Citation Nr: A23011678 Decision Date: 05/30/23 Archive Date: 05/30/23 DOCKET NO. 190823-27526 DATE: May 30, 2023 ORDER Entitlement to service connection for diabetes mellitus II is granted pursuant to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act). Entitlement to service connection for diabetic neuropathy is granted secondary to the PACT Act grant of service connection for diabetes mellitus II. Entitlement to service connection for diabetic retinopathy and cataracts (claimed as eye condition) is granted secondary to the PACT Act grant of service connection for diabetes mellitus II. Entitlement to service connection for erectile dysfunction is granted secondary to the PACT Act grant of service connection for diabetes mellitus II. Entitlement to service connection for bilateral hearing loss is granted. Entitlement to service connection for tinnitus is granted. REMANDED Entitlement to service connection for a heart disorder, to include premature ventricular contraction (PVC), due to toxic exposures during service (including Agent Orange), is remanded. Entitlement to service connection for a lung disorder, to include chronic obstructive pulmonary disease (COPD), due to toxic exposures during service (including Agent Orange), is remanded. Entitlement to service connection for diabetes mellitus II on a basis other than under the PACT Act, prior to August 10, 2022, is remanded. Entitlement to service connection for diabetic neuropathy on a basis other than secondary to the PACT Act grant of service connection for diabetes mellitus II PACT Act, prior to August 10, 2022, is remanded. Entitlement to service connection for diabetic retinopathy and cataracts (claimed as eye condition) on a basis other than secondary to the PACT Act grant of service connection for diabetes mellitus II, prior to August 10, 2022, is remanded. Entitlement to service connection for erectile dysfunction on a basis other than secondary to the PACT Act grant of service connection for diabetes mellitus II, prior to August 10, 2022, is remanded. FINDINGS OF FACT 1. The Veteran is presumed to have been exposed to Agent Orange during his active duty service on multiple bases in Thailand, including the Korat Royal Thai Air Force Base, and his diabetes mellitus II is presumptively related to that exposure. 2. The Veteran's neuropathy, retinopathy, and erectile dysfunction are caused by/proximately due to his service-connected diabetes mellitus II disability. 3. The Veteran's hearing loss and tinnitus are each directly related to his exposure to loud noise during active duty service. CONCLUSIONS OF LAW 1. The criteria for service connection for diabetes mellitus II have been met. 38 U.S.C. §§ 1110, 1116(d)(2), 5108; 38 C.F.R. §§ 3.102, 3.309(e); Honoring our PACT Act of 2022, Pub. L. 117-168. 2. The criteria for service connection for neuropathy secondary to the PACT Act grant of diabetes mellitus II have been met. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. §§ 3.102, 3.310; Honoring our PACT Act of 2022, Pub. L. 117-168. 3. The criteria for service connection for diabetic retinopathy and cataracts (claimed as eye condition) secondary to the PACT Act grant of diabetes mellitus II have been met. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. §§ 3.102, 3.310; Honoring our PACT Act of 2022, Pub. L. 117-168. 4. The criteria for service connection for erectile dysfunction secondary to the PACT Act grant of diabetes mellitus II have been met. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. §§ 3.102, 3.310; Honoring our PACT Act of 2022, Pub. L. 117-168. 5. The criteria for service connection for bilateral hearing loss have been met. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5108; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1967 to March 1969, including in Thailand from January 1968 to March 1969 during the Vietnam War. The case is on appeal from an August 2019 Higher-Level Review rating decision after an October 2018 RAMP Opt-In Election from an August 2017 Legacy rating decision. Following additional re-adjudications in January and June 2019, the Veteran requested a Higher-Level Review of all decisions in July 2019 (see Veteran's July 1, 2019, VA Form VA Form 20-0996), which ultimately culminated in the August 2019 Higher-Level Review rating decision that is on appeal. See Veteran's August 2019 VA Form 10182-Board Appeal. In his Appeal the Veteran requested a Board Hearing, which was held on July 2022 Board Hearing. The evidentiary window for all claims is thus all of the evidence of record on the date of the AOJ's October 15, 2018, receipt of the Veteran's RAMP Opt-in election form plus an allotted 30 day Supplemental claim period thereafter (that is, until November 14, 2018); and all evidence submitted by the Veteran within 90 days of the July 2022 Board Hearing; that is, from July 12, 2022, to October 10, 2022. Additionally, and regarding the claims for hearing loss and tinnitus, there is an additional evidentiary window spanning from March 2019 (the date of a March 14, 2019, VA Form 20-0995 Supplemental claim regarding these two issues) until June 20, 2019; the date of the respective rating decision. The issue of service connection for diabetes mellitus II is granted pursuant to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act); and the issues of service connection for diabetic neuropathy, diabetic retinopathy and cataracts (claimed as eye condition), and erectile dysfunction are granted secondary to the PACT Act award of service connection for diabetes mellitus II. 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 is requesting service connection for numerous disorders (including diabetes mellitus, diabetic neuropathy, an eye condition, and erectile dysfunction) that he maintains are either directly or proximately due to in-service exposure to Agent Orange; and service connection for hearing loss and tinnitus, which he attributes to his noise exposure during active duty service. 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. § 1131; 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)). Service connection may also be granted for certain chronic diseases listed at 38 C.F.R. § 3.309(a), including hypertension and diabetes mellitus, if manifested to a compensable degree within 1 year from the date of separation from service. See 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. See 38 C.F.R. § 3.310. Additionally, if a veteran was exposed to an herbicide agent during active military, naval, or air service, certain enumerated diseases listed at 38 C.F.R. § 3.309(e), such as diabetes mellitus II and coronary artery/ischemic heart disease, shall be service-connected even though there is no record of such disease during service. See 38 C.F.R. § 3.307(a)(6). Relevant to these provisions, Congress has recently passed the PACT Act, which provides that a veteran who had active military, naval, air, or space service in Thailand at any United States or Royal Thai base during the period beginning on January 9, 1962, and ending on June 30, 1976, without regard to where on the base the veteran was located or his/her military job specialty, shall be presumed to have been exposed during such service to an herbicide agent containing dioxin or 2,4-dichlorophenoxyacetic acid, and may be presumed to have been exposed during such service to any other chemical compound in an herbicide agent, unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service. See 38 U.S.C. § 1116(d)(2). See also ''Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022'' or the ''Honoring our PACT Act of 2022,'' Public Law 117-168 117th Congress, 136 Stat. 1775, 1780-1782 (Aug. 10, 2022). "Congress specifically limits entitlement to service-connected disease or injury where such cases have resulted in a disability. In the absence of a proof of present disability there can be no claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (internal citation omitted). The requirement of a "current disability" is satisfied if a disorder is present at the time a claim is filed or at any time during the pendency of the appeal; service connection may be awarded even though the disability resolves prior to adjudication of the claim. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). A formal diagnosis is not required where the veteran provides competent lay evidence of pain that causes functional impairment of earning capacity. Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018). The standard is whether a disability exists at the time the claim was filed. See Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). 1. Entitlement to service connection for diabetes type II The Veteran is requesting service connection for diabetes mellitus II that he attributes to exposure to Agent Orange during his Vietnam war era service in Thailand. He elaborates that the exposure likely occurred in the performance of his duties on the perimeter of multiple bases where he lived and worked in Thailand. See, e.g., Veteran's May 2017 correspondence regarding his location and duties in Thailand, in which the Veteran averred: I drove 4-5 days from base to base delivering supplies. I was stationed mainly at Phanom (between Korat + U-Tapao). I delivered supplies from U-Tapao north to Engineer bases, between U-Tapao and Korat. I delivered to Korat a lot. I delivered to Takhli . . . I delivered at least 5 days each week. I passed thru perimeters many times each day or night, all hours of the day. I did this for 15 months so to me it would be almost impossible to pass thru a parameter an average of 20+ times each week and not come in contact with the spray. For the reasons that follow the Board finds that an award of service connection for diabetes mellitus II under the PACT Act is warranted. The Veteran has a current diagnosis of diabetes mellitus II. See, e.g., VA Problem List dated January 16, 2017, which includes a diagnosis of diabetes mellitus II. This document was in the claims file during the initial evidence window which closed on November 14, 2018, and may now be considered by the Board. Moreover, the Veteran contends that he was exposed to herbicide agents/Agent Orange during his active duty service on and around U-Tapao, Korat, and Phanon (see, e.g., February 2017 statement from the Veteran); and the Veteran's location at these bases in Thailand is corroborated by the Veteran's military records. See, e.g., TDY records dated March 2, 1969, which confirm that the Veteran was at Phanon, Korat, and Pakhli, Thailand. See also April 2017 Memorandum For Herbicide Exposure, in which the RO conceded that the Veteran had "service on the Korat Royal Thai Air Force Base during a qualifying period;" and the January 2019 rating decision, in which the RO reaffirmed this finding. As stated before, VA law has recently changed and now provides that exposure to Agent Orange is presumed for all veterans who served at any United States or Royal Thai base during the period beginning on January 9, 1962, and ending on June 30, 1976. In the absence of affirmative evidence to the contrary, this veteran's exposure to Agent Orange during his military service is therefore presumed. 38 U.S.C. § 1116(d)(2). Moreover, diabetes mellitus II is one of the listed disorders at 38 C.F.R. § 3.309(e) that is subject to presumptive service connection based on exposure to Agent Orange. Accordingly, and all presumptive criteria having been met, the Board finds that service connection for diabetes mellitus II due to exposure to herbicides/Agent Orange under the PACT Act is warranted and the appeal is granted under this basis. 38 U.S.C. § 1116(d)(2); 38 C.F.R. § 3.309(e). The issue of service connection for diabetes mellitus II on a basis other than the PACT Act, prior to August 10, 2022, is addressed in the remand portion of this decision. 2. Entitlement to service connection for diabetic neuropathy The Veteran is also requesting service connection for neuropathy, which he claimed as diabetic neuropathy. During his July 2022 Board Hearing he complained of bilateral lower extremity numbness and tingling. See Board Hearing Transcript, p. 23. For the reasons that follow, the Board finds that an award of service connection for diabetic neuropathy secondary to the PACT Act grant of diabetes mellitus II is warranted. Medical records confirm that the Veteran has been diagnosed with neuropathy during the appeal period. See, e.g., VA medical records dated in November 2015. These records were in the claims file during the initial evidence window which closed on November 14, 2018, and may now be considered by the Board. The evidence also confirms that the Veteran's service-connected diabetes mellitus II is productive of neuropathy. See, e.g., VA medical records dated in November 2015, which show a current diagnosis of diabetic neuropathy. Although the medical evidence of neuropathy that is presently in the claims file is somewhat sparse, the Board is mindful that the presence of a chronic disability at any time during the claim process can justify a grant of service connection, even where the most recent diagnosis is negative. See McClain v. Nicholson, 21 Vet. App. 319, 323 (2007). The Board accordingly finds that the evidence persuasively favors an award of service connection for neuropathy that is proximally due to the now service-connected diabetes mellitus II. Service connection for neuropathy secondary to the PACT Act award of service connection for diabetes mellitus II is thus warranted and to this extent the appeal is granted. 38 C.F.R. § 3.310(a). The issue of service connection for diabetic neuropathy on a basis other than as secondary to the PACT Act grant of diabetes mellitus II, prior to August 10, 2022, is addressed in the Remand portion of this decision. 3. Entitlement to service connection for diabetic retinopathy and cataracts (claimed as eye condition) The Veteran is also requesting service connection for an eye disorder. Although the AOJ narrowly construed the issue as service connection for cataracts in its April 2017 (and subsequent) rating decisions, the Board is mindful that the Veteran broadly requested service connection for "eye condition" in his initial (April 2, 2016) claim and will consider this matter accordingly. For the reasons that follow, the Board finds that an award of service connection for diabetic retinopathy and cataracts (claimed as eye condition) secondary to the PACT Act grant of diabetes mellitus II is warranted. Medical records confirm that the Veteran has been diagnosed with retinopathy, and with cataracts, during the appeal period. See, e.g., private medical records dated in December 2006, and VA Optometry Clinic records dated in May 2013. These records were in the claims file during the initial evidence window which closed on November 14, 2018, and they may now be considered by the Board. Moreover, the Veteran's retinopathy and his cataracts have both been medically ascribed to his diabetes mellitus II. See, e.g., VA Optometry Clinic records dated in June 2017, which read: "NIDDM II x 10 years w/ retinopathy OU." See also February 23, 2016, Physicians Statement from Dr. G.B. of Pageland Family Medicine, who averred that the Veteran's visual cataracts "are directly due to diabetes mellitus." Although the Veteran's retinopathy has apparently waxed and waned during the appeal period and the Veteran has apparently undergone surgery for his cataract(s), the Board is mindful that the presence of a chronic disability at any time during the claim process can justify a grant of service connection, even where the most recent diagnosis is negative. See McClain, 21 Vet. App. 319, 323. The Board accordingly finds that the evidence persuasively favors an award of service connection for recurrent diabetic retinopathy and visual cataracts proximally due to the now service-connected diabetes mellitus II. Service connection for diabetic retinopathy and visual cataracts (claimed as eye condition) secondary to the PACT Act award of service connection for diabetes mellitus II is thus warranted and to this extent the appeal is granted. 38 C.F.R. § 3.310(a). The issue of service connection for diabetic retinopathy and visual cataracts (claimed as eye condition) on a basis other than as secondary to the PACT Act grant of diabetes mellitus II, prior to August 10, 2022, is addressed in the Remand portion of this decision. 4. Entitlement to service connection for erectile dysfunction The Veteran is also requesting service connection for erectile dysfunction, which he says began when he was first diagnosed and given medication for his now service-connected diabetes mellitus II. See Board Hearing Transcript, p. 27. He added that clinicians offered to write a prescription for his erectile dysfunction in addition to the medication that he was taking for his diabetes, but he "decided not to do that right then." Id. For the reasons that follow, the Board finds that service connection for erectile dysfunction secondary to the PACT Act grant of diabetes mellitus II is warranted. There is no allegation or evidence of any complaints, diagnosis, or treatment for erectile dysfunction, per se, in the STRs, although there is evidence of male reproduction organ issues during service. See, e.g., STRs dated in September 1967, which advise of inpatient care for right epididymitis and dark urine. Based on these facts, alone, the Veteran should have been afforded a VA examination, and the RO's failure to do so was a pre-decisional duty to assist error. However, the Board is persuaded that the lay evidence provided by the Veteran is sufficient to favorable resolve this claim secondary to the PACT Act grant of diabetes mellitus II. 38 C.F.R. § 3.310. See also Charles v. Principi, 16 Vet. App. 370, 374 (2002) (regarding a veteran's ability to sufficiently identify a disorder where manifestations and symptoms are capable of lay observation). See also Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006) (holding that "Lay evidence is one type of evidence that must be considered, if submitted, when a veteran's claim seeks disability benefits. Nothing in the regulatory or statutory provisions requires both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself."). The Veteran avers that his doctors apprised him that his erectile dysfunction was related to prescribed medication that he must take for his diabetes mellitus. See Board Hearing Transcript, p. 28, in which the Veteran, on further discussing his erectile dysfunction, lamented, "if you take the pill for the -- for the diabetes, it keeps you from eating your feet off, and if you don't -- if you do take the pill, you're (inaudible) damned if you do and damned if you don't." Although this consultation is not documented in the medical records that are in the claims file, the Board finds that the Veteran is competent to report that he has erectile dysfunction. Also compelling is the Veterans testimony that doctors at some point communicated to him that his erectile dysfunction was a side effect of his diabetes mellitus medication and offered to provide him with medication to offset the erectile dysfunction side-effects of the diabetes medication(s), which he refused. See Owens v. Brown, 7 Vet. App. 429 (1995) (it is the Board's fundamental responsibility to evaluate the probative value of all medical and lay evidence). The fact that the Veteran was not afforded a VA examination on the matter is not sufficient reason to now deny this claim for erectile dysfunction, about which the Veteran has competently and credibly reported. See Buchanan, 451 F.3d 1331, 1335. The Board accordingly finds that the evidence that is of record persuasively favors an award of service connection for erectile dysfunction that is proximally due to service-connected diabetes mellitus II. Service connection for erectile dysfunction secondary to the PACT Act award of service connection for diabetes mellitus II is thus warranted and to this extent the appeal is granted. 38 C.F.R. § 3.310(a). The issue of service connection for erectile dysfunction on a basis other than as secondary to the PACT Act grant of diabetes mellitus II, prior to August 10, 2022, is addressed in the Remand portion of this decision. 5. Entitlement to service connection for bilateral hearing loss 6. Entitlement to service connection for tinnitus The Veteran is also requesting service connection for hearing loss and tinnitus, both of which he attributes to his exposure to loud noise during service. See Board Hearing Transcript, p. 20. He elaborates that he was "exposed to a lot of loud military acoustical noises" in the performance of his work in Thailand, including the noise from heavy trucks and other heavy equipment, helicopters, and jet/B-52 plane engines. Id., p. 16. He recalled feeling a "fills up and swells up" sensation in his head which caused his "ears to ring and pop," and adds that he "never did see any ear protection in the military." Id., at pp. 16-17. The evidence during at least one allowable evidentiary window confirms a current diagnosis of hearing loss and tinnitus. See, e.g., March 2017 VA Hearing Loss and Tinnitus examination report. See also Charles v. Principi, 16 Vet. App. 370, 374 (2002) (noting that ringing in the ears is capable of lay observation); Buchanan, 451 F.3d 1331, 1335 (holding that nothing in the regulatory or statutory provisions requires both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself). Additionally, military records confirm the Veteran's report that he served in Thailand and that his military occupational specialty was Heavy Truck Driver. The question then is whether a current disorder is related to service. On review of the evidence the Board finds that service connection is warranted. There is no record of any complaints, diagnosis, or treatment for hearing loss or tinnitus during service, although active duty audiograms do show that the Veteran's hearing acuity decreased after his entry into service. See Veteran's January 18, 1967, Induction Audiogram and February 19, 1969, Separation Audiogram reports, which reflect a right ear decrease in hearing acuity at 4000 hertz and a left ear decrease in hearing acuity at 2000 hertz by the time of the Veteran's 1969 separation from service. On VA Hearing Loss and Tinnitus examination in March 2017, the diagnosis was left and right ear sensorineural hearing loss, which the examiner averred was not related to service because there was "no significant permanent shift in thresholds, objective evidence of no permanent auditory damage from conceded noise on active duty." See March 2017 VA examination report, pp. 4-5. The examiner added, Military noise is conceded, but damage and hearing loss is not conceded on basis of noise only. There is evidence of no continuity of care for or chronicity of tinnitus. Military noise is conceded, but damage and tinnitus is not conceded on basis of noise only, there is evidence of no nexus to relate HL to military event This is negative evidence against the claim, but its utility is dubious because there is no indication that the examiner converted the pre-1970 in-service data to current ISO-ANSI standards per VA guidance. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that an opinion based upon an inaccurate factual premise has no probative value). Moreover, a private audiologist avers that the Veteran's hearing loss and tinnitus are related to his in-service noise exposure. See March 7, 2019, audiology evaluation and opinion from J. H., Au.D., who reasoned: "Since the veteran was exposed to wheeled vehicle noise, weapons fire, and explosions, it is at least as likely as not that his hearing loss and tinnitus is due to hazardous noise exposure." This favors the claim. The Board accordingly finds that there is an approximate balance of evidence for and against these two claims for service connection. Service connection for hearing loss and tinnitus due to military noise exposure is thus warranted and the appeal is granted. 38 C.F.R. §§ 3.102, 3.303. REASONS FOR REMAND 1. Entitlement to service connection for a heart disorder, to include as due to toxic exposures during service (including Agent Orange), is remanded. 2. Entitlement to service connection for a lung disorder, to include chronic obstructive pulmonary disease (COPD), to include as due to toxic exposures during service (including Agent Orange), is remanded. The Veteran is also requesting service connection for heart disease and a lung disorder, both of which he says are caused by Agent Orange exposure; the significance of which is particularly magnified in view of VA's new PACT Act procedures regarding the development of claims based on toxic exposures. As provided by 38 U.S.C. § 1116(d)(2), the Veteran's exposure to Agent Orange during service is now presumed. As for the claimed medical disorders, there were numerous accounts of heart disease in the claims file at the time of the initial evidentiary window which closed in November 2018, including a rather vague intimation of coronary artery disease. See, e.g., November 2008 CT scan report, which contains a somewhat nebulous mention of coronary artery disease in the diagnosis portion. See also VA's August 20, 2008, synopsis of a private EKG report findings of "Sinus rhythm with occasional Premature ventricular complexes in a pattern of bigeminy;" and VA's November 2, 2010, Cardiology Summary of an October 25, 2010, private EKG, which reads: Sinus rhythm with sinus arrhythmia with occasional Premature ventricular complexes Incomplete right bundle branch block Borderline ECG When compared with ECG of 20-AUG-2008 12:16, Incomplete right bundle branch block is now Present. There was also evidence of a lung disorder in the claims file during the initial evidentiary window which closed in November 2018. See, e.g., active duty inpatient treatment records dated in September 1967, which included radiologic examination of the lungs due to hematuria. See also Veteran's January 16, 2017, VA Problem List, which includes diagnoses of pulmonary emphysema and "nonspecific abnormal findings (radiological) of lung field." Unfortunately, this evidence is not sufficient for favorable resolution of the claims for service connection for heart disorder and a lung disorder without further development (such as VA examinations), and there was no apparent pre-decisional duty to further develop these two claims at the time of the August 2019 rating decision on appeal. In this regard, the Board notes that while not claimed by the Veteran or presently on appeal, medical records substantiate a diagnosis of hypertension. See e.g., VA Primary Care records dated May 16, 2018. This is significant since VA regulations now provide for service connection for hypertension on a presumptive basis due to Agent Orange exposure. However, the Board is, on its own volition, unable to grant an award of service connection for hypertension because hypertension is not in and of itself a heart disease, and the issue of service connection for hypertension has never been mentioned by the Veteran or adjudicated at any time. See, e.g., 38 C.F.R. § 3.309(a) and § 3.309(e), Note 2, which each clearly and categorically identify hypertension as a disorder that is separate and distinct disorder from heart disease. See also 38 C.F.R. § 4.104, Diagnostic Code 7101, which defines hypertension as "hypertensive vascular disease" [emphasis added]; contrasted by Diagnostic Code 7007, which expressly pertains to Hypertensive heart disease. The Board does, however, observe that in addition to the records that are viewable in the claims file, the RO has apparently obtained more than 30 years of medical records from a private provider dating from 1974. See, e.g., VA medical records entry dated July 24, 2008, in which a VAMC clerk noted that private medical records [specifically, records from Pageland Family Medicine dating from July 16, 1974, to July 24, 2008] had been received and scanned by VA into its VistA Imaging system. Unfortunately, the Board is unable to view these records and is in turn estopped from deciding the claims for service connection for heart disease and a lung condition because these records have not been associated with the claims file. Remand for correction of this procedural error is warranted. 38 C.F.R. § 20.802. 3. Entitlement to service connection for diabetes mellitus II on a basis other than under the PACT Act, prior to August 10, 2022, is remanded. 4. Entitlement to service connection for diabetic neuropathy on a basis other than secondary to the PACT Act grant of service connection for diabetes mellitus II, prior to August 10, 2022, is remanded. 5. Entitlement to service connection for diabetic retinopathy and cataracts (claimed as eye condition) on a basis other than secondary to the PACT Act grant of service connection for diabetes mellitus II, prior to August 10, 2022, is remanded. 6. Entitlement to service connection for erectile dysfunction on a basis other than secondary to the PACT Act grant of service connection for diabetes mellitus II, prior to August 10, 2022, is remanded. As stated before, in addition to the records that are viewable in the claims file, the RO has apparently obtained more than 30 years of medical records from a private provider dating from 1974. See, e.g., VA medical records entry dated July 24, 2008, in which a VAMC clerk noted that private medical records [specifically, records from Pageland Family Medicine dating from July 16, 1974, to July 24, 2008] had been received and scanned by VA. Unfortunately, the Board is unable to view these records and is in turn estopped from deciding the claim for service connection for diabetes mellitus II and the secondary claims for neuropathy, retinopathy/cataracts, and erectile dysfunction on a basis other than under the PACT Act because these records have not been uploaded to the claims file from VA's CPRS VistA Imaging system. Although the Veteran has already been granted service connection for diabetes mellitus II under the PACT Act as well as service connection for diabetic neuropathy, diabetic retinopathy and cataracts (claimed as eye condition), and erectile dysfunction secondary to the PACT Act grant of service connection, the Board is unable to ascertain whether a more favorable award of service connection (and in turn an entitlement to an effective date prior to August 10, 2022) may be warranted for these disorders. Remand for correction of this procedural failure to associate the reported Pageland Family Medicine medical records with the claims file prior to submission of the case to the Board is warranted. 38 C.F.R. § 20.802. The matters are REMANDED for the following action: Associate all of the Veteran's Pageland Family Medicine records dating from July 16, 1974, to July 24, 2008, which are presently only accessible via CPRS VistA Imaging, with the claims file. David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Childers, Phyllis 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.