Citation Nr: 0602051 Decision Date: 01/24/06 Archive Date: 01/31/06 DOCKET NO. 04-08 980 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUE Entitlement to service connection for squamous cell carcinoma of the left true vocal chord, claimed as due to asbestos exposure. REPRESENTATION Veteran represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD S. Bush, Associate Counsel INTRODUCTION This matter is before the Board of Veterans' Appeals (the Board) on appeal of a March 2003 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in Muskogee, Oklahoma (the RO). Procedural history The veteran served on active duty in the United States Navy from August 1947 to August 1951. In November 2001, the veteran filed a claim of entitlement to service connection for throat cancer. This claim was denied in the above-mentioned March 2003 RO rating decision. The veteran initiated an appeal of this decision and requested de novo review of his claim by a Decision Review Officer (DRO). The DRO issued a statement of the case (SOC) in December 2003 that continued the previous denial of the claim. The veteran's appeal was perfected with the timely submission of his substantive appeal (VA Form 9) in March 2004. In December 2004, a motion to advance this case on the Board's docket was granted. See 38 U.S.C.A. § 7107 (West 2002); 38 C.F.R. § 20.900 (2005). In January 2005, this claim was remanded by the Board in order to obtain additional records and for a VA medical nexus opinion. In September 2005, the VA Appeals Management Center (AMC) issued a supplemental statement of the case which continued to deny the veteran's service connection claim. Issues not on appeal In January 2005, the Board denied the veteran's claims of entitlement to service connection for prostate cancer, adenocarcinoma of the colon and esophageal cancer. The Board's decision is final. See 38 C.F.R. § 20.1100 (2005). FINDING OF FACT The competent medical evidence of record indicates that the veteran's squamous cell carcinoma of the left true vocal chord is not related to asbestos exposure in military service. CONCLUSION OF LAW Service connection for squamous cell carcinoma of the left true vocal chord is not warranted. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2005). REASONS AND BASES FOR FINDING AND CONCLUSION The veteran seeks entitlement to service connection for squamous cell carcinoma of the left true vocal cord. He contends that repairing steam line jackets and cleaning boilers in service led to the eventual development of throat cancer. See the veteran's March 2005 statement. In the interest of clarity, the Board will first discuss certain preliminary matters. The issue on appeal will then be analyzed and a decision rendered. The Veterans Claims Assistance Act of 2000 The Board has given consideration to the Veterans Claims Assistance Act of 2000 (the VCAA) [codified as amended at 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107]. The VCAA eliminated the former statutory requirement that claims be well grounded. Cf. 38 U.S.C.A. § 5107(a) (West 1991). The VCAA includes an enhanced duty on the part of VA to notify a claimant as to the information and evidence necessary to substantiate claims for VA benefits. The VCAA also redefines the obligations of VA with respect to its statutory duty to assist claimants in the development of their claims. See 38 U.S.C.A. §§ 5103, 5103A (West 2002). Regulations implementing the VCAA have been enacted. See 66 Fed. Reg. 45,630 (Aug. 29, 2001) [codified as amended at 38 C.F.R. §§ 3.102, 3.156(a), 3.159, and 3.326(a) (2005)]. The VCAA is applicable to all claims filed on or after the date of enactment, November 9, 2000, or filed before the date of enactment and not yet final as of that date. The VCAA is accordingly applicable to this case. See Holliday v. Principi, 14 Vet. App. 280 (2000) [the Board must make a determination as to the applicability of the various provisions of the VCAA to a particular claim]. The Board has carefully considered the provisions of the VCAA and the implementing regulations in light of the record on appeal, and for reasons expressed immediately below finds that the development of the issue has proceeded in accordance with the provisions of the law and regulations. The VCAA alters the legal landscape in three distinct ways: standard of review, notice and duty to assist. The Board will now address these concepts within the context of the circumstances presented in this case. Standard of review After the evidence has been assembled, it is the Board's responsibility to evaluate the entire record. See 38 U.S.C.A. § 7104(a) (West 2002). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107 (West 2002); 38 C.F.R. § 3.102 (2005). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims (the Court) stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Notice The VCAA requires VA to notify the claimant and the claimant's representative, if any, of any information and any medical or lay evidence not previously provided to VA that is necessary to substantiate the claim. As part of the notice, VA is to specifically inform the claimant and the claimant's representative, if any, of which portion, if any, of the evidence is to be provided by the claimant and which part, if any, VA will attempt to obtain on behalf of the claimant. See 38 U.S.C.A. § 5103 (West 2002); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002) [a letter from VA to an appellant describing evidence potentially helpful to the appellant but not mentioning who is responsible for obtaining such evidence did not meet the standard erected by the VCAA]. After having carefully reviewed the record, the Board has concluded that the notice requirements of the VCAA have been satisfied with respect to the issue on appeal. The Board observes that the veteran was informed of the relevant law and regulations pertaining to his claim in the December 2003 SOC. Specifically, the December 2003 SOC detailed the evidentiary requirements for service connection. Crucially, the RO informed the veteran of VA's duty to assist him in the development of his claim in letters dated November 27, 2001 and January 23, 2003, whereby the veteran was advised of the provisions relating to the VCAA. An additional VCAA letter dated January 24, 2005 was sent to the veteran by the AMC subsequent to the Board's January 2005 remand. Specifically, the veteran was advised in the January 2005 VCAA letter that VA would obtain all evidence kept by the VA and any other Federal agency, including VA facilities and the Social Security Administration. He was also informed that VA would, on his behalf, make reasonable efforts to obtain relevant private medical records not held by a Federal agency as long as he completed a release form for such. The veteran was asked in all three letters to complete and sign a VA Form 21-4142, Authorization and Consent to Release Information to the Department of Veterans Affairs, for each health care provider so that the RO could obtain records on the veteran's behalf. Both the November 2001 and January 2003 VCAA letters specifically informed the veteran that "you must give us enough information about these records so that we can request them from the person or agency who has them. If the holder of the records declines to give us the records or asks for a fee to provide them, we'll notify you of the problem. It is still you responsibility to make sure these records are received by us." Finally, the Board notes that the January 2003 VCAA letter specifically requested of the veteran: "Tell us if you know of any additional evidence you would like us to consider for the condition addressed by this claim . . . . Tell us if you do not know of additional evidence you would like us to consider." The Board believes that this request complies with the requirements of 38 C.F.R. § 3.159 (b) in that it informed the veteran that he could submit or identify evidence other than what was specifically requested by the RO. Review of the record reveals that the veteran was initially provided notice of the VCAA in November 2001 and January 2003, prior to the initial adjudication of his claim for entitlement to service connection for squamous cell carcinoma of the left true vocal chord, which was by rating decision in March 2003. As stated above, the veteran was provided with additional VCAA notice by the AMC via the January 2005 VCAA letter. His claim was readjudicated in the September 2005 SSOC, after he was provided with the opportunity to submit evidence and argument in support of his claim and to respond to the VA notice. The veteran has pointed to no prejudice resulting from the timing of the VCAA notices. Because there is no indication that there exists any evidence which could be obtained which would have an effect on the outcome of this case, no further VCAA notice is necessary. See Dela Cruz v. Principi, 15 Vet. App. 143, 149 (2001) [VCAA notice not required where there is no reasonable possibility that additional development will aid the veteran]. In short, the record indicates that the veteran received appropriate notice under 38 U.S.C.A. § 5103 and Quartuccio. Duty to assist In general, the VCAA provides that VA shall make reasonable efforts to assist a claimant in obtaining evidence necessary to substantiate claims for VA benefits, unless no reasonable possibility exists that such assistance would aid in substantiating the claim. The law provides that the assistance provided by VA shall include providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on the claim. An examination is deemed "necessary" if the record does not contain sufficient medical evidence for VA to make a decision on the claim. See 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2005). The Board finds that reasonable efforts have been made to assist the veteran in obtaining evidence necessary to substantiate his claim, and that there is no reasonable possibility that further assistance would aid in substantiating it. In particular, the RO has obtained reports of private medical treatment of the veteran, which will be discussed below. Additionally, the veteran was provided VA examinations in February 2003, October 2003 and June 2005, the results of which will be discussed below. The reports of the medical examinations reflect that the examiners recorded the veteran's past medical history, noted his current complaints, conducted appropriate physical examinations and rendered appropriate diagnoses and opinions. An addendum was added by the February 2003 VA examiner a week after the February 2003 examination. The veteran's representative argues in a January 2006 Informal Hearing Presentation that the June 2005 VA examination was inadequate because "we were unable to determine the examiner's specialty; or even if he is a M.D." With respect to the contention that the June 2005 VA examiner was not a M.D., the June 2005 X-ray report clearly lists the examiner as a physician. [The Board observes in passing that there is in fact no requirement that an examiner in fact be a physician. See Goss v. Brown, 9 Vet. App. 109 (1996) [to qualify as an expert, a person need not be licensed to practice medicine, but just have special knowledge and skill in diagnosing and treating human ailments]; see also 38 C.F.R. § 3.159(a)(1) [competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions]. Moreover, the veteran has not explained how a specialist would provide a more "competent" nexus opinion than the June 2005 VA examiner. Indeed, the June 2005 VA examiner made similar findings to the October 2003 VA examiner, who is a board certified otolaryngologist. The Court has held that the statutory duty to assist requires a thorough and contemporaneous medical examination that is sufficient to ascertain the current level of disability. See Floyd v. Brown, 9 Vet. App. 88 (1996). The report of the June 2005 VA examination shows that the examiner documented the veteran's history and complaints, completed a thorough physical examination and rendered a medical opinion based on these findings. It is now well established that laypersons without medical training, such as the veteran and his representative are not competent to comment on medical matters. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-5 (1992); see also 38 C.F.R. § 3.159 (a)(1) [competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions]. In short, the veteran and his representative are not qualified or competent to evaluate the sufficiency of the veteran's own physical examination or to pass judgement on the qualifications of the examiner. The Board finds, therefore, that the report of the June 2005 examination is adequate for determining service connection, and that remand of this issue to obtain an additional examination is not appropriate and would needlessly delay a claim that has been advanced on the docket. Accordingly, the Board finds that under the circumstances of this case, the VA has satisfied the notification and duty to assist provisions of the law and that no further actions pursuant to the VCAA need be undertaken on the veteran's behalf. The Board additionally observes that all appropriate due process concerns have been satisfied. See 38 C.F.R. § 3.103 (2005). The veteran and his representative have been accorded the opportunity to present evidence and argument in support of his claim. The veteran declined the option of a personal hearing on his March 2004 substantive appeal. Accordingly, the Board will proceed to a decision on the merits. Pertinent law and regulations Service connection - in general Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303 (2005). For certain chronic disorders, including cancer, service connection may be granted if the disease becomes manifest to a compensable degree within one year following separation from service. 38 U.S.C.A. §§ 1101, 1110, 1112, 1113 (West 2002); 38 C.F.R. §§ 3.307, 3.309 (2005). In addition, service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 U.S.C.A. § 1113(b) (West 2002); 38 C.F.R. § 3.303(d) (2005). In order to establish service connection for the claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). Asbestos exposure There is no specific statutory guidance with regard to asbestos-related claims, nor has the Secretary of VA promulgated any regulations in regard to such claims. However, VA has issued a circular on asbestos-related diseases. DVB Circular 21-88-8, Asbestos-Related Diseases (May 11, 1988) provides guidelines for considering compensation claims based on exposure to asbestos. The information and instructions from the DVB Circular have been included in a VA Adjudication Procedure Manual, M21-1 (M21- 1), Part VI, 7.21. The Court has held that VA must analyze an appellant's claim to entitlement to service connection for asbestosis or asbestos-related disabilities under the administrative protocols under these guidelines. See Ennis v. Brown, 4 Vet. App, 523, 527 (1993); McGinty v. Brown, 4 Vet. App. 428, 432 (1993). VA Manual M21-1, Part VI, para. 7.21 (October 3, 1997) provides that inhalation of asbestos fibers can produce fibrosis and tumor, most commonly interstitial pulmonary fibrosis (asbestosis). Asbestos fibers may also produce pleural effusion and fibrosis, pleural plaques, mesotheliomas of pleura and peritoneum, lung cancer, and cancers of the gastrointestinal tract. Cancers of the larynx and pharynx, as well as the urogenital system (except the prostate) are also associated with asbestos exposure. Thus persons with asbestos exposure have increased incidence of bronchial, lung, pharyngolaryngeal, gastrointestinal and urogenital cancer. See M21-1, Part VI, para 7.21(a). The applicable section of Manual M21-1 also notes that some of the major occupations involving exposure to asbestos include mining, milling, work in shipyards, carpentry and construction, manufacture and servicing of friction products such as clutch facings and brake linings, manufacture and installation of roofing and flooring materials, asbestos cement and pipe products, military equipment, etc. High exposure to respirable asbestos and a high prevalence of disease have been noted in insulation and shipyard workers, and this is significant considering that, during World War II, U.S. Navy veterans were exposed to chrysotile, amosite, and crocidolite that were used extensively in military ship construction. Furthermore, it was revealed that many of these shipyard workers had only recently come to medical attention because the latent period for asbestos-related diseases varies from 10 to 45 or more years between first exposure and development of disease. Also of significance is that the exposure to asbestos may be brief (as little as a month or two) or indirect (bystander disease). See Department of Veterans Affairs, Veteran's Benefits Administration, Manual M21-1, Part 6, Chapter 7, Subchapter IV, § 7.21 b. In Dyment v. West, 13 Vet. App. 141, 145 (1999), the Court found that provisions in former paragraph 7.68 (predecessor to paragraph 7.21) of VBA Manual M21-1, Part VI, did not create a presumption of exposure to asbestos. Medical nexus evidence is required in claims for asbestos related disease related to alleged asbestos exposure in service. VA O.G.C. Prec. Op. No. 04-00. In short, with respect to claims involving asbestos exposure, VA must determine whether or not military records demonstrate evidence of asbestos exposure during service, develop whether or not there was pre-service and/or post- service occupational or other asbestos exposure, and determine whether there is a relationship between asbestos exposure and the claimed disease. See M21-1, Part VI, 7.21; DVB Circular 21- 88-8, Asbestos-Related Diseases (May 11, 1988). Analysis The veteran is seeking entitlement to service connection for squamous cell carcinoma of the left true vocal chord due to exposure to asbestos in service. Essentially, he contends that repairing steam line jackets made of asbestos and servicing boilers laden with asbestos in dry dock during service caused inhalation of airborne asbestos particles and eventual development of throat cancer. See the veteran's March 2005 statement. He has proffered no other theory of entitlement, and the evidence of record does not suggest any. As noted above, in order for a veteran to prevail on an issue of service connection there must be (1) medical evidence of a current disability; (2) medical evidence, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in-service injury or disease and the current disability. See Hickson, supra. With respect to Hickson element (1), current disability, a letter dated in November 1996 from Dr. V.S.J. confirms that the veteran was diagnosed with lung cancer in 1996. Element (1) has therefore been satisfied. Moving to element (2), in-service incurrence of disease or injury, the Board will separately address disease and injury. The veteran's service medical records, to include the August 1951 separation examination report, do not demonstrate that the veteran had throat cancer in service or within the one year presumptive period after service. The veteran himself has not indicated that he was treated for throat problems in service, and the medical evidence indicates that lung cancer was initially diagnosed in 1996, over 40 years after the veteran left military service in 1951. With respect to in-service injury, the alleged injury is exposure to asbestos in service. As noted above, asbestos exposure is a fact to be determined from the evidence. See Dyment, supra. The veteran's service records indicate that he served aboard the U.S.S. General J.C. Breckinridge and completed the Navy Training Course for Firemen. Among his tasks were repairing steam line jackets and cleaning boilers. See the veteran's March 2005 statement. Taking into consideration the veteran's military occupational specialty and in-service activities, the Board concludes that the veteran was exposed to asbestos in service, thus satisfying Hickson element (2). See McGinty, supra. With respect to Hickson element (3), medical nexus, resolution of this issue requires competent medical evidence, which can be provided neither by the Board or by the veteran himself. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) [the Board is prohibited from exercising its own independent judgment to resolve medical questions] and Espiritu, supra. The veteran's extensive history of smoking is well documented throughout the record. The medical opinions of record focus on two matters: (1) the matter of the veteran's long-standing history of tobacco smoking, versus his history of asbestos exposure, being the cause of his current throat cancer; and (2) his well-documented, lengthy post-service history of industrial asbestos exposure being a cause of the throat cancer. The Board has the authority to "discount the weight and probity of evidence in the light of its own inherent characteristics and its relationship to other items of evidence." See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). However, consistent with Colvin, the Court has held that the Board may not reject medical opinions based on its own medical judgment. See Obert v. Brown, 5 Vet. App. 30 (1993). In evaluating the probative value of competent medical evidence, the Court has stated, in pertinent part: The probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches. . . . As is true with any piece of evidence, the credibility and weight to be attached to these opinions [are] within the province of the adjudicator . . . Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). The Board may appropriately favor the opinion of one competent medical authority over another. See Owens v. Brown, 7 Vet. App. 429, 433 (1995); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). There are of record several competent medical opinions which ascribe the veteran's throat cancer to tobacco use, not asbestos exposure. The VA examiner in February 2003 was of the opinion that the veteran's cancer of the larynx was most likely related to his history of chronic smoking for 30 years and prior alcohol consumption, and not to asbestos exposure. [The veteran points to a January 2004 statement from A.M., M.D., and February 2004 statement from R.K.J., M.D. to dispel any notion by the February 2003 examiner that the veteran abused alcohol in the past. However, the matter of the veteran's alcohol abuse, or lack thereof, is not germane to the issue before the Board.] In any event, the February 2003 VA examiner was not alone in relating the veteran's current throat cancer to his extensive history of smoking. The October 2003 VA examiner also related the veteran's laryngeal cancer to his history of smoking, not his asbestos exposure in service. The October VA 2003 examiner supported his opinion by pointing to recent literature, including a three-decade study on the matter that found that "the weight of evidence did not support the relationship of asbestos and laryngeal cancer." The study's ultimate conclusion was that asbestos exposure did not increase the relative risk of laryngeal cancer; indeed, association of the two was confounded by tobacco and alcohol abuse. Additionally, the June 2005 VA examiner also opined that it was less likely than not that the veteran's asbestos exposure caused the onset of the veteran squamous cell carcinoma of the left vocal chord, but instead was more likely due to tobacco smoking. The June 2005 VA examiner based his conclusion on the veteran's normal chest X-ray, indicating no presence of asbestos in the lungs. This is powerful evidence against the claim. There is also the matter of in-service versus post-service exposure to asbestos. The veteran served on the United States navy for four years. Subsequent to service, the veteran spent over 30 years working as a mechanic, one of the occupations detailed above as involving exposure to asbestos. Indeed, the veteran received a substantial settlement for asbestos exposure from his work setting. Included with the veteran's settlement documents is a February 2000 opinion from G.B., M.D., who, although mentioning the veteran's work as a fireman in the Navy, found the veteran had "significant occupational exposure to asbestos" in the 33 years he worked as a mechanic which was a "significant contributing factor in causing his throat cancer." In support of his claim, the veteran points to a number of opinions by private physician R.K.J. Dr. R.K.J. stated in May 2003 that "it is my understanding that he worked for a period of time on a ship and was exposed to asbestos. It is as likely as not this exposure was a factor in his developing this type of carcinoma in situ." It is obvious that Dr. R.K.J. did not review the veteran's claims folder in rendering his opinion. Dr. R.K.J.'s attribution of the veteran's throat cancer to asbestos exposure in service, with complete disregard for well- documented 33 years of post-service exposure, indicates that his opinion was based on the veteran's self-reported history of asbestos exposure. As such, these statements are of no probative value. See Godfrey v. Brown, 8 Vet. App. 113, 121 (1995) [the Board is not required to accept doctors' opinions that are based upon the claimant's recitation of medical history]; and Elkins v. Brown, 5 Vet. App. 474, 478 [rejecting medical opinion as "immaterial" where there was no indication that the physician reviewed the claimant's service medical records or any other relevant document that would have enabled him to form an opinion on service connection on an independent basis]. Disregarding Dr. R.K.J.'s statements as lacking probative value, there is no medical opinion of record in support of the veteran's claim. The other medical opinions either discount asbestos exposure as a cause of the veteran's disability or point to post-service asbestos exposure as the cause. In a December 2004 Informal Hearing Presentation, the veteran's representative points to a number of studies linking asbestos exposure and throat cancer to support the veteran's claim. That asbestos exposure may lead to throat cancer is not in dispute. See M21-1, Part VI, para 7.21(a), supra. However, the evidence must be in equipoise as to whether in-service asbestos exposure led to cancer in this veteran. Neither M21-1 or the studies referenced by the veteran's representative serve to do so. Medical treatise evidence can, in some circumstances, constitute competent medical evidence. See Wallin v. West, 11 Vet. App. 509, 514 (1998); see also 38 C.F.R. § 3.159(a)(1) [competent medical evidence may include statements contained in authoritative writings such as medical and scientific articles and research reports and analyses]. However, the Court has held that medical evidence is speculative, general or inconclusive in nature cannot support a claim. See, e.g., Beausoleil v. Brown, 8 Vet. App. 459, 463 (1996); Libertine v. Brown, 9 Vet. App. 521, 523 (1996). So it is in this case. To the extent that there is evidence supporting the general premise that asbestos exposure may lead to throat cancer, it is of little probative value in light of competent medical evidence specific to this veteran showing that his throat cancer was due to a long history of smoking or post-service asbestos exposure. In short, the record contains three persuasive nexus opinions that indicate the veteran's current throat cancer is due to his lengthy history of cigarette smoking. Moreover, the only persuasive opinion of record that relates the veteran's current throat cancer to asbestos exposure indicates that post-service asbestos exposure was the cause. This evidence far outweighs the evidence in support of the claim. To the extent that the veteran himself and his representative contend that a medical relationship exists between throat cancer and asbestos exposure in service, their opinions are entitled to no weight of probative value. See Espiritu, supra; see also Voerth v. West, 13 Vet. App. 117, 119 (1999) [unsupported by medical evidence, a claimant's personal belief, no matter how sincere, is not probative of a nexus to service]. Any such statements offered in support of the veteran's claim does not constitute competent medical evidence and cannot be accepted by the Board. See also Cromley v. Brown, 7 Vet. App. 376, 379 (1995). The Board notes that in a January 2006 Informal Hearing Opinion, the veteran's representative argued that VA may not reject medical evidence favorable to the veteran "without providing a complete rationale as to why the VA physician's opinion is more creditable than that of the private physicians." The Board has already explained why Dr. R.K.J.'s opinion lacks probative value in light of the evidence of record, why studies in support of the claim carry little probative weight, and why the veteran's own opinion is not probative. Additionally, as stated above Dr. G.B.'s opinion, which is not a VA opinion, does not support the veteran's claim. Therefore, the opinion of the VA examiners is not being favored over the opinion of Dr. G.B. All of these opinions collectively refute the veteran's claim. However, to the extent that the Board must choose between the three VA opinions (concluding that asbestos exposure had nothing to do with the veteran's cancer) or the opinion of Dr. G.B. (which concluded that asbestos exposure, albeit largely post-service in nature, caused the cancer), it chooses the former. The VA opinions are well reasoned, while Dr. G.B.'s opinion is conclusory in nature and provides no rationale for his conclusion. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998) [the failure of the physician to provide a basis for his/her opinion goes to the weight or credibility of the evidence]. In short, the preponderance of the competent and probative evidence of record indicates that the veteran's currently diagnosed throat cancer is not related to asbestos exposure in service. Accordingly, Hickson element (3), medical nexus, has not been satisfied, and the claim fails on that basis alone. Conclusion As discussed above, in arriving at its decision VA is obligated to determine whether or not military records demonstrate evidence of asbestos exposure during service, develop whether or not there was pre-service and/or post- service occupational or other asbestos exposure, and determine whether there is a relationship between asbestos exposure and the claimed disease. See M21-1, Part VI, 7.21; DVB Circular 21- 88-8, Asbestos-Related Diseases (May 11, 1988). The Board has done so. As discussed above, the record documents in-service asbestos exposure of four years duration, and post-service asbestos exposure of 33 years duration, significant enough to warrant a monetary settlement in the veteran's favor. For reasons stated above, the Board concludes that there is no relationship between the in- service asbestos exposure and the claimed throat cancer. In conclusion, for the reasons and bases expressed above the Board finds that the preponderance of the evidence is against the veteran's claims for entitlement to service connection for squamous cell carcinoma of the left true vocal chord, as Hickson element (3) has not been met. Contrary to the assertions of the veteran's representative, the benefit of the doubt rule is not for application as the evidence is not in relative equipoise. The benefit sought on appeal is accordingly denied. ORDER Entitlement to service connection for squamous cell carcinoma of the left true vocal chord, claimed as due to asbestos exposure, is denied. ____________________________________________ Barry F. Bohan Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs