Citation Nr: 1038165 Decision Date: 10/08/10 Archive Date: 10/15/10 DOCKET NO. 05-05 267 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma THE ISSUES 1. Entitlement to service connection for renal cancer of the left kidney as a result of exposure to ionizing radiation. 2. Entitlement to service connection for metastatic renal cancer as a result of exposure to ionizing radiation. REPRESENTATION Appellant represented by: Oklahoma Department of Veterans Affairs WITNESSES AT HEARING ON APPEAL The Veteran and his spouse ATTORNEY FOR THE BOARD Suzie S. Gaston, Counsel INTRODUCTION The Veteran served on active duty from March 1966 to January 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2004 rating decision, by the Muskogee, Oklahoma, Regional Office (RO), which denied the Veteran's claim of entitlement to service connection for renal cancer of the left kidney as a result of exposure to ionizing radiation, and entitlement to service connection for metastatic renal cancer. In June 2005, the Veteran and his wife appeared at the Muskogee RO and testified at a videoconference hearing before the undersigned Veterans Law Judge, sitting in Washington, DC. A transcript of the hearing is of record. At the hearing, the Veteran submitted additional evidence for which he has provided written waiver of RO review under 38 C.F.R. § 20.1304 (2009). In December 2006, the Board remanded the case for further evidentiary development. FINDINGS OF FACT 1. The Veteran was exposed to ionizing radiation during active military service. 2. The Veteran's kidney disease, to include left renal cell carcinoma, and metastatic renal cancer were not manifested during service or within one year thereafter, and are not related to any incident of service, including exposure to ionizing radiation. CONCLUSION OF LAW The Veteran does not have renal cancer of the left kidney or metastatic disease therefrom that is the result of disease or injury incurred in or aggravated by active military service, including exposure to ionizing radiation, and renal cancer is not presumed to have been incurred in or aggravated by active military service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113, 5103, 5103A, 5107 (West 2002 & Supp 2010); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.311 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Duty to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) enhanced VA's duty to notify and assist claimants in substantiating their claims for VA benefits, as codified in pertinent part at 38 U.S.C.A. §§ 5103, 5103A (West 2002 & Supp. 2010); 38 C.F.R. §§ 3.159, 3.326(a) (2009). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant of the information and evidence not of record that is necessary to substantiate the claim; and to indicate which information and evidence VA will obtain and which information and evidence the claimant is expected to provide. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b). The United States Court of Appeals for Veterans Claims (Court) has held that VCAA notice should be provided to a claimant before the initial RO decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). However, if VCAA notice is provided after the initial decision, such a timing error can be cured by subsequent readjudication of the claim, as in a statement of the case (SOC) or supplemental SOC (SSOC). Mayfield v. Nicholson, 20 Vet. App. 537, 543 (2006); Prickett v. Nicholson, 20 Vet. App. 370, 376 (2006). In this case, VA satisfied its duty to notify by means of a letter dated in April 2004 from the RO to the Veteran, which was issued prior to the RO decision in August 2004. Additional letters were issued in May 2007, January 2009 and April 2009. Those letters informed the Veteran of what evidence was required to substantiate the claim and of his and VA's respective duties for obtaining evidence. The case was re-adjudicated by the agency of original jurisdiction (AOJ) by way of a SSOC in February 2010. The Board finds that the content of the above-noted letters provided to the Veteran complied with the requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) regarding VA's duty to notify. Regarding the duty to assist, the Veteran was provided an opportunity to submit additional evidence. It also appears that all obtainable evidence identified by the Veteran relative to his claims has been obtained and associated with the claims file, and that neither he nor his representative has identified any other pertinent evidence not already of record that would need to be obtained for a fair disposition of this appeal. It is therefore the Board's conclusion that the Veteran has been provided with every opportunity to submit evidence and argument in support of his claims, and to respond to VA notice. The Board is unaware of any outstanding evidence or information that has not already been requested. In addition, the RO has obtained identified relevant private outpatient treatment records. The Veteran provided oral testimony before the Board. The Veteran has not referenced outstanding records that he wanted VA to obtain or that he felt were relevant to the claims on appeal. Moreover, as discussed below, VA has undertaken significant efforts to estimate the maximum total dose equivalent of radiation exposure. Finally, in accordance with the December 2006 Board remand, the RO has solicited the necessary medical opinions in this case, including obtaining a medical opinion from VA's Chief Public Health and Environmental Hazards Officer in accordance with 38 C.F.R. § 3.311. Based on a review of the record in this case, the Board concludes that the record on appeal contains sufficient medical evidence to make a decision on the claim. See 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c) (4) (2009); see also McLendon v. Nicholson, 20 Vet. App. 79 (2007). Accordingly, the Board finds that VA has satisfied its duty to notify and assist the Veteran in apprising him as to the evidence needed, and in obtaining evidence pertinent to his claim under the VCAA. Therefore, no useful purpose would be served in remanding this matter for yet more development. Such a remand would result in unnecessarily imposing additional burdens on VA, with no additional benefit flowing to the Veteran. The Court has held that such remands are to be avoided. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). II. Factual Background The Veteran's service treatment records (STRs) indicate that he entered active duty in March 1966. His military personnel records indicate that his military occupational specialty was Munitions Maintenance Specialist. He served as a munitions handling specialist at Ramstein Air Force Base from September 1966 to October 1968. Of record is AF Form 910, which shows that during the period from March 21, 1968 to October 1, 1968, the Veteran was assigned to the 26th A&E Maintenance Squadron at Ramstein AB in Germany. He was responsible for performing the inspection, handling, delivery and storage of conventional and special weapons. The Veteran's enlistment examination was negative for any complaints or findings of a kidney tumor or cancer. In April 1966, the Veteran was seen for complaints of kidney trouble with nocturia for a number of years. No clinical findings were reported, and no diagnosis was noted. The separation examination, dated in November 1969, was negative for any complaints or findings of a kidney tumor. The Veteran's claim for cancer of the kidney with metastases (VA Form 21-526) was received in January 2004. Submitted in support of the claim were medical records, VA as well as private treatment reports, dated from February 1998 to January 2004. The records indicate that the Veteran was diagnosed with renal cell cancer of the left kidney and metastatic renal cell carcinoma of the right bicep, brachialis and brachial. On September 24, 2003, the Veteran underwent a left nephrectomy laparoscopically and resection of right biceps brachial radialis lesions. His left kidney was surgically removed in October 2003. In November 2003, it was noted that the renal cell cancer had metastasized to the right upper arm, the right bicep. Of record is a statement in support of the claim (VA Form 21- 4138), dated in May 2004. The Veteran indicated that he was a munitions specialist at Ramstein AF Base in Ramstein, Germany. He indicated that he worked at the South Ammunition nuclear weapons storage unit. Received in September 2004 was a copy of a student study guide from the Air Training Command, dated in May 1966, which discussed the storage of nuclear weapons. This report noted that nuclear weapons were generally stored in standard, earth-covered, igloo- type structures. The report stated that there was no radiation hazard to personnel who were handling and storing nuclear weapons. It was noted that while most weapons emit some radiation, the amount is so slight that no danger to personnel exists. Received in March 2005 was a copy of a letter written by Dr. John W. Gofman, Professor Emeritus of Molecular and Cell Biology, dated in May 1999. The professor stated that he had studied the biological effects of ionizing radiation. Professor Gofman stated that, by any reasonable standard of biomedical proof, there is no safe dose, which means that just one decashing radioactive atom can produce permanent mutation in a cell's genetic molecules. He further explained that mutation is the basis not only for inherited inflictions but also for cancer. Also submitted in March 2005 were other articles regarding the health hazards of exposure to chronic low dose ionizing radiation. In a February 2000 article, referring to an acknowledgement that radiation had caused cancers in the nuclear weapon industry, it was concluded that "in the 14 plants with elevated cancer rates, there were 22 categories of the disease that were more frequent than expected. They ranged from leukemia and Hodgkin's lymphoma to cancer of the prostate, kidney, salivary gland and lung." At his personal hearing in June 2005, the Veteran maintained that he was exposed to low levels of radiation as a result of his occupational specialty as a munitions specialist in service. The Veteran indicated that he was in charge of the maintenance and general care of the nuclear weapons; he stated that this included the direct contact with the weapons. The Veteran reported that they had to keep the weapons dust free and they had to move them to and from the igloos where they were kept, and to and from the flight line during drills. The Veteran indicated that he performed periodic inspection of the weapons, including checking the seals and the paints. The Veteran testified that the Air Force had not implemented a true directive on the proper handling of those types of munitions until a much later date. The Veteran also testified that he was not informed of the possible threat that the weapons would be emanating or leaking radiation. The Veteran stated that he was not provided any type of protective clothing for maintaining those weapons. The Veteran indicated that he had problems with his kidneys and arms all during service. Submitted at the hearing were several lay statements from individuals who served in the United States Air Force and were stationed at the Ramstein Air Base. These individuals expressed knowledge of the fact that the Veteran was also stationed at Ramstein Air Base. They also reported that the Veteran was assigned to the South Ammo Munitions area; this area was reportedly classified as top secret and each of the individuals assigned there had a top secret clearance. They concurred that the individuals assigned to the munitions area, including the Veteran, were responsible for loading, storing, maintenance and repair, and transporting of nuclear weapons. They did not recall seeing any type of radiation detection or scanning devices available for the individuals during the period they were stationed at Ramstein during the period from 1966 to 1970. Also submitted at the hearing was an article, dated in May 2005, which confirmed that the United States stored nuclear weapons at three locations in Germany, one of which is Ramstein. Received in January 2006 was a response from the United States Air Force Office of Surgeon General, indicating that the Air Force Safety Center (AFSC) reviewed records for the Veteran and those similarly exposed personnel with common duty specialty codes and periods of exposure. Based on their records, they estimated that the Veteran's annual dose was less than 500 mrem/year and that his total dose was less than 1.5 rem from work performed between 1966 and 1968. Of record is an opinion from the Under Secretary of Health, the Director of Radiation and Physical Exposures, dated in December 2009. It was noted that the Veteran incurred occupational exposure to ionizing radiation while serving as a munitions specialist during maintenance work around nuclear warheads in the United States Air Force from March 1966 to January 1970. A letter from the Air Force Medical Support Agency, dated July 28, 2004, indicated that there was no DD Form 1141 Record of Occupational Exposure to Ionizing Radiation in the Veteran's record. The Air Force Safety Center subsequently reviewed their records for the Veteran and those of similarly exposed personnel with similar duty specialty codes and periods of exposure. The Air Force indicated that the Veteran would have received less than 500 mrem per year from 1966 to 1968. In 2003, the Veteran was diagnosed with renal cell carcinoma of the left kidney, metastatic to the right biceps. It was noted that the interactive radioepidmiological program of the National Institute for Occupational Safety and Health (NIOSH) was used to estimate the likelihood that exposure to ionizing radiation was responsible for the Veteran's renal cancer. The program calculated a 99th percentile value for the probability of causation of 2.13%. In view of the above, the physician stated that it was her opinion that it was unlikely that the Veteran's renal cell carcinoma can be attributed to radiation exposure while in military service. III. Analysis Service connection may be awarded for disability "resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty." 38 U.S.C. § 1110. To establish a right to service connection, a Veteran must show: "(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"--the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Holton v. Shinseki, 557 F.3d 1362 (2009). Service connection will be granted for disability resulting from injury or disease incurred in or aggravated by active military service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service incurrence or aggravation will be presumed for malignant tumors if they are manifest to a compensable degree within the year after separating from active military service; this presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C.A. §§ 1101, 1112, 1113 (West 2002 & Supp. 2010); 38 C.F.R. §§ 3.307, 3.309 (2009). Service connection for disability that is claimed to be attributable to exposure to ionizing radiation during service can be demonstrated by different methods. Davis v. Brown, 10 Vet. App. 209, 211 (1997); Rucker v. Brown, 10 Vet. App. 67, 71 (1997). First, it may have been manifested during service or within one year of separation. Second, there are certain types of cancer that are presumptively service connected, specific to radiation-exposed veterans. 38 U.S.C.A. § 1112(c) (West 2002); 38 C.F.R. § 3.309(d) (2009). Third, when a "radiogenic disease" first becomes manifest after service, and it is contended that the disease resulted from exposure to ionizing radiation during service, various development procedures must be undertaken in order to establish whether or not the disease developed as a result of exposure to ionizing radiation. 38 C.F.R. § 3.311(a) (1). Fourth, even if the claimed disability is not listed as a presumptive disease under 38 C.F.R. § 3.309(d) or as a radiogenic disease under 38 C.F.R. § 3.311, service connection must still be considered under 38 C.F.R. § 3.303(d)--whether a disease diagnosed after discharge is attributable to active service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). First, if a veteran qualifies as a "radiation-exposed veteran" and later develops one of the diseases listed in 38 U.S.C.A. § 1112(c) or 38 C.F.R. § 3.309(d), a rebuttable presumption of service connection arises. See 38 U.S.C.A. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. These diseases are ones in which it has been determined that a positive association with radiation exposure exists. In this regard, the Board observes that kidney cancer is not one of the diseases listed under 38 U.S.C.A. § 1112(c) and 38 C.F.R. § 3.309(d). (The Board mistakenly indicated that it was when it earlier remanded the case.) Thus, the first method concerning presumptive service connection based on certain delineated exposures to ionizing radiation does not apply in this case. 38 U.S.C.A. § 1112(c); 38 C.F.R. § 3.309(d) (3) (iii). Second, service connection may be established if a veteran develops a "radiogenic disease" (one that may be induced by ionizing radiation, either listed at 38 C.F.R. § 3.311(b) or established by competent scientific or medical evidence to be a radiogenic disease), and if the VA Under Secretary for Benefits (USB) determines that a relationship does in fact exist between the disease and the veteran's exposure in service. When a claim is based on a disease other than one of those listed in 38 C.F.R. § 3.311(b) (2), VA shall nevertheless consider the claim under the provisions of 38 C.F.R. § 3.311 provided that the claimant has cited or submitted competent scientific or medical evidence that the claimed condition is a radiogenic disease. 38 C.F.R. § 3.311(b). In this regard, kidney cancer is listed as a radiogenic disease in 38 C.F.R. § 3.311(b) (2). In all claims in which it is established that a radiogenic disease first became manifest after service and was not manifest to a compensable degree within any applicable presumptive period as specified in 38 C.F.R. § 3.307 or 38 C.F.R. § 3.309, and it is contended that the disease is a result of exposure to ionizing radiation in service, an assessment will be made as to the size and nature of the radiation dose or doses. 38 C.F.R. § 3.311(a) (1). When dose estimates provided are reported as a range of doses to which a veteran may have been exposed, exposure at the highest level of the dose range reported will be presumed. 38 C.F.R. § 3.311(a) (2). When it has been determined that a Veteran has been exposed to ionizing radiation in service, and he subsequently develops a potentially radiogenic disease, the claim will be referred to the USB for further consideration. The USB is to consider the claim with reference to specified factors and may request an advisory medical opinion from the Under Secretary for Health; if, after this consideration, the USB determines that there is no reasonable possibility that the Veteran's disease resulted from radiation exposure in service, then the USB shall so inform the RO in writing, setting forth the rationale for this conclusion. 38 C.F.R. § 3.311. Dose data is requested from the Department of Defense in claims based on participation in atmospheric nuclear testing, and claims based on participation in the U.S. occupation of Hiroshima or Nagasaki, Japan, prior to July 1, 1946. 38 C.F.R. § 3.311(a) (2). In all other claims involving radiation exposure, a request will be made for any available records concerning the veteran's exposure to radiation. These records normally include but may not be limited to the veteran's Record of Occupational Exposure to Ionizing Radiation (DD Form 1141), if maintained, service medical records, and other records which may contain information pertaining to the veteran's radiation dose in service. All such records will be forwarded to the Under Secretary for Health, who will be responsible for preparation of a dose estimate, to the extent feasible, based on available methodologies. 38 C.F.R. § 3.311(a) (2) (iii). An opinion will be provided as to the probabilities that disease was caused by radiation exposure and the USB will thereafter provide an advisory opinion as to the likelihood that the disease at issue resulted from radiation exposure during military service. Third, as noted above, service connection may be established by competent evidence establishing the existence of a medical nexus between the claimed condition and service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). See also Davis v. Brown, 10 Vet. App. 209, 211 (1997); Rucker v. Brown, 10 Vet. App. 67, 71 (1997). A veteran can attest to factual matters of which he had first- hand knowledge, e.g., experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). However, the Veteran in this case, as a lay person, has not been shown to be capable of making medical conclusions, thus, his statements regarding medical causation are not competent. See Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992). Thus, while the Veteran is competent to report what comes to him through his senses, he does not have medical expertise. See Layno v. Brown, 6 Vet. App. 465 (1994). Therefore, he cannot provide a competent opinion regarding diagnosis and causation. However, the United States Court of Appeals for the Federal Circuit has held that lay evidence is one type of evidence that must be considered and competent lay evidence can be sufficient in and of itself. The Board, however, retains the discretion to make credibility determinations and otherwise weigh the evidence submitted, including lay evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). This would include weighing the absence of contemporary medical evidence against lay statements. In Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007), the Federal Circuit determined that lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition (noting that sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. The relevance of lay evidence is not limited to the third situation, but extends to the first two as well. Whether lay evidence is competent and sufficient in a particular case is a question of fact. Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted")). Barr v. Nicholson, 21 Vet. App. 303 (2007). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Initially, the Board notes that service treatment records are negative for complaints, diagnoses, or treatment for a kidney disease, to include kidney cancer. The Veteran had complaints, but no underlying disease was diagnosed. Post-service, the first diagnosis of renal cancer is not found in the record until 2003. Additionally, the record is negative for any evidence tending to directly relate renal cancer to any event or disease during military service. Therefore, entitlement to service connection for renal cancer based on direct incurrence must be denied. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303(a). As to post-service continuity of symptomatology under 38 C.F.R. § 3.303(b), the Board finds that the length of time between the Veteran's separation from active duty in 1970 and his first diagnosis of renal cancer in 2003 to be compelling evidence. Put another way, the nearly 30-year gap between the Veteran's discharge from active duty and the first evidence of a chronic kidney disorder weighs heavily against his claim. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd., 230 F.3d 1330 (Fed. Cir. 2000) (service incurrence may be rebutted by the absence of medical treatment for the claimed condition for many years after service); Forshey v. West, 12 Vet. App. 71, 74 (1998), aff'd sub nom. Forshey v. Principi, 284 F.3d 1335, 1358 (Fed. Cir. 2002) (noting that the definition of evidence encompasses "negative evidence" which tends to disprove the existence of an alleged fact); Mense v. Derwinski, 1 Vet. App. 354, 356 (1991) (holding that VA did not err in denying service connection when the veteran failed to provide evidence which demonstrated continuity of symptomatology, and failed to account for the lengthy time period for which there is no clinical documentation of his low back condition); Shaw v. Principi, 3 Vet. App. 365 (1992) (a veteran's delay in asserting a claim can constitute negative evidence that weighs against the claim). Even the Veteran in this case has not argued that he had continued symptoms since service. In addition, renal (kidney) cancer is not among those forms of cancer which may be presumptively service-connected under the provisions of 38 C.F.R. § 3.309 for "radiation-exposed veterans." Therefore, service connection cannot be granted under the second method of entitlement. 38 C.F.R. § 3.309(d); Sabonis v. Brown, 6 Vet. App. 426 (1994). However, renal cancer is a radiogenic disease identified under 38 C.F.R. § 3.311, which, in essence, amounts to recognition on VA's part that exposure to ionizing radiation may be an etiological factor for its development. The degree to which radiation exposure is a factor in the development of a malignancy varies depending on the type of malignancy, the amount rate and type of radiation exposure, and other relevant risk factors such as age at time of exposure. Therefore, the question presented in this case is whether the Veteran's level of radiation exposure was sufficient to cause his renal cancer. In this case, the Board finds that the preponderance of the medical evidence is against a finding that the Veteran's renal cancer is causally related to his in-service exposure to radiation. The record confirms that the Veteran was assigned to an Air Force base in Ramstein, Germany as a munitions maintenance specialist. As such, he was exposed to weapons that would have emitted radiation. In January 2006, the Department of the Air Force determined that the Veteran had been exposed to an annual dose of less than 500 millirem per year and that the total dose was less than 1.5 rem from work performed between 1966 and 1968. In December 2009, the Veteran's claims folders were referred to the Chief Public Health and Environmental Hazards Officer for an opinion. It was determined that it was unlikely that the Veteran's kidney cancer could be attributed to exposure to ionizing radiation in service. This opinion was based on the Interactive Radio-epidemiological Program (IREP) of the National Institute for Occupational Safety and Health (NIOSH). It was noted that the program calculated a 99th percentile value for the probability of causation of 2.13 %. As a result, in 2009, the VA Director of Compensation and Pension Services ("Director") provided the opinion that there was no reasonable possibility that the Veteran's kidney cancer resulted from radiation exposure in service. The Director noted that the diagnosis of kidney cancer was 35 years after his last exposure to ionizing radiation in service and that the Veteran was between 21 and 23 years old when exposed. The opinion reflects that it was based on a review of the evidence in its entirety. Thus, the opinions set forth by the VA Chief Public Health and Environmental Hazards Officer and VA Director of Compensation and Pension Services constitute probative evidence against finding a causal connection between the Veteran's left renal cell carcinoma and exposure to ionizing radiation in service, as the opinion was based on a scientific dose estimate provided by the Air Force Safety Center, as well as a review of the entire evidence of record. Moreover, this opinion was provided by a public health official specifically tasked and specialized in evaluating environmental hazard risks, to include radiation exposure, and the evidentiary record contains no competent medical opinion to the contrary. Indeed, there is nothing in the claims file, which would tend to establish that the Veteran's renal cancer is related to his military service other than his contentions. Lay statements may be competent to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C.A. § 1153(a); 38 C.F.R. §§ 3.303(a), 3.159(a); see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). See also Robinson v. Shinseki, 312 Fed. Appx. 336 (Fed. Cir. 2009) (non-precedential) (confirming that, "in some cases, lay evidence will be competent and credible evidence of etiology"). Though the Veteran's personal belief that his renal cancer is due to his in service radiation exposure is well-intentioned, it holds no probative value in this case as he is not shown to possess the requisite medical training and expertise to speak to issues of medical causation. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (lay testimony is competent to establish the presence of observable symptomatology that is not medical in nature). The Board must decide cases such as this in light of sound scientific data, and, based upon the record before the Board, the claim for service connection for renal cancer under 38 C.F.R. § 3.311 must be denied. The Board finds that the evidence demonstrates that the Veteran's renal cancer, which was first shown medically many years after his period of active service, is not related to events during active service. Therefore, the preponderance of the evidence is against the claim, and there is no reasonable doubt to be resolved. 38 U.S.C.A. § 5107(b). For the same reasons that service connection is not warranted for kidney cancer, service connection is not warranted for metastatic progression of that cancer. As noted above, it has been determined that there was no reasonable possibility that the Veteran's renal cancer of the left kidney resulted from radiation exposure in service. As such, the claim of service connection for renal cancer has been denied. Because the underlying disability is not service connected, which is the primary site of the cancer, there is no basis for granting the claim of service connection for metastatic renal cancer. Therefore, this claim is also denied. See 38 C.F.R. § 3.310 (2006). ORDER Service connection for renal cancer of the left kidney is denied. Service connection for metastatic renal cancer is denied. ________________________________ MARK F. HALSEY Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs