ARTERIOSCLEROTIC HEART DISEASE (CORONARY ARTERY DISEASE)

Summary

The Veteran, an Air Force Veteran who served from September 1971 to September 1975, appeals a July 2019 rating decision. The Veteran sought service connection for coronary artery disease (CAD), diabetes mellitus type II (DM), and diabetic neuropathy in all four extremities. The Board granted service connection for CAD and DM on a presumptive basis due to established herbicide exposure at the U-Tapao Royal Thai Air Force Base, finding the Veteran's duties near the perimeter were sufficiently shown. The Board also granted service connection for diabetic neuropathy in all four extremities, finding it was at least as likely as not that the Veteran suffers from neuropathy and that it would not exist but for his service-connected DM, applying the "but-for" standard for secondary service connection. The Board noted the Veteran's testimony regarding symptoms consistent with neuropathy and a reference to bilateral plantar neuropathy in a medical note. The Board found the evidence persuasive for these conditions, granting service connection for CAD, DM, and all four extremities of diabetic neuropathy. The appeal regarding the specific effective date for the PACT Act grant was remanded.

Rationale

Veteran served at U-Tapao Royal Thai Air Force Base; Duties near perimeter shown; Exposure to herbicide agents established on facts-found basis

Full Decision Text

Citation Nr: A26038036
Decision Date: 04/23/26	Archive Date: 04/23/26

DOCKET NO. 200210-68637
DATE: April 23, 2026

ORDER

Service connection for coronary artery disease (CAD) is granted on a basis other than the PACT Act.

Service connection for diabetes mellitus type II (DM) is granted on a basis other than the PACT Act.

Service connection for diabetic neuropathy of the right upper extremity is granted.

Service connection diabetic neuropathy of the right lower extremity is granted.

Service connection diabetic neuropathy of the left upper extremity is granted.

Service connection diabetic neuropathy of the left lower extremity is granted.

FINDINGS OF FACT

1. The Veteran is shown, on a facts-found basis, to have exposure to herbicide agents during his service in Thailand.

2. The Veteran has CAD.

3. The Veteran has DM.

4. The Veteran's CAD and DM were caused by herbicide.  

5. The Veteran's neuropathy of four extremities resulted from his service-connected diabetes.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for coronary artery disease, on a presumptive basis 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 entitlement to service connection for diabetes, on a presumptive basis 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 entitlement to service connection for diabetic neuropathy of the right upper extremity have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.10.

4. The criteria for entitlement to service connection for diabetic neuropathy of the right lower extremity have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.10.

5. The criteria for entitlement to service connection for diabetic neuropathy of the left upper extremity have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.10.

6. The criteria for entitlement to service connection for diabetic neuropathy of the left lower extremity have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.10.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from September 1971 to September 1975.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a July 2019 rating decision by the Regional Office (RO). The Veteran filed an appeal to the Board by way of a February 2020 notice of disagreement (Form 10182).

In the February 2020 VA Form 10182, Decision Review Request: Board Appeal,

the Veteran elected the Hearing docket. In May 2024, the Veteran testified before

the undersigned Veterans Law Judge at a hearing. A copy of the transcript is

associated with the Veteran's claims file. Therefore, the Board may only consider

the evidence of record at the time of the AOJ decision on appeal, as well as any

evidence submitted by the Veteran or his representative at the hearing or within 90

days following the hearing. 38 C.F.R. § 20.302 (a).

In October 2024, the Board granted the Veteran's appeal for service connection for coronary artery disease and diabetes.  The Veteran timely entered a notice appeal with the United States Court of Appeals for Veterans Claims (CAVC).  In an October 2025 Joint Motion for Partial Remand (JMPR), the CAVC vacated and remanded that portion of the October 2024 Board decision only effectuating a PACT service connection grant back to August 10, 2022.

1. Service connection for CAD granted.

2. Service connection for DM granted.

The Board is mindful that where service connection is granted based on a liberalizing law, which here would be the PACT Act, the effective date for service connection cannot be earlier than the effective date of the liberalizing law, which would be August 10, 2022.  The
 Veteran timely entered a notice appeal with the United States Court of Appeals for Veterans Claims (CAVC).  In an October 2025 Joint Motion for Partial Remand (JMPR), the CAVC vacated and remanded that portion of the October 2024 Board decision only effectuating a PACT service connection grant back to August 10, 2022.

1. Service connection for CAD granted.

2. Service connection for DM granted.

The Board is mindful that where service connection is granted based on a liberalizing law, which here would be the PACT Act, the effective date for service connection cannot be earlier than the effective date of the liberalizing law, which would be August 10, 2022.  The Board is also mindful that the Veteran filed an Intent to File a supplemental claim for CAD and DM, prior to enactment of the PACT Act on April 26, 2019 (Form 21-526EZ).  Therefore, in the interest of maximizing benefits, the Board will now turn to whether exposure to herbicide agents during the Veteran's service in Thailand is otherwise shown on a facts-found basis.

For purposes of the period prior to the PACT Act, the M21-1 provided that exposure to herbicide agents may be conceded on a direct/facts-found basis for certain veterans who served at one of the Royal Thai Air Force Bases (RTAFB) listed, including U-Tapao, whose duties took them near the base perimeter as shown by evidence of daily work duties, performance evaluation reports, or other credible evidence.  See M21-1, IV.ii.1.H.5 (March 18, 2019) (Emphasis added); see also Parseeya-Picchione v. McDonald, 28 Vet. App. 171, 177 (2016) ("VA Compensation Service has acknowledged that there is some evidence that the herbicides used on the Thailand base perimeters may have been either tactical, procured from Vietnam, or a commercial variant of much greater strength and with characteristics of tactical herbicides").

Here, the Veteran reported that he did serve at the U-Tapao in June 1973, specifically repairing equipment used on or near the flight line.  The Veteran further stated that when vehicles broke down on or near the flight line he went to the perimeter itself and was within 10 feet of the perimeter fence 3-5 times a week. The Board finds that these statements are consistent with the Veteran's MOS of vehicle mechanic duties at or near the perimeter.  Therefore, the Board finds that perimeter duties of the Veteran at U-Tapao Royal Thai base are sufficiently shown, and as such, exposure to herbicide agents on a facts-found basis is warranted.

Accordingly, because exposure to herbicide agents is shown on a facts-found basis, service connection for CAD and diabetes is warranted on a presumptive basis under 38 U.S.C. § 1116, and the claim is granted on a basis other than the PACT Act.

3. Service connection for diabetic neuropathy of the right upper extremity is remanded.

4. Service connection for diabetic neuropathy of the right lower extremity is remanded.

5. Service connection for diabetic neuropathy of the left upper extremity is remanded.

6. Service connection for diabetic neuropathy of the left lower extremity is remanded.

When a service-connected disability causes another disability, the secondary disability is also service connected. Secondary service connection is established by showing three elements: (1) the existence of a disability that is already service connected; (2) the existence of another disability; and, (3) a cause-and-effect relationship between the service-connected, or primary, disability and the claimed, or secondary, disability. 38 C.F.R. § 3.310(a); Wallin v. West, 11 Vet. App. 509, 512 (1998). 

The Board is cognizant of the need to "stay in its lane," so to speak, and avoid invading the province of scientific or medical experts by exercising independent judgment on matters requiring specialized knowledge. See, e.g., Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). Yet, the Board also notes lay evidence can establish any element of service connection. See 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a); Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006); Kahana v. Shinseki, 24 Vet. App. 428 (2011); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). 

When evaluating claims for service connection, the Board must scrupulously apply the standards of
 v. Derwinski, 1 Vet. App. 171, 175 (1991). Yet, the Board also notes lay evidence can establish any element of service connection. See 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a); Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006); Kahana v. Shinseki, 24 Vet. App. 428 (2011); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). 

When evaluating claims for service connection, the Board must scrupulously apply the standards of proof pertaining to the award of disability benefits, which may sharply diverge from the type of evidence and degree of certainty employed in a medical setting.

As the Supreme Court has explained, the standard of proof instructs the fact finder as to two key matters: 1) the "degree of confidence" they should feel in the correctness of the finding; and 2) the allocation of the risk of error-in other words, where to assign the benefit of the doubt. Addington v. Texas, 441 U.S. 418, 423 (1979); Santosky v. Kramer, 455 U.S. 745, 754-55 (1982). 

When adjudicating entitlement to secondary service connection, only a "but-for" causal relationship between a service-connected disability and the claimed disability is required. Therefore, the service-connected disability need not be the sole cause or even the primary cause of the claimed disability for service connection to apply-rather, it need only be an essential factor in the development of the disability. In other words, no matter how much or how many other factors also contributed to the claimed disability, if removing the service-connected injury, disease, or event from the equation would have prevented the development of the disability, then service was an essential factor in and a but-for cause of the disability, and service connection for that disability is established. 38 U.S.C. § 1110; Spicer v. McDonough, 61 F.4th 1360, 1363 (Fed. Cir. 2023); see also, Burrage v. United States, 571 U.S. 204, 211-12 (2014).

Turning to the degree of certainty necessary to find in favor of an appellant, in American jurisprudence, there is a "wide spectrum" of standards, and the VA's "benefit-of-the-doubt" doctrine lies at "the farthest end of the spectrum...." Gilbert v. Derwinski, 1 Vet. App. 49, 53-54 (1990). In other words, no party in any adjudicative forum is entitled to greater deference in establishing their case than a veteran who has brought an appeal to the Board. 

This is a matter not only of judicial precedent, but of legislative intent and moral logic: Congress created the benefit-of-the-doubt doctrine as a unique and intentionally generous standard of proof for veterans' appeals, in recognition of the nation's great debt to its veterans. Wise v. Shinseki, 26 Vet. App. 517, 531 (2014). 

In operation, the benefit-of-the-doubt doctrine mandates a finding in favor of a claimant if the evidence before the Board is insufficient to eliminate all reasonable doubt concerning the existence of a disability, the occurrence of an in-service event, or the but-for cause-and-effect relationship between service and a claimed disability. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 

"Reasonable doubt" is deemed to exist if the positive evidence for the claim and the negative evidence against it are at least "approximately balanced" or nearly equal." Id.; Ortiz v. Principi, 274 F.3d 1361, 1364-1365 (Fed. Cir. 2001). As a result, the Board denies an appeal only when the evidence as a whole is persuasively against the claim. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc); Mattox v. McDonough, 56 F.4th 1369, 1378-1379 (2023).

Turning to the three-element test for secondary service connection, there is no dispute the Veteran has service-connected DM. Thus, the first element has been established.

While it is far less well established than the existence of DM, the Board finds there is also sufficient evidence of the existence of the Veteran's neuropathy. Specifically, there is no express formal diagnosis of this condition among the documents in
 the evidence as a whole is persuasively against the claim. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc); Mattox v. McDonough, 56 F.4th 1369, 1378-1379 (2023).

Turning to the three-element test for secondary service connection, there is no dispute the Veteran has service-connected DM. Thus, the first element has been established.

While it is far less well established than the existence of DM, the Board finds there is also sufficient evidence of the existence of the Veteran's neuropathy. Specifically, there is no express formal diagnosis of this condition among the documents in the record, but there is a reference to bilateral plantar neuropathy from a December 2014 Oncology Note. See February 2019 CAPRI record. Also, the Veteran described symptomatology consistent with that condition in a September 2018 Internal Medicine Consult at the Syracuse VA Medical Center ("cramping" in hands and legs associated with exposure to Agent Orange), during a March 2019 VA examination (tingling in fingers and toes), and during a telephone consultation with Primary Care at the Hidden Rivers VA Clinic (tingling in upper extremities). See December 2018 and October 2024 CAPRI record and March 2019 Sensory-Motor Peripheral Neuropathy Disability Benefits Questionnaire. Furthermore, the Veteran has explicitly described his condition as "neuropathy," implying his medical providers have offered that as a diagnosis. See April 209 VA 21-4138 Statement In Support of Claim.

Based on the above, the Board finds it is at least as likely as not the Veteran does have neuropathy of the right upper, right lower, left upper and left lower extremities. Additionally, the Board finds it is at least as likely as not the Veteran's neuropathy would not exist but for his service-connected DM. Therefore, secondary service connection is warranted, and this appeal is granted.

 

 

Timothy Cothrel

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Nadia Kamal, 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.