Citation Nr: A23011820 Decision Date: 05/31/23 Archive Date: 05/31/23 DOCKET NO. 210301-144739 DATE: May 31, 2023 ORDER Entitlement to service connection for hypertensive vascular disease (claimed as vascular disease) is granted. Entitlement to service connection for diabetes mellitus type II is granted. Entitlement to service connection for peripheral vascular disease is granted. Entitlement to service connection for heart disease is granted. Entitlement to service connection for neuropathy, secondary to diabetes mellitus type II is granted. Entitlement to service connection for erectile dysfunction, secondary to diabetes mellitus type II is granted. Entitlement to special monthly compensation (SMC) based on loss of use of a creative organ is granted. FINDINGS OF FACT 1. The probative evidence of record reflects the Veteran's hypertensive vascular disease is related to his active service. 2. The probative evidence of record reflects the Veteran's diabetes is related to his active service. 3. The probative evidence of record reflects the Veteran's peripheral vascular disease is related to his active service. 4. The probative evidence of record reflects the Veteran's heart disease is related to his active service. 5. The Veteran's peripheral neuropathy is proximately due to his service connected diabetes mellitus, type II. 6. The Veteran's erectile dysfunction is proximately due to his service connected diabetes mellitus, type II. 7. The Veteran's erectile dysfunction resulted in loss of use of a creative organ. CONCLUSIONS OF LAW 1. The criteria for service connection of hypertensive vascular disease have been met. 38 U.S.C. § § 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for diabetes have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for peripheral vascular disease have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection of heart disease have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection on a secondary basis for peripheral neuropathy are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 6. The criteria for service connection on a secondary basis for erectile dysfunction are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 7. The criteria for SMC for loss of use of creative organ are met. 38 U.S.C. § 1114 (k); 38 C.F.R. § 3.350. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably on active duty in the United States Army from February 1980 to February 1983. This matter comes before the Board of Veteran's Appeals (Board) on appeal from a February 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). A January 2021 supplemental statement of the case (SSOC) was issued, and the Veteran timely submitted a VA Form 10182 to opt into the Appeals Modernization Act (AMA). In the March 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the January 2021 SSOC, as well as any evidence submitted by the Veteran or his with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. These matters were previously before the Board in August 2019. The Board remanded entitlement to service connection for hypertensive vascular disease, diabetes, peripheral vascular disease, and peripheral neuropathy secondary to diabetes. The Board finds there has been substantial compliance with the prior remand directives. Service Connection 1. Entitlement to service connection for hypertensive vascular disease is granted. 2. Entitlement to service connection for diabetes mellitus type II is granted. 3. Entitlement to service connection for peripheral vascular disease is granted. 4. Entitlement to service connection for heart disease is granted. Service connection may be established for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. That determination requires a finding of current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Service connection may be established for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). The law provides a presumption of service connection for certain diseases that are associated with exposure to herbicide agents and that become manifest within a specified time period in a Veteran who, during active military, naval, or air service, served in the Republic of Vietnam, even if there is no record of evidence of such disease during the period of service. 38 C.F.R. § 3.307(a)(6). Notwithstanding the presumption, service connection for a disability claimed as due to exposure to herbicide agents may be established by showing that a disorder resulting in disability or death was in fact causally linked to such exposure. See Combee v. Brown, 34 F.3d 1039, 1044 (Fed. Cir. 1994). Generally, a claimant has the responsibility to present and support a claim for benefits. All information, lay evidence, and medical evidence in a case is to be considered by the Board in deciding the claim. When there is an approximate balance of positive and negative evidence regarding any material issue, the claimant is to be given the benefit of the doubt. 38 U.S.C. § 5107. To deny a claim on its merits, the evidence must persuasively weigh against the claim. Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). If a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases shall be service connected if the requirements of 38 U.S.C. § 1116, 38 C.F.R. § 3.307 (a)(6)(iii) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113, 38 C.F.R. § 3.307 (d), are also satisfied. If in-service herbicide agent exposure is not presumed, actual exposure to an herbicide agent must be verified through the appropriate service department or other sources in order for the presumption of service connection for an herbicide agent related disease under 38 C.F.R. § 3.309 (e) to be applicable. Exposure to an herbicide agent is not legally presumed in such instances. However, once exposure to an herbicide agent has been established by the evidence of record, the presumption of service connection found in 38 C.F.R. § 3.309 (e) for herbicide agent related diseases is applicable. The Veteran contends that service connection is warranted for vascular disease, diabetes, peripheral vascular disease, and heart disease due to herbicide exposure during service. He reported that he was exposed to various herbicides while serving at Fort McClellan. The Veteran's military personnel records reflect service at Fort McClellan. The Veteran's private records, VA treatment records, and VA examinations contain current diagnoses of cardiac disabilities to include coronary artery disease, diabetes, hypertension, and peripheral vascular disease. The Veteran's military occupational specialty (MOS) chemical operations specialist with service at Fort McClellan. The Veteran contends his heart disease, hypertensive vascular disease, and diabetes are related to his exposure to environmental toxins, to include herbicide agents. As noted in the August 2019 Board decision, the Veteran's attorney submitted competent and comprehensive evidence detailing the nature and extent of the use of environmental toxins at Fort McClellan. The August 2019 Board decision referenced that some members of the U.S. Army Chemical Corp School, Army Combat Development Command Chemical/Biological/Radiological Agency, Army Military Police School, and Women's Army Corps, among others, have been exposed to one or more hazardous materials during their service at Fort McClellan. "Potential exposures could have included, but are not limited to, the following: Radioactive compounds (cesium-137 and cobalt-60) used in decontamination training activities in isolated locations on base, Chemical warfare agents (mustard gas and nerve agents) used in decontamination testing activities in isolated locations on base, and airborne polychlorinated biphenyls (PCBs) from the Monsanto plant in the neighboring town. See http://www.publichealth.va.gov/exposures/fort-mcclellan/. The Veteran's attorney submitted an article about Agent Orange and a connection to Fort McClellan and legal references. The Veteran's attorney also submitted a report the law firm prepared dated August 25, 2013 (submitted June 2017) titled "Combined Environmental Exposure Report for Fort McClellan Alabama." The report is a collection of information from various sources that, per the law firm, "provides a per chemical exposure-event summary of Fort McClellan, Alabama, covering the past 50 years; and in some cases, much longer." It discusses the production, use, and storage of various chemicals at Fort McClellan and a nearby Monsanto plant between 1917 and 1998. The report, which contains citations for its assertions, indicates that Fort McClellan was the home of the U.S. Army Chemical school from 1951 to 1999, and chemicals were located, used, and occasionally spilled during that time, including various pesticides, herbicides, chemical warfare agents, dioxins, benzenes, lead, polychlorinated biphenyls (PCB), arsenic, trichloroethene (TCE), explosive compounds, chlorinated compounds, and radiological materials. The packet also discusses that from 1929 to 1971 (many years before the Veteran was at the base), a company produced PCBs at a nearby manufacturing plant, which, according to the U.S. Environmental Protection Agency (EPA), had the potential to leave the property and possibly affect adjacent properties and downstream waterways. It was noted that PCBs remain in the environment for long periods of time, especially in soil sediment, and can be transferred to humans by consuming water and food, such as fish, animals, and dairy products. The report also noted that 99 percent of soil samples taken by the EPA in 1991 throughout the area surrounding the company plant, including two on the perimeter of Fort McClellan's Pelham Range, tested positive for PCBs. The packet also notes that the base used radioactive isotopes Cobalt and Cesium in large quantities. Considerable attention is dedicated to the fact that until 1971, the Monsanto Company had a PCB manufacturing plant in Anniston, Alabama, which is the neighboring municipality to Fort McClellan. It was noted that the EPA opined on the potential for hazardous substances to leave the property thereby possibly affecting adjacent properties and downstream waterways. It was noted that the EPA published information that the primary means of exposure to chemicals from the plant were direct contact with contaminated media, consumption of agricultural products from the floodplain, and consumption of fish as well as recreation in specified waterways. Throughout the period on appeal, VA has attempted to verify the Veteran's herbicide agent exposure. In April 2017, a memo was issued stating that there were insufficient details regarding herbicide agent exposure to submit a request to the AO mailbox. The RO's memo stated they have developed similar contentions and found that in review of the Veteran's service records, it was concluded the Veteran did not serve during the period or in an area where Agent Orange was used or stored and therefore there is no evidence of exposure. In June 2017, the Veteran attended a hearing with a Decision Review Officer (DRO). The Veteran discussed his time at the chemical school at Fort McClellan and the training he participated in and chemicals he handled. He reported he trained in chemical warfare and chemical testing and trained with tear gas grenades and chambers. He reported he was in the barracks and in the field, exposed to soil and chemicals during training exercises. He also testified he used the water on base, he cooked with it, and he decontaminated with the water. The record contains an email regarding a query related to the Veteran and his contentions. The email stated the Department of Defense (DoD) provided a list of locations outside of Vietnam and Korean DMZ where Agent Orange was used, tested, or stored. The email noted that commercial herbicides were used on all military bases and do not fall under the regulations governing Agent Orange exposure at 38 C.F.R. § 3.307 (a)(6)(i). The email stated that regarding the Veteran, DoD has not identified Fort McClellan as a location where Agent Orange was used, tested, or stored nor was there evidence associating Agent Orange with the U.S. Army Chemical School or Chemical-Biological-Radiological (CBR) Agency located in Fort McClellan. The email concluded that all evidence shows herbicide agent use the Veteran or others observed was associated with the commercial variety, not Agent Orange. The email stated that regarding other claimed chemical exposure, VA has no evidence of such exposures or evidence of long-term health effects associated with any such exposures. In addition to the email of record, the RO issued a June 2017 memo stating a request was sent to the AO mailbox with the report provided by the Veteran's attorney and the response included a memo from Compensation Service which concluded that from the accumulated evidence from U.S. government sources, Compensation Services has no basis for acknowledging that Veterans stationed at Fort McClellan were exposed to Agent Orange or experienced generalized exposure to other environmental contaminants associated with long term health effects. The RO concluded in the memo that there is still no evidence of exposure to Agent Orange or other environmental contaminants. VA Compensation Services issued a memo titled Agent Orange and Other Chemical Exposure Claims Based on Fort McClellan Service. The memo noted that Fort McClellan served as the location of the U.S. Army Chemical School and U.S. Chemical-Biological-Radiological (CBR) Agency. The memo stated DoD has no credible evidence showing use, testing, or storage of tactical herbicides such as Agent Orange at Fort McClellan. The memo also noted VA receives claims based on exposure to other chemicals and this was based on the perception the U.S. Army Chemical School and CBR activity produced widespread contamination of the area. The memo states that VA has no evidence from DoD or elsewhere that these activities affected other sections of the base or that participants in training experienced adverse exposure or health effects. The memo referenced a 1977 U.S. Army Toxic and Hazardous Material Agency Report stating that field samples around the base were negative for chemical warfare agents. The memo further states that when the base closed in 1999, an Environmental Protection Agency (EPA) Superfund Report was mandated by law and the VA stated the report did not identify any significant on-base potential environmental health risks, public perception was complicated by evidence that Monsanto Chemical Corporation polluted off-base ground water with PCBs in the 1970s. The memo references a follow-up EPA report in 2008 that focused on closed off-base chemical production facility and surrounding landfills and it indicated the human health risks were minimal. The memo stated a more comprehensive report was issued by the U.S. Department of Health and Human Services Agency for Toxic Substances and Disease Registry. It reviewed and collected environmental samples of municipal and private well water and concluded no apparent human health hazards from volatile organic chemicals were found. The memo concluded that as a result of the accumulated evidence from U.S. government sources, Compensation Service has no basis for acknowledging that Veterans stationed at Fort McClellan were exposed to Agent Orange or experienced generalized exposure to other environmental contaminates associated with long term health effects. Thus, herbicide agent exposure is not conceded. Recent legislation extended the presumption of herbicide exposure to Vietnam era veterans defined as having served in the Republic of Vietnam from January 9, 1962 to May 7, 1975; Thailand at any U.S. or Royal Thai Base from January 9, 1962, to June 30, 1976; Laos from December 14, 1965, to September 30, 1969; certain provinces of Cambodia between April 16, 1962, and April 30, 1969; the Korean Demilitarized Zone (DMZ) from April 1, 1968, to August 31, 1971; Guam, American Samoa or territorial waters thereof from January 9, 1962, to July 31, 1980; Johnston Atoll or on a ship that called at Johnson Atoll from January 1, 1972, to September 31, 1977. Also afforded a presumption of herbicide exposure are Air Force or Air Force Reserve veterans who regularly and repeatedly operated, maintained or served aboard a C-123 aircraft known to have been used for spraying herbicides. See the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxins Act of 2022 (PACT Act), Pub. L. 117-168 (August 10, 2022). The Veteran did not serve and of the aforementioned locations. Therefore, exposure to an herbicide agent must be verified through the appropriate service department or other sources in order for the presumption of service connection for an herbicide agent related disease under 38 C.F.R. § 3.309 (e) to be applicable. Evidence of potential exposure to herbicides at Fort McClellan has not been verified by VA and therefore, as exposure to herbicides has not been conceded, presumptive service connection is not applicable. When a veteran is found not to be entitled to a regulatory presumption of service connection for a given disability, the claim must nevertheless be reviewed to determine whether service connection can be established on another basis. See Combee v. Brown, 34 F.3d 1039, 104344 (Fed. Cir. 1994). The Board recognizes the Veteran's private records, VA treatment records, and VA examinations contain current diagnoses of cardiac disabilities to include coronary artery disease, diabetes, hypertension, and peripheral vascular disease. As such, the first element of establishing service connection for the aforementioned disabilities is met. The Board next finds that the Veteran suffered from an event, injury, or disease in-service. The Board finds the previously referenced environmental articles, reports, and studies to be inadequate to concede exposure to herbicide agents. However, the articles, reports, studies, DRO hearing testimony, Veteran's MOS, and lay statements are sufficient to find the in-service element required for service connection to be met. The Veteran testified that he underwent chemical training at Fort McClellan and his training was in the field, involved decontamination units, the use of chemicals, tear gas, chemical reactive detectors, blister agents, and mustard agents. Additionally, additional evidence of record reflects chemicals were used at Fort McClellan. As such, the Board finds that the in-service element of service connection is met. The final criteria to be met is whether there is a causal link between the Veteran's current disability and his active service. The August 2019 Board decision remanded the claims on appeal for the Veteran to undergo VA examinations to evaluate whether there was a causal relationship between the Veteran's exposure to environmental toxins in-service. The Veteran underwent VA examinations in January 2021. The Veteran underwent a VA examination for his heart conditions and the VA examiner documented his diagnoses as acute, subacute, or old myocardial infarction and coronary artery disease. The VA examiner reported the Veteran underwent an EKG, chest x-ray, and echocardiogram in 2020. The EKG reflected abnormal results with occasional PVCs and artifact was noted. The chest x-ray was normal, and the echocardiogram reported the Veteran's left ventricular ejection fraction was 55%. The VA examiner reported the Veteran's METs test reflected the Veteran reported dyspnea, fatigue, and angina. His METs level was found to be >5-7, consistent with activities such as walking one flight of stairs, golfing without a card, mowing the lawn, and heavy yard work. The VA examiner found the Veteran's METs level was due solely to his heart conditions. The Veteran underwent a VA examination for his diabetes and the VA examiner confirmed his diagnosis of diabetes mellitus type II. The examiner noted the Veteran's disability is managed by a restricted diet and one injection of insulin per day, the Veteran is not required to regulate his activities as part of medical management of diabetes. The VA examiner reported the Veteran has complications from diabetes, to include diabetic peripheral neuropathy and erectile dysfunction. The Veteran underwent a VA examination for vascular diseases. The Veteran was diagnosed peripheral vascular disease. The VA examiner noted the Veteran has undergone surgery for the condition. He had three angioplasties in his legs and one in his left arm. The VA examiner reported the Veteran has claudication on walking less than 25 yards on a level grade in the left extremity, persistent coldness and diminished peripheral pulses in the left extremity, trophic changes in the left extremity, and one or more deep ischemic ulcers on the right extremity. The VA examiner document the records were reviewed. The Veteran reported he has had ongoing issues with heart disease, peripheral vascular disease, diabetes, diabetic peripheral neuropathy, and erectile dysfunction. The Veteran reported he did not have a family history of these disabilities. The VA examiner reported the Veteran had right lower extremity amputation and weak peripheral pulses of the left lower extremity, which the VA examiner noted consistent with peripheral vascular disease. The Veteran's blood pressure readings were elevated at the VA examination and the VA examiner noted this is consistent with heart disease and hypertension. The VA examiner noted the Veteran's heart sounded normal and there was no peripheral edema. The examiner reported the Veteran had diminished sensations to cold, vibration, touch, and his left upper extremity was mild and right upper extremity was moderately severe. The VA examiner noted the Veteran had normal right upper extremity sensation, vibration, and cold sensory and diminished moderately in the right lower extremity at the knee and thigh level. The VA examiner noted he reviewed the DRO hearing transcript, the Board's prior remand, and noted the Veteran's reported chemical and toxin exposure at Fort McClellan and the referenced Monsanto plant exposures. The VA examiner concluded that based on the Veteran's negative family history of heart disease, hypertensive vascular disease, diabetes and in conjunction with the VA examination, the Veteran's past medical and surgical histories (to include coronary stent placement, multiple arteriograms, venograms of lower extremities, reperfusion therapy, and the right lower extremity amputation) the VA examiner concluded it was at least as likely as not the Veteran's hypertensive vascular disease, peripheral vascular disease, heart disease, and diabetes, began in or is otherwise causally related to the Veteran's active duty service, to include exposure to environmental toxins in-service. In March 2021, the Veteran's attorney submitted a report by a weed specialist, who opined that it is more likely than not that those serving at Fort McClellan between 1974 to 1976 were exposed to the same type of herbicide agents used in Vietnam. The opinion regarding exposure to herbicide agents after 1976 is couched in speculative terms ("potentially"). The private opinion provides extensive information regarding herbicides and risk of exposure from 1974 to 1976. The Veteran served at Fort McClellan from 1980 to 1982. As such, the opinion provided copious amounts of detailed information regarding herbicide agents, but the private opinion does apply to the Veteran's service and contains vague and speculative references. Therefore, the Board does not find the private opinion to be competent, credible, or probative evidence. However, although the private opinion is not sufficient to provide a causal link here, the Veteran's VA examinations provided a positive nexus opinion that the Veteran's claims on appeal for hypertensive vascular disease, diabetes, peripheral vascular disease, and heart disease are otherwise etiologically related to the Veteran's in-service exposures to toxins. The Board finds the positive January 2021 VA opinions to be adequate and probative. The examiner reported the claims file was reviewed and provided a sufficient rationale for the Board to make an informed decision. In light of the foregoing, the Board concludes that the probative evidence of record weighs in favor of service connection for hypertensive vascular disease, diabetes, peripheral vascular disease, and heart disease. Therefore, entitlement to service connection for hypertensive vascular disease, diabetes, peripheral vascular disease, and heart disease are granted. The Board notes that the grant herein is based on the unique facts and circumstances of this Veteran's service. Secondary Service Connection Entitlement to service connection for neuropathy, secondary to diabetes mellitus type II is granted. Entitlement to service connection for erectile dysfunction, secondary to diabetes mellitus type II is granted. Establishing service connection on a secondary basis requires evidence sufficient to show that 1) a current disability exists, and 2) the current disability was either a) caused by or b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). VA will adjudicate as part of a claim entitlement to any ancillary benefits that arise as a result of the adjudication decision, including entitlement to any additional benefits for complications of the claimed condition. 38 C.F.R. § 3.155 (d)(2); Bailey v. Wilkie, 33 Vet. App. 188, 203 (2021) (holding that VA is required to develop and adjudicate related claims for secondary service connection for disabilities that are reasonably raised during the adjudication of an increased rating claim). Significantly, the claimant need not assert entitlement to such ancillary benefits at the time the claim is filed. Id.; see also Grimes v. McDonough, 34 Vet. App. 84 (2021). As determined in this decision, the Board has granted entitlement to service connection for diabetes. The Veteran underwent a VA examination for peripheral neuropathy in January 2021. The VA examiner confirmed the Veteran's diagnosis of diabetic peripheral neuropathy due to his now service connected diabetes. The Veteran has numbness in his left hand and arm and legs. The VA examiner reported the Veteran had intermittent mild pain and numbness in his right and left upper and lower extremities. The VA examiner reported the Veteran had decreased light touch and monofilament results in both hands and fingers, both knees and thighs, and the left ankle and lower leg and left foot and toes. The Veteran had decreased position sense in the left upper extremity, right lower extremity, and left lower extremity. The VA examiner reported the Veteran had decreased vibration sensation and cold sensation in the left upper extremity, right lower extremity, and left lower extremity. The VA examiner also noted the Veteran had trophic changes attributable to diabetic peripheral neuropathy. The VA examiner reported the Veteran has upper extremity diabetic neuropathy in the radial nerve with incomplete mild paralysis bilaterally and in the left ulnar nerve with mild incomplete paralysis. The VA examiner found the Veteran had lower extremity peripheral neuropathy. The Veteran does have a right leg amputation under the knee. The VA examiner reported the Veteran had bilateral left lower extremity peripheral neuropathy in the sciatic nerve with mild incomplete paralysis on the right and moderately severe peripheral neuropathy on the left. The VA examiner also reported the Veteran had left lower extremity peripheral neuropathy of the femoral nerve with bilateral moderate incomplete paralysis. The January 2021 VA examiner reported that diabetes is commonly causative of diabetic peripheral neuropathy due to vascular damage. The VA examiner noted the Veteran has diabetic peripheral neuropathy and concluded the Veteran's diabetic peripheral neuropathy was at least as likely as not caused by his now service connected diabetes. The record shows the Veteran's erectile dysfunction is due to his service connected diabetes. Thus, the record raises the issue as to whether this condition should be service connected. The Veteran underwent a VA examination in January 2021 for erectile dysfunction and his diagnosis was confirmed. In his January 2021 VA examination for diabetes, the VA examiner found the Veteran's erectile dysfunction was at least as likely as not due to his diabetes. The current record shows that the January 2021 VA examiners are competent to provide a medical opinion as to the etiology of the Veteran's peripheral neuropathy and erectile dysfunction and the examiner's opinions include adequate rationales. Thus, these opinions are probative and weigh in favor of the Veteran's claims. Therefore, the Board finds that the Veteran's peripheral neuropathy and erectile dysfunction are due to his service connected diabetes mellitus. Accordingly, service connection for peripheral neuropathy and service connection for erectile dysfunction, as secondary to his diabetes is warranted. See 38 C.F.R. § 3.102. SMC Entitlement to special monthly compensation (SMC) based on loss of use of a creative organ is granted. Special Monthly Compensation (SMC) is warranted if a veteran, as a result of service-connected disability, has suffered the anatomical loss or loss of use of one or more creative organs. 38 U.S.C. § 1114 (k). Entitlement to SMC based on loss of use of a creative organ can also be granted based on erectile dysfunction. 38 C.F.R. § 3.350. (Continued on the next page) ? As the Board has granted service connection for erectile dysfunction, the Veteran is entitled to SMC for loss of use of a creative organ based on loss of erectile power. 38 U.S.C. § 1114 (k). H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Mouzakis, 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.