DIABETES MELLITUS

SHEREEN M. MARCUS · 2025 · Case ID: A25062493

DENIED

Summary

The Veteran, a Navy veteran who served from November 1967 to August 1971, appealed the denial of service connection for diabetes mellitus type II (DM), peripheral neuropathy in all four extremities as secondary to DM, and erectile dysfunction (ED) as secondary to DM. The Veteran contended that his DM was presumptively related to service due to claimed herbicide exposure and that his other conditions were secondary to DM. The Board acknowledged the Veteran's diagnoses of DM, peripheral neuropathy, and ED. However, the Board found that the evidence persuasively weighed against a finding of herbicide exposure, as the Veteran's ships did not travel in eligible offshore waters of Vietnam, and his claims of exposure were inconsistent with his military occupational specialty and lack of corroborating evidence. The Board also found the Veteran's contentions regarding helicopter refueling and dockside activities in Vietnam to be unprobative and inconsistent with the record. Regarding DM, the Board noted the lack of in-service complaints or diagnoses, with the first documented diagnosis occurring decades after service. VA examinations consistently opined that the Veteran's DM was more likely due to civilian lifestyle factors like obesity and diet, rather than service or conceded toxic exposure risk activities (TERA). The Board found these negative nexus opinions, supported by medical literature and the Veteran's clinical history, to be persuasive. Consequently, the Board denied service connection for DM and the secondary conditions of peripheral neuropathy and ED, as the primary condition (DM) was not service-connected.

Rationale

No in-service complaints or diagnosis of DM.; First DM diagnosis documented decades after service.; VA examiners opined DM more likely due to civilian factors (diet, obesity, family history).; No nexus established between DM and service or conceded TERA.; Herbicide exposure claim denied due to lack of evidence of travel in eligible offshore waters and inconsistent lay statements.

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250228-520657

Full Decision Text

Citation Nr: A25062493
Decision Date: 07/23/25 Archive Date: 07/23/25

DOCKET NO. 250228-520657
DATE: July 23, 2025

ORDER

Entitlement to service connection for diabetes mellitus, type II (diabetes) is denied.

Entitlement to service connection for peripheral neuropathy of the right upper extremity as secondary to diabetes is denied.

Entitlement to service connection for peripheral neuropathy right lower extremity as secondary to diabetes is denied.

Entitlement to service connection for peripheral neuropathy left upper extremity as secondary to diabetes is denied.

Entitlement to service connection for left lower extremity peripheral neuropathy as secondary to diabetes is denied.

Entitlement to service connection for erectile dysfunction (ED) as secondary to diabetes is denied.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding the Veteran was exposed to herbicide agents during service.

2. The Veteran's service is consistent with "Garrison" toxic exposure risk activity (TERA), to include asbestos, firefighting foams, aqueous fil forming foam (AFFF), perfluoroalkyl and polyfluoroalkyl substances (PFAS), and oils.

3. The evidence of record persuasively weighs against finding the Veteran's diabetes was chronic in service; manifested to a compensable degree within the applicable presumptive period; had continuity of symptomatology; or is otherwise etiologically related to an in-service injury or disease, to include conceded TERA.

4. The evidence of record persuasively weighs against finding that the Veteran has bilateral upper and lower extremity peripheral neuropathy and ED that is related to service or secondary to a service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for diabetes mellitus, type II (diabetes) have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for entitlement to service connection for peripheral neuropathy of the right upper extremity as secondary to diabetes have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for entitlement to service connection for peripheral neuropathy right lower extremity as secondary to diabetes have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

4. The criteria for entitlement to service connection for peripheral neuropathy left upper extremity as secondary to diabetes have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

5. The criteria for entitlement to service connection for left lower extremity peripheral neuropathy as secondary to diabetes have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

6. The criteria for entitlement to service connection for erectile dysfunction (ED) as secondary to diabetes have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from November 1967 to August 1971.

These matters come to the Board of Veterans' Appeals (Board) on appeal from a December 2023 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), which was later reviewed upon request of Higher-Level-Review (HLR) by the Veteran in May 2024. Upon HLR, the RO discovered a development error, and the claim was assigned to the Supplemental Claim review lane in September 2024. Upon completion of additional development, the RO issued another rating decision in January 2025 once more denying the Veteran's service connection claims.
S FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from November 1967 to August 1971.

The Veteran appealed the decision in a February 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), electing the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the January 2025 agency of original jurisdiction (AOJ) supplemental claim decision on appeal. 38 C.F.R. § 20.301. If evidence was submitted after the AOJ issued the supplemental claim decision on appeal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008).

Service Connection

The Veteran contends he has diabetes mellitus type II (DM/diabetes) that should be presumptively related to service based on contended herbicide exposure and that the remaining claims are secondary to DM. Significantly, the AOJ favorably found that the Veteran has a diagnosis of DM, erectile dysfunction (ED), and bilateral upper and lower extremity peripheral neuropathy which will not be disturbed. 38 C.F.R. § 3.104. For the reasons that follow, the Board finds service connection for any of these claims is not warranted.

Generally, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Certain chronic diseases, such as DM, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Veterans who, during active service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975, shall be presumed to have been exposed to an herbicide agent, unless there is affirmative evidence of non-exposure. 38 U.S.C. § 1116; 38 C.F.R. § 3.307. If a Veteran was exposed to an herbicide agent (to include Agent Orange) during active military, naval or air service and has contracted an enumerated disease, including DM, to a degree of 10 percent or more at any time after service, the Veteran is entitled to a presumption of service connection even though there is no record of such disease during service. 38 U.S.C. § 1112; 38 C.F.R. §§ 3.307, 3.309(e); see also Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act).

In rendering this decision, the Board has reviewed all evidence of record whether discussed in detail. See Newhouse v. Nicholson, 497 F.3d 1298, 1302 (Fed. Cir. 2007) (holding the Board must only discuss the evidence which is relevant to the issues on appeal). To the extent the evidence is found in "approximate balance," the Board will afford the benefit of the doubt in favor of the Veteran. Lynch v. McDonough, 21 F. 4th 776 (Fed, Cir. 2021) (holding that exact equipoise is not required for the benefit of the doubt to be applied, but rather the Veteran is entitled to the benefit of the doubt when the evidence is in approximate balance or "nearly equal").

Here, it is not in dispute that the Veteran did not have documented service in the Republic of Vietnam. If a veteran did not serve in the Republic of Vietnam during the Vietnam era, actual exposure to herbicides must be verified through an appropriate service department or other sources for the presumption of service connection for an herbicide-related diseased under 38 C.F.R. § 3.309(e) to be applicable.

Regarding herbicide exposure specifically, the Veteran has contended that he was exposed while aboard the USS Bronstein from February 1971 to August 1971 during which time the USS Bronstein entered the offshore eligible waters as defined in the Blue Water Navy Vietnam Veterans Act of 2019, Public Law 116-23, or in the alternative, was exposed while dockside in Danang, Vietnam to take on fuel and supplies while aboard search and rescue vessels, and/or while refueling helicopters aboard the USS Bronstein that had returned from Vietnam that were being used to spray herbicides. See February 2020 Supporting Statement; see also September 2024 HLR Informal Conference.

In light of the Veteran's contentions of herbicide agent exposure during service, additional development has been completed in an attempt to verify actual exposure. The evidence, however, persuasively weighs against finding the Veteran had actual herbicide agent exposure at any time during service.

Upon review, the Veteran's military personnel records reference service aboard the USS Shields from July 1968 to September 1968, the USS Mullany from September 1968 to December 1970, the USS Schofield from January 1971 to March 1971, and the USS Bronstein from March 1971 to August 1971.

The Records Research Team review was unable to concede herbicide agent exposure under the Blue Water Navy Vietnam Veterans Act of 2019 as the ships noted above did not conduct operations in the eligible offshore waters of Vietnam while the Veteran was aboard. However, the ships were noted to have been deployed in the Western Pacific theater. Nonetheless, the claim was submitted to the Joint Services Records Research Center (JSRRC) for further review.

A professional researcher from the VBA, Office of Field Operations Service, Military Records Research Center, then completed comprehensive research on the Veteran's claimed herbicide exposure while serving aboard the USS Shields, Mullany, Schofield, and Bronstein. The researcher reviewed the command history records and ship histories. A request was made to the Naval History and Heritage Command (NHHC), the custodian of Naval command history records, but they were unable to be located for the USS Shields. The researcher ultimately concluded there was no evidence located to support documentation of the claimed exposure.

In response, VA issued a memorandum in September 2020 that exposure to herbicides could not be conceded as the evidence of record did not show that the Veteran had duty or visitation
.

In response, VA issued a memorandum in September 2020 that exposure to herbicides could not be conceded as the evidence of record did not show that the Veteran had duty or visitation in the Republic of Vietnam, or on its inland waterways, or nautical service in the offshore eligible waters.

Additional development into the Veteran's claimed herbicide exposure was conducted in October 2023. Several Records Research Memoranda from this time indicate extensive research was conducted to determine the whereabouts of the Veteran's ships upon which he was assigned during his active-duty service. These memoranda indicate that the RO once more attempted to obtain the command histories and deck logs of the USS Shields, USS Mullany, USS Schofield, and USS Bronstein to verify the Veteran's claimed exposure. Ultimately, the RO concluded in an October 2023 memorandum, that "exposure to herbicides cannot be recognized as the evidence of record does not show the Veteran had service in a qualifying nautical location...did not have duty or visitation in the Republic of Vietnam, or its inland waterways, or nautical service in the offshore eligible waters as defined in the Blue Water Navy Vietnam Veterans Act of 2019, Public Law 116-23".

Based on the above, the Board finds the evidence persuasively weighs against finding that the various ships the Veteran served aboard, in particular the USS Bronstein, traveled within the eligible offshore waters of Vietnam as identified within the Blue Water Navy Vietnam Veterans Act of 2019. Accordingly, the presumptions related to herbicide agent exposure afforded under the Blue Water Navy Vietnam Veterans Act of 2019 are not applicable here.

As mentioned above, however, the Veteran has also contended to being exposed to herbicide agents while refueling helicopters which were used to spray herbicides in Vietnam. The Board finds this statement is not probative as the Veteran is not competent to determine whether the helicopters were actually used to spray herbicide agents in Vietnam and most importantly, this statement is not consistent with his military occupational specialty (MOS), nor the duties associated therewith. The Veteran's MOS during his active-duty service, was fireman with additional training in boiler water, feedwater testing, and treatment. Therefore, refueling helicopters or simply being around them seems highly unlikely given the Veteran's MOS and the presumed duties of a fireman and/or a water treatment/testing technician. See Gardin v. Shinseki, 613 F.3d 1374, 1379-80 (Fed. Cir. 2010) (affirming rejection of lay evidence based, in part, on fact that it was inconsistent with the record). In addition, even if the Board were to presume the Veteran's duties involved being in and around helicopters, the Board finds the Veteran is not qualified to render any opinion regarding whether the helicopters he refueled were used for the spraying of herbicide agents or that any leaked on or near him. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). To this point, the Board finds most significant the fact that the Veteran's various ships he was assigned to during his active duty service were found to have not been within the offshore eligible waters as defined in the Blue Water Navy Vietnam Veterans Act of 2019, and thus tends to indicate that it was highly unlikely that any helicopters used for missions in Vietnam were to have been flown from the ships he was stationed on as they have been determined to have been over 12 nautical miles from the offshore waters of Vietnam during his active duty service period.

The Veteran also contends that he was dockside at Danang, Vietnam while refueling during search and rescue missions. However, the Veteran has provided no supporting information in regard to this assertion and in similar fashion to the above, his reported participation in search and rescue missions is in direct contrast to his MOS and associated duties. Moreover, as indicated above, the Veteran's ships he was stationed on during active-duty service were not located within the offshore eligible waters under the Blue Water Navy Vietnam Veterans Act of 2019. Important to note, the offshore eligible waters include an area of 12 nautical miles from the coast of Vietnam. The fact that the Veteran was stationed aboard ships found to have been further than 12 nautical miles from Vietnam, seems to suggest
also contends that he was dockside at Danang, Vietnam while refueling during search and rescue missions. However, the Veteran has provided no supporting information in regard to this assertion and in similar fashion to the above, his reported participation in search and rescue missions is in direct contrast to his MOS and associated duties. Moreover, as indicated above, the Veteran's ships he was stationed on during active-duty service were not located within the offshore eligible waters under the Blue Water Navy Vietnam Veterans Act of 2019. Important to note, the offshore eligible waters include an area of 12 nautical miles from the coast of Vietnam. The fact that the Veteran was stationed aboard ships found to have been further than 12 nautical miles from Vietnam, seems to suggest that any search and rescue missions would have been further out to sea and would not have involved any docking for resupply given that the ships he was stationed on, would have been the closest to him rather than land (Vietnam) in order to resupply. The Board thus finds the Veteran's lay assertions are not probative to establish herbicide agent exposure as it is inconsistent with the available evidence of record. See Gardin, 613 F.3d 1374, 1379-80 (Fed. Cir. 2010).

In summary, the Board finds the evidence persuasively weighs against finding that the Veteran had verified actual exposure to herbicides at any time during his active service. While the Veteran was aboard several ships, to specifically include the USS Bronstein, they did not travel in the eligible offshore waters of Vietnam as identified within the Blue Water Navy Vietnam Veterans Act of 2019 during the Veteran's service. Moreover, the record lacks competent evidence of herbicide agent exposure while aboard the various vessels during the Veteran's active service. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable here. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. That is, mere assertions of herbicide exposure by a veteran without competent supporting evidence does not trigger a benefit of the doubt analysis. Accordingly, the presumptions related to herbicide agent exposure are not applicable as said exposure has not been conceded.

When service connection cannot be established on a presumptive basis, the Court has held that the claim must nevertheless be reviewed to determine whether service connection can be established on a direct basis. See Combee v. Brown, 34 F.3d 1039 (1994). To this point, the Board again notes the Veteran has been favorably found to have a diagnosis of DM, ED, and bilateral upper and lower extremity peripheral neuropathy. Additionally, the Veteran has conceded "Garrison" exposure TERA due to his military occupation specialty of fireman and training in water boiler treatment and testing with exposure to asbestos, fire fight foams (AFFF), PFAS and oils. See September 2024 VA Memorandum. The evidence, however, persuasively weighs against finding that DM is related to service, to include conceded TERA for the reasons that follow.

1. Entitlement to service connection for diabetes mellitus, type II (diabetes), is denied.

The Veteran contends his diabetes (DM) is related to service, to include conceded TERA. See November 2023 Supporting Statement. The Board finds service connection is not warranted.

Turning to the relevant evidence of record, upon entrance to active service, the Veteran was clinically evaluated as normal. Service treatment records (STRs) lack any mention of complaints related to DM. At separation, the Veteran was again clinically evaluated as normal with no indication of any DM related issue.

Post service private treatment records dated from September 2007 note the first documented report of a diagnosis of DM.

In November 2022, the Veteran was afforded a VA diabetes examination. At which time, the examiner diagnosed the Veteran with diabetes mellitus type II and ED. The Veteran's ED was reported to be caused by his DM. Otherwise; no recognized complications of DM were reported. Ultimately, the examiner opined that the Veteran's DM was not incurred in or caused by service due to a lack of information in the Veteran's STRs to find that his DM began during service. Also, the examiner noted the significant amount of time between separation from service and the first documented report of DM. Therefore, the examiner concluded that the Veteran's DM is more likely due to "a post discharge condition related to his civilian life".

The Veteran was afforded another VA diabetes examination in December 2023. At which time, the examiner diagnosed the Veteran with DM and noted complications of DM to include bilateral upper and lower extremity peripheral neuropathy as well as ED. Ultimately, the examiner opined that there "is no evidence to show that this condition can be caused by exposure to asbestos, cleaning solvents, diesel/
caused by service due to a lack of information in the Veteran's STRs to find that his DM began during service. Also, the examiner noted the significant amount of time between separation from service and the first documented report of DM. Therefore, the examiner concluded that the Veteran's DM is more likely due to "a post discharge condition related to his civilian life".

The Veteran was afforded another VA diabetes examination in December 2023. At which time, the examiner diagnosed the Veteran with DM and noted complications of DM to include bilateral upper and lower extremity peripheral neuropathy as well as ED. Ultimately, the examiner opined that there "is no evidence to show that this condition can be caused by exposure to asbestos, cleaning solvents, diesel/JP4, or exhaust fumes". The examiner explained that DM is mainly caused by obesity, poor diet, and lack of exercise. The examiner noted the Veteran had a diagnosis of obesity for many years and upon review of the Veteran's presumed TERAs and in consultation with online medical research, he concluded that "it is less likely than not that Veteran's diabetes mellitus was caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all toxic exposure risk activities of the veteran".

Upon special review mandated by the RO, an addendum medical opinion was sought and obtained in January 2025. Once again, the VA examiner opined that the Veteran's DM was less likely than not, "caused by the indicated toxic exposure risk activities, after considering the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran". Specifically, the examiner noted the findings within the September 2024 VA TERA memorandum which found the Veteran to have been presumed exposed to asbestos, fighting foams (or aqueous file forming foam (AFFF)), perfluoroalkyl and polyfluoroalkyl substances (PFAS) and various oils. The examiner explained the presence of insulin resistance in those diagnosed with DM and that medical literature shows that DM is more likely caused by diet, family history, and age. The examiner reported that the Veteran's claims file contained evidence that the Veteran has hyperlipidemia as well as a family history of diabetes. Therefore, the examiner found that a "nexus has not been established" and cited to several medical articles in support of her findings.

Based on the above, the Board finds the persuasive weight of the evidence is against finding that the presumptions regarding chronic conditions are applicable to the Veteran's DM claim. The Veteran's DM was not shown as chronic in service, did not manifest to a compensable degree within a year of separation, and was not noted in service with attributable continuity of symptomatology. Indeed, treatment records note that the Veteran was not diagnosed with DM until 2007, multiple decades after separation from active-duty service. Despite this, as noted above, service connection may be granted on a direct basis if his current DM is attributable to service. See Combee, 34 F.3d 1039 (1994).

The Board finds probative the January 2025 VA opinion and that it is sufficient to resolve the claim. The examiner considered the Veteran's medical history, military occupational specialty and associated TERAs, and set forth all pertinent findings, such that the Board is able to make a fully informed decision. The examiner also provided an explanation that contains clear conclusions and supporting data. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); see also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Notably, the record lacks any opinion in support of the claim, and the negative nexus opinion is found to be consistent with earlier VA medical opinions, to specifically include the findings by the December 2023 VA examiner. When considered together, both VA examiners considered the Veteran's conceded TERAs during service but found that he had multiple other risk factors leading to his diabetes, and the condition is understood given the Veteran's clinical history. While the Veteran believes his DM is related to his TERA during service, the Board finds he is not competent to render a nexus opinion as it requires specialized knowledge and training. See Jandreau, 492 F.3d at 1377. Accordingly, the Board relies upon the competent and probative 2023 and 2025 VA opinions regarding nexus.

Based on the above, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for diabetes is not warranted. See
but found that he had multiple other risk factors leading to his diabetes, and the condition is understood given the Veteran's clinical history. While the Veteran believes his DM is related to his TERA during service, the Board finds he is not competent to render a nexus opinion as it requires specialized knowledge and training. See Jandreau, 492 F.3d at 1377. Accordingly, the Board relies upon the competent and probative 2023 and 2025 VA opinions regarding nexus.

2. Entitlement to service connection for peripheral neuropathy of the right upper extremity as secondary to diabetes, is denied.

3. Entitlement to service connection for peripheral neuropathy right lower extremity as secondary to diabetes, is denied.

4. Entitlement to service connection for peripheral neuropathy left upper extremity as secondary to diabetes, is denied.

5. Entitlement to service connection for left lower extremity peripheral neuropathy as secondary to diabetes, is denied.

6. Entitlement to service connection for erectile dysfunction (ED) as secondary to diabetes, is denied.

The Veteran contends that his currently diagnosed ED and bilateral upper and lower extremity peripheral neuropathy are due to his diabetes. The Board finds service connection is not warranted.

The Board acknowledges that VA examinations have revealed diagnoses of ED as well as bilateral upper and lower extremity peripheral neuropathy. See October 2022 and December 2023 VA Examinations. Moreover, the December 2023 VA examiner opined that the Veteran's ED and bilateral upper and lower extremity peripheral neuropathy are due to his nonservice-connected DM.

However, the record lacks any contention that the Veteran experienced any symptoms of either condition during service or is in any way related to service. Indeed, the Veteran's STRs lack any complaints, treatment, or diagnosis related to ED or peripheral neuropathy. Further, upon separation, the Veteran was clinically evaluated as normal. Moreover, the Veteran himself has not contended, nor does the record reflect, his ED and diabetic peripheral neuropathy are related to service. Rather, the Veteran has only contended that his ED and peripheral neuropathy are secondary to DM. The Veteran, however, has not been granted service connection for DM from which to seek secondary service connection as the claim for said benefit has been denied in the decision above. Therefore, secondary service connection for ED and bilateral upper and lower extremity peripheral neuropathy, cannot be granted. See generally 38 C.F.R. § 3.310.

While the Veteran has a conceded TERA for which development pertaining to these claims has not been completed, such development is not required here. Indeed, TERA examinations are not required where there is a clear etiology that is not associated with the toxic exposure, as is the case here. That is, the Board finds probative the December 2023 VA examiner's opinion that his ED and peripheral neuropathies are due to his DM. Based on this, the Board finds that no further development of the Veteran's claims for service connection for ED and peripheral neuropathy is required.

Accordingly, the evidence is persuasively against the claims. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for ED and bilateral upper and lower extremity peripheral neuropathy is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

SHEREEN M. MARCUS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Minnitte, Samuel F.

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.

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