DIABETES MELLITUS

ARDIE A. BLAND · 2025 · Case ID: A25088674

MIXED

Summary

The veteran, who served from August 1975 to June 1978, appeals the denial of service connection for several conditions. The primary claim involves presumptive service connection for diabetes mellitus (DM), hypertension, and prostate cancer due to herbicide exposure during service at Ft. McClellan, Alabama. The veteran also claimed secondary service connection for erectile dysfunction (ED), nephropathy, bilateral lower extremity peripheral neuropathy (BLEPN), bilateral upper extremity peripheral neuropathy (BUEPN), and diabetic retinopathy (DR) secondary to DM or prostate cancer. The Board found that while VA's initial assessment did not find toxic exposure at Ft. McClellan, the veteran's submitted evidence, including scientific reports and lay statements, established a factual basis for herbicide exposure. Resolving doubt in the veteran's favor, the Board granted service connection for DM, hypertension, and prostate cancer. Consequently, secondary service connection for ED, nephropathy, BLEPN, BUEPN, and DR due to DM or prostate cancer was also granted. The Board remanded claims for a lung condition, liver condition, tremors, and GERD, citing a duty to assist error for failing to obtain necessary VA examinations to determine the etiology of these conditions.

Rationale

Persuasive evidence establishes herbicide exposure at Ft. McClellan; Resolving doubt in Veteran's favor; DM is a condition presumptively linked to herbicide exposure

Special Benefit

NO SPECIAL BENEFIT

Docket No.

241011-481772

Full Decision Text

Citation Nr: A25088674
Decision Date: 10/15/25 Archive Date: 10/15/25

DOCKET NO. 241011-481772
DATE: October 15, 2025

ORDER

Service connection for diabetes mellitus, type II (DM) as due to exposure to herbicides is granted.

Service connection for hypertension as due to exposure to herbicides is granted.

Service connection for prostate cancer as due to exposure to herbicides is granted.

Service connection for erectile dysfunction (ED) as secondary to DM or prostate cancer is granted.

Service connection for nephropathy as secondary to DM is granted.

Service connection for bilateral lower extremity peripheral neuropathy (BLEPN) as secondary to DM is granted.

Service connection for bilateral upper extremity peripheral neuropathy (BUEPN) as secondary to DM is granted.

Service connection for diabetic retinopathy (DR) as secondary to DM is granted.

REMANDED

Service connection for a lung condition as due to exposure to herbicides is remanded.

Service connection for a liver condition as due to exposure to herbicides is remanded.

Service connection for tremors as due to exposure to herbicides is remanded.

Service connection for gastroesophageal reflux disease (GERD) as secondary to DM is remanded.

FINDINGS OF FACT

1. The persuasive evidence of record establishes that the Veteran was exposed to toxins, including herbicides, while stationed at Ft. McClellan.

2. The evidence of record establishes that the Veteran has diagnoses of DM, hypertension, and prostate cancer.

3. The Veteran's ED, nephropathy, BLEPN, BUEPN, and DR have been caused or aggravated by his DM or prostate cancer.

CONCLUSIONS OF LAW

1. The criteria for service connection for DM have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

2. The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

3. The criteria for service connection for prostate cancer have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307. 3.309.

4. The criteria for service connection for ED as secondary to DM and/or prostate cancer have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310.

5. The criteria for service connection for nephropathy as secondary to DM have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310.

6. The criteria for service connection for BLEPN have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310.

7. The criteria for service connection for BUEPN have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310.

8. The criteria for service connection for DR have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1975 to June 1978.

In the October 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the
309, 3.310.

8. The criteria for service connection for DR have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1975 to June 1978.

In the October 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the September 2024 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

Because the Board is remanding the claims for service connection for a lung condition, a liver condition, tremors, and GERD, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 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).

Service connection on a presumptive basis may be established for certain enumerated diseases listed at 38 C.F.R. § 3.309 (e) associated with exposure to certain herbicide agents used in support of military operations in Vietnam during the Vietnam era. 38 U.S.C. § 1116 (a)(1); 38 C.F.R. § 3.307 (a)(6).

DM, hypertension, and prostate cancer are among the diseases afforded presumptive service connection when exposure to herbicides has been established. 38 C.F.R. § 3.309 (e) and Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, Pub. L. No. 117-168 § 3373, 136 Stat. 1759 (2022).

Hypertension

Prostate Cancer

Here, the Veteran has asserted that he was exposed to herbicides while he was stationed at Ft. McClellan, Alabama. See August 2024 Fully Developed Claim, Supplemental Claim, and correspondence. The Veteran's military personnel records confirm that the Veteran was stationed at Ft. McClellan in 1975. See Record of Assignments.

Currently, VA does not presume that any adverse health conditions are associated with service at Fort McClellan; however, a Veteran not entitled to a presumption of exposure may still factually demonstrate that they were at least as likely as not exposed to an herbicide agent in a claim for benefits, with VA deciding claims by Veterans who are experiencing health issues that they believe are related to their service while at Fort McClellan on a case-by-case basis. See 38 U.S.C. § 1113 (b); 38 C.F.R. § 3.303 (d) (the availability of service connection on a presumptive basis does not preclude consideration of service connection on a direct basis).

In June 2024, VA determined that the Veteran had no toxic exposure while in-service. See June 2024 TERA memo and ILER report. However, that determination was made on a conclusory basis of his duty stations and did not address the evidence submitted by the Veteran or his statements which reported in-service toxic exposure.

In contrast, the Veteran submitted a lay statement, articles, and scientific reports which documented the toxic exposures of personnel stationed at Ft. McClellan. See August 2024 correspondence, and lay statement. The submitted medical and scientific articles specifically address the toxins at Ft. McClellan during the period of time in which the Veteran was stationed there. See Correspondence articles and Lay Statement of the Veteran submitted in August 2024. Specifically, a scientific report submitted by the Veteran provided a detailed and thorough analysis of the
TERA memo and ILER report. However, that determination was made on a conclusory basis of his duty stations and did not address the evidence submitted by the Veteran or his statements which reported in-service toxic exposure.

In contrast, the Veteran submitted a lay statement, articles, and scientific reports which documented the toxic exposures of personnel stationed at Ft. McClellan. See August 2024 correspondence, and lay statement. The submitted medical and scientific articles specifically address the toxins at Ft. McClellan during the period of time in which the Veteran was stationed there. See Correspondence articles and Lay Statement of the Veteran submitted in August 2024. Specifically, a scientific report submitted by the Veteran provided a detailed and thorough analysis of the toxins at Ft. McClellan and concluded that the same herbicides used in Vietnam were used at Ft. McClellan. The Board notes that there was no development after VA received the Veteran's statements and evidence of in-service exposure which addressed the Veteran's contentions and scientific evidence or established that he was not exposed to herbicides while stationed at Ft. McClellan. Seeking to obtain negative evidence against the Veteran is prohibited by VA law. See Mariano v. Principi, 17 Vet. App. 305, 312 (2003).

Therefore, resolving any reasonable doubt in favor of the Veteran, the Board finds that the persuasive evidence of record establishes that the Veteran was exposed to herbicides while stationed at Ft. McClellan in 1975.

As noted above, DM, hypertension, and prostate cancer are all conditions which are afforded presumptive service connection when there is exposure to herbicides. The rating decision on appeal specifically contained favorable findings that the Veteran had diagnoses of DM and hypertension. The Board is bound by the findings. 38 C.F.R. § 3.104 (c). Additionally, the Veteran's VA medical records establish his diagnosis of prostate cancer in January 2024. See January 2024 VA medical record. Thus, as the Veteran's record shows that he was exposed to such toxins while in-service, and the record establishes diagnosis of DM, hypertension, and prostate cancer, the Board finds that service connection for DM, hypertension, and prostate cancer is granted.

Erectile Dysfunction (ED)

Nephropathy

Bilateral Lower Extremity Peripheral (BLEPN)

Bilateral Upper Extremity Peripheral (BUEPN)

Diabetic Retinopathy (DR)

Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310.

Here, the record shows that the Veteran has a diagnosis of ED, nephropathy, BLEPN, BUEPN, and DR. Again, the rating decision on appeal established favorable findings that the Veteran had ED and nephropathy, and the Board is bound by those findings. Also, the Veteran's VA medical records show he has diagnosis of BLEPN, BUEPN, and DR. See January 2022, February 2024, and June 2024 VA medical records. January 2022 and June 2024 VA medical records showed that the Veteran's diagnosed ED, nephropathy, BLEPN, BUEPN, and DR are related to his DM or his prostate cancer.

Thus, service connection for ED, nephropathy, tremors, BLEPN, BUEPN, and DR as secondary to DM and/or prostate cancer is granted.

REASONS FOR REMAND

Lung Condition

Liver Condition

Tremors

The Veteran sought service connection for lung and liver conditions and tremors as due to his exposure to herbicides. See May 2024 Fully Developed Claim and August 2024 Supplemental Claim. Prior to the issuance of the rating decision on appeal, a VA examination regarding the diagnosis or etiology of the Veteran's claimed liver and lung disabilities was not conducted. Though the rating decision on appeal noted a diagnosis of tremors, no examination opinion on the etiology of such tremors was obtained. The failure to obtain such examinations prior to the issuance of the rating decision on appeal is a pre-decisional duty to assist error which must be corrected on remand.

GERD

The Veteran has sought service connection for GERD as due to his DM. See August 2024 Fully Developed Claim. While the record shows that the Veteran has a diagnosis of GERD, there is no evidence of record that the Veteran's GERD was caused or aggravated by his DM. The Board finds that a VA examination is warranted to determine if the Veteran's diagnosed GERD is secondary to his now service connected DM. The failure to obtain such an examination prior to the issuance of the rating decision on appeal is a pre-decisional duty to assist error which must be corrected on remand.

The matters are REMAN
decision on appeal is a pre-decisional duty to assist error which must be corrected on remand.

GERD

The matters are REMANDED for the following action:

Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed lung or liver disability and the etiology of the Veteran's diagnosed tremors and GERD. The claims file should be made available to the examiner for review.

As to the Veteran's claimed lung, liver, and tremor disabilities, the examiner must opine whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any diagnosed lung or liver disability or his diagnosed tremors were incurred in, or due to, the Veteran's service, to include his conceded exposure to herbicides and other toxins while in-service, as established by the August 2024 scientific report.

As to the Veteran's diagnosed GERD, the examiner must opine whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that his GERD was caused or aggravated by his service connected diabetes mellitus, type II.

The examiner is advised that for secondary service connection, "aggravation" need not be permanent in nature. Ward v. Wilkie, 31 Vet. App. 233, 241-42 (2019).

The opinion as to whether a claimed disability has been aggravated by a service-connected disability should be provided without regard to the phrase "beyond its natural progression." See Spicer v. McDonough, 61 F.4th 1360, 1364 (2023).

The Veteran's lay statements regarding onset and continuity of symptomology should be recorded and considered.

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A rationale for all opinions must be provided.

Ardie A. Bland

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Parrish

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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