DIABETES MELLITUS

Summary

The Veteran, a United States Air Force Veteran who served from February 1968 to July 1974, including service in Thailand, is the subject of this appeal initiated by his surviving spouse following his death in May 2022. The Veteran's claims for service connection for diabetes mellitus type II (DM II), hypertension, ischemic heart disease (IHD), prostate cancer, and atrial fibrillation as secondary to a service-connected disability were all granted. The Board found that the Veteran's service in Thailand at U-Tapao and Nakhon Phanom Royal Thai Air Force Bases during the Vietnam era, specifically near the base perimeter, established a factual basis for herbicide exposure. The Veteran's statements regarding his duties as a munitions specialist, which involved daily travel near the base perimeter, were found credible and consistent with his service records. Applying the benefit of the doubt, the Board concluded that the Veteran was as likely as not exposed to herbicides, presumptively linking his DM II, hypertension, IHD, and prostate cancer to this exposure under 38 C.F.R. § 3.309(e). For atrial fibrillation, the Board found persuasive evidence linking it to the service-connected ischemic heart disease, supported by a VA examiner's opinion that it was most likely due to coronary artery disease. Service connection for all claimed conditions was granted.

Rationale

Veteran served in Thailand during Vietnam era near base perimeter; Credible statements consistent with service records; Presumed exposure to herbicide agents under 38 C.F.R. § 3.309(e)

Full Decision Text

Citation Nr: A26038368
Decision Date: 04/23/26	Archive Date: 04/23/26

DOCKET NO. 251112-616728
DATE: April 23, 2026

ORDER

Service connection for diabetes mellitus type II (DM II) is granted.

Service connection for hypertension is granted.

Service connection for ischemic heart disease (also claimed as coronary artery disease) is granted.

Service connection for prostate cancer is granted.

Service connection for atrial fibrillation as secondary to a service-connected disability is granted.

FINDINGS OF FACT

1. The Veteran served at U-Tapao and Nakhon Phanom Royal Thai Air Force Bases during the Vietnam era, the Veteran served near the air base perimeter, and he has a diagnosis of DM II. 

2. The Veteran served at U-Tapao and Nakhon Phanom Royal Thai Air Force Bases during the Vietnam era, the Veteran served near the air base perimeter, and he has a diagnosis of hypertension.

3. The Veteran served at U-Tapao and Nakhon Phanom Royal Thai Air Force Bases during the Vietnam era, the Veteran served near the air base perimeter, and he has a diagnosis of ischemic heart disease.

4. The Veteran served at U-Tapao and Nakhon Phanom Royal Thai Air Force Bases during the Vietnam era, the Veteran served near the air base perimeter, and he has a diagnosis of prostate cancer.

5. The most probative evidence of record supports the finding that the Veteran's atrial fibrillation is related to the service-connected ischemic heart disease.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for DM II as due to in-service herbicide agent exposure have been met. 38 U.S.C. §§ 1110, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

2. The criteria for entitlement to service connection for hypertension as due to in-service herbicide agent exposure have been met. 38 U.S.C. §§ 1110, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

3. The criteria for entitlement to service connection for ischemic heart disease as due to in-service herbicide agent exposure have been met. 38 U.S.C. §§ 1110, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

4. The criteria for entitlement to service connection for prostate cancer as due to in-service herbicide agent exposure have been met. 38 U.S.C. §§ 1110, 1113, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

5. The criteria for entitlement to service connection for atrial fibrillation have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active military service in the United States Air Force from February 1968 to July 1974, which included service in Thailand. The Veteran died in May 2022. The Appellant is the Veteran's surviving spouse and is recognized as the substitute claimant. See August 2022 notice letter. 

This matter comes before the Board of Veterans' Appeals (Board) on appeal of a November 2024 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). 

In November 2025 the Appellant submitted a VA Form 10182, Decision Review Request: Board Appeal Notice of Disagreement (NOD), the Appellant elected the Direct Review option; therefore, the Board may only consider the evidence of record at the time of the Agency of Original Jurisdiction (AOJ) decision on appeal.

In Williams v. McDonough, 37 Vet. App. 305 (2024), the United States Court of Appeals for Veterans Claims held the Board should not adjudicate an appeal until the time for the appellant to switch Board dockets has ended. This period ends either one year from the date the AOJ mailed notice of the decision on appeal, or 60 days from the date the Board received the VA Form 10182, whichever date is later.  38 C.F.R. § 20.202(c)(2). Here, the Board may proceed with
 the Direct Review option; therefore, the Board may only consider the evidence of record at the time of the Agency of Original Jurisdiction (AOJ) decision on appeal.

In Williams v. McDonough, 37 Vet. App. 305 (2024), the United States Court of Appeals for Veterans Claims held the Board should not adjudicate an appeal until the time for the appellant to switch Board dockets has ended. This period ends either one year from the date the AOJ mailed notice of the decision on appeal, or 60 days from the date the Board received the VA Form 10182, whichever date is later.  38 C.F.R. § 20.202(c)(2). Here, the Board may proceed with adjudication because, in the November 2025 VA Form 10182, the Appellant expressly waived the additional time which to modify the selected Board appeal lane. 

1. Service connection for diabetes mellitus type II 

2. Service connection for hypertension

3. Service connection for prostate cancer

4. Service connection for ischemic heart disease (also claimed as coronary artery disease)

Applicable Law

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: "(1) the existence of a present disability; (2) 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. "Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Effective in August 2022, under the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022, also known as the PACT Act, veterans that performed covered service in Thailand at any Royal Thai base during the period beginning on January 9, 1962, and ending on June 30, 1976, are presumed to be exposed to certain herbicide agents, without regard to where on the base the veteran was located or military occupational specialty (MOS). See PACT Act, Pub. L. No. 117-168, § 403 (2022). This legal presumption is afforded without consideration of facts specific to each veteran. Claims granted under the PACT Act will be effective no earlier than August 10, 2022. As the Veteran passed away prior to the effective date of the PACT Act, that is, August 10, 2022, he would have been owed no past-due benefits under the PACT Act at the time of his death. As such, it is inapplicable in the current case.

Prior to the effective date of the PACT Act, however, there was no legal presumption of herbicide agent exposure for service in Thailand. Such exposure was a fact-specific determination made regarding each veteran. VA's Compensation Service determined that there was significant use of herbicides on the fenced-in perimeters of military bases in Thailand intended to eliminate vegetation and ground cover for base security purposes. A primary source for that information was the declassified Department of Defense (DoD) Report titled, "Project CHECO Southeast Asia Report: Base Defense in Thailand." Although DoD indicated that the herbicide use was commercial in nature, rather than tactical (such as Agent Orange), Compensation Service has determined that there was some evidence that herbicides of a tactical nature, or that of a "greater strength" commercial variant, were used. VA's Compensation Service noted that if a veteran's MOS or unit is one that regularly had contact with the base perimeter, there was a greater likelihood of exposure to herbicides. If the veteran served on one of these bases as a security policeman, security patrol dog handler, member of a security police squadron, or otherwise served near the air base perimeter as shown by evidence of daily work duties, as shown by his MOS, performance evaluations, or other credible evidence, then herbicide exposure should be acknowledged on a facts-found or direct basis. However, this applies only during the Vietnam era, from February 28, 1961, to May 7, 1975.

Where a veteran was exposed to herbicide agents during active service, and AL amyloidosis; chloracne or other acneform disease consistent with chloracne; Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes); Hodgkin's disease; ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial
 served near the air base perimeter as shown by evidence of daily work duties, as shown by his MOS, performance evaluations, or other credible evidence, then herbicide exposure should be acknowledged on a facts-found or direct basis. However, this applies only during the Vietnam era, from February 28, 1961, to May 7, 1975.

Where a veteran was exposed to herbicide agents during active service, and AL amyloidosis; chloracne or other acneform disease consistent with chloracne; Type 2 diabetes (also known as Type II diabetes mellitus or adult-onset diabetes); Hodgkin's disease; ischemic heart disease (including, but not limited to, acute, subacute, and old myocardial infarction; atherosclerotic cardiovascular disease including coronary artery disease (including coronary spasm) and coronary bypass surgery; and stable, unstable and Prinzmetal's angina); all chronic B-cell leukemias (including, but not limited to, hairy-cell leukemia and chronic lymphocytic leukemia; multiple myeloma; non-Hodgkin's lymphoma; Parkinson's disease; early-onset peripheral neuropathy; porphyria cutanea tarda; prostate cancer; respiratory cancers (cancer of the lung, bronchus, larynx, or trachea); and soft tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma) becomes manifest to a degree of 10 percent or more at any time after service, service connection shall be established for such disability if the requirements of 38 C.F.R. § 3.307(a)(6) are met even though there is no record of that disease during service, provided that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied. 38 U.S.C. § 1116; 38 C.F.R. § 3.309(e).

Discussion

As there is considerable overlap in the applicable evidence for the Veteran's claims for service connection for DMII, hypertension, ischemic heart disease, and prostate cancer, the Board will discuss them together.

The Veteran argued that the disabilities listed above are due to his exposure to herbicide agents during service. See October 2015 statement. He asserted that he was stationed in Thailand at the base perimeter where Agent Orange was sprayed. Id. He further indicated that he served at U-Tapao Air Field and Nakhon Phanom during his deployment. Id.

In the November 2024 rating decision, the AOJ made favorable findings that the Veteran was diagnosed with diabetes mellitus type II, hypertension, coronary artery disease (IHD), and prostate cancer. The Board is bound by these favorable findings. See AMA, Pub. L. No. 115-55, § 5104A, 131 Stat. 1105, 1106-07.

Turning to the evidence, his military personnel records confirm that he was stationed at U-Tapao Royal Thai Air Force Base (RTAFB) from October 1969 to April 1970 and at Nakhon Phanom RTAFB from March 1969 to October 1969. See Airman Performance Report. His duties included that of a munitions specialist. His duties consisted of line delivery, bomb assembly and disassembly, pre-load operations, and build-up out of experimental munitions. Id. Therefore, the Veteran's period of service in Thailand is within the February 28, 1961, to May 7, 1975 timeframe for special consideration of herbicide agent exposure. 

In his August 2020 declaration, the Veteran stated that during his time at both bases he served as a munitions specialist. He explained that his duties included storing and assembling munitions and delivering them to the flight line. He further noted that for safety reasons munitions storage areas were located along the base perimeter, requiring him to travel daily between the perimeter and the flight line. Additionally, he reported that his living quarters at Nakhon Phanom RTAFB were approximately 100 yards from the base perimeter, while at U-Tapao they were approximately 250 to 300 yards away.

The Board finds the Veteran's statements credible as they are consistent with the circumstances of his service. See 38 U.S.C. § 1154 (2012); Caluza v. Brown, 7 Vet. App. 498, 511 (1995). The Veteran's reports of being at the perimeter of the base are consistent with the places, types, and circumstances of his service and his reports are supported by his military personnel records. Resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran's duties took him near the perimeter of the RTAB and that he was as likely as
100 yards from the base perimeter, while at U-Tapao they were approximately 250 to 300 yards away.

The Board finds the Veteran's statements credible as they are consistent with the circumstances of his service. See 38 U.S.C. § 1154 (2012); Caluza v. Brown, 7 Vet. App. 498, 511 (1995). The Veteran's reports of being at the perimeter of the base are consistent with the places, types, and circumstances of his service and his reports are supported by his military personnel records. Resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran's duties took him near the perimeter of the RTAB and that he was as likely as not exposed to herbicides while stationed in Thailand. Moreover, the record clearly demonstrates that the Veteran has been diagnosed with diabetes mellitus type II, hypertension, coronary artery disease, and prostate cancer. Accordingly, his disabilities are presumed to related to exposure to herbicide agents. 38 C.F.R. § 3.309(e). Thus, service connection is warranted.

5. Service connection for atrial fibrillation as secondary to a service-connected disability

Applicable Law

VA has a duty to fully and sympathetically develop a Veteran's claim to its optimum, which includes determining all potential claims raised by the evidence and applying all relevant laws and regulations. Moody v. Principi, 360 F.3d 1306, 1310 (Fed. Cir. 2004).

Secondary service connection may be granted for a disability, which is proximately due to the result of, or aggravated by, an established service-connected disorder. 38 C.F.R. § 3.310 (2018); Allen v. Brown, 7 Vet. App. 439 (1995).

Discussion

First, the Board acknowledges that the Veteran has been diagnosed with atrial fibrillation. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). In the November 2024 rating decision, the AOJ made a favorable finding that the Veteran had a diagnosis of atrial fibrillation. The Board is bound by this favorable finding. See AMA, Pub. L. No. 115-55, § 5104A, 131 Stat. 1105, 1106-07. 

The Board finds that evidence of record is persuasively in favor of a relationship between the Veteran's atrial fibrillation and his ischemic heart disability. Regarding secondary service connection, as noted above, this decision grants service connection for ischemic heart disability. 

The Veteran received an August 2023 VA examination. The examiner opined that the Veteran's atrial fibrillation is most likely due to his ischemic heart disease/CAD. The examiner reasoned that the atrial fibrillation is a type of arrhythmia that causes an irregular heartbeat and according to medical literature the condition can be due to among other things, coronary artery disease.  

In sum, the Board finds there is sufficient evidence that the atrial fibrillation is proximately due to the service-connected ischemic heart disease. Therefore, based on the foregoing and resolving reasonable doubt in the appellant's favor, the Board finds that service connection for atrial fibrillation as secondary to the service-connected ischemic heart disease is warranted. To this extent, the appellant's appeal is granted. 38 C.F.R. § 3.310. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995).

 

 

David Gratz

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Braxton

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.