around the base, he has conceded that he has no knowledge of what was sprayed.  His photographs of barrels of unknown chemicals likewise cannot be presumed to contain herbicide agents.  His reports that the ditches were an orange color is not probative as the Board take notice that the color classification of herbicide agents was made independent of the color of the agents or residual orange discoloration.  As such, the Veteran has failed to establish actual exposure to herbicide agents during his active duty military service.  Thus, exposure to herbicide agents cannot be conceded.
Similarly, the Board notes that although the Veteran worked as aircraft mechanic, there is no indication in the record that he regularly and repeatedly operated, maintained, or served onboard C-123 aircraft.  As such, the presumption of exposure to herbicide agents extended to these individuals under 38 C.F.R. § 3.307(a)(6)(v) does not apply.  Instead, the record only refers to the Veteran’s expertise in jet maintenance.
Alternately, certain chronic diseases, including diabetes mellitus, will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause.  38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a).
The question for the Board is whether the Veteran has a chronic disease that manifested to a compensable degree in service or within the applicable presumptive period, or whether continuity of symptomatology has existed since service.
The Board concludes that there is no showing that any of the claimed diseases manifest to a compensable degree within one year of separation of service or were present during service.  Hence, service connection cannot be presumed based on the provisions for chronic diseases at 38 C.F.R. § 3.309(a).  
VA did not obtain a medical nexus opinion on these issues.  VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim.  See McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006).  Here, the Board finds no evidence beyond the Veteran’s claim suggesting that his current ischemic heart disease, prostate cancer, and/or diabetes mellitus are causally related to his military service or were present during his active service.  This is insufficient to warrant the need to provide a medical examination as this would, contrary to the intent of Congress, result in medical examinations being “routinely and virtually automatically” provided to all veterans claiming service connection.  See Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010); see also Colantonio v. Shinseki, 606 F.3d 1378 (Fed. Cir. 2010).  Moreover, as exposure to herbicide agents cannot be established, the evidence does not show a relevant in-service disease or injury.  As such, an opinion is not necessary. 
For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claims of entitlement to service connection for ischemic heart disease, prostate cancer, and diabetes mellitus and his appeal must be denied.  There is no reasonable doubt to be resolved as to these issues.  See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).
4. Service connection for erectile dysfunction
The Veteran contends that he has erectile dysfunction secondary to either his prostate cancer or due to exposure to herbicide agents. 
The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or was aggravated beyond its natural progress by service-connected disability.  The February 2013 disability benefits questionnaire (DBQ) found that the Veteran’s erectile dysfunction was attributable to his prostate cancer and the subsequent removal of his prostate.
In this case, the Veteran is only service connected for bilateral hearing loss and tinnitus.  The Veteran has not alleged and the record does not suggest a causal relationship between either of these conditions and erectile dysfunction.  As such, the preponderance of the evidence is against finding that the Veteran’s erectile dysfunction is proximately due to or the result of, or aggravated beyond its natural progression by service-connected disability.  38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a).  
Likewise, service connection on a presumptive basis is not available for erectile dysfunction.  See 38 C.F.R. § 3.307, 3.309.
Service connection may be granted on a direct basis, but the preponderance of the evidence is also against finding that the Veteran’s erectile is related to an in-service injury, event, or disease.  38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d).
Again, no examination was provided in this case.  VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim.  See McLendon, 20 Vet. App. 79, 81-82.  As explained above, exposure to herbicide agents cannot be established.  The Veteran has not suggested any other in-service disease or injury to which erectile dysfunction may be linked.  Furthermore, the medical evidence has linked this condition to prostate cancer, which is not service connected, and no evidence links this condition to either of his service connected disabilities.  Thus, no examination is necessary.
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For the reasons stated above, the Board finds that the preponderance of evidence is against the Veteran’s claims of entitlement to service connection for erectile dysfunction and his appeal must be denied.  There is no reasonable doubt to be resolved as to this issue.  See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49.
 
JAMES G. REINHART
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	B. Houbeck, Counsel 

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